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Indian River County SOCC-EMPLOYEES ONLY GEHRING AGROUP
<br /> PPO Dental Insurance RFP Evaluation I N 5 0 R A N C E B R O K E R$A & C O N 5 U L T A N T 5
<br /> Effective Date:October 1,2014
<br /> Current Renewal
<br /> SC"IEDLU OF KNERTS flotida Combined We Novi 44 combinodige Florida Co"11ned We Flotids Combined Life
<br /> -.nitaf Choke LOW Plan ental Choke High Plan BlueDeotal Choke ,
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<br /> Calendar Year Mor 01xirrr $1000 ` <
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<br /> Single $50 t $100 $25 i $So $50 1 $100 $25 r $50
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<br /> Family $150 t $300 $75 1 $150 $150 1 $300 $75 1 $150
<br /> Deductible Waived for Preventive 1 1 1 t
<br /> Yes I Yes Yes ° Yes Yes 1 Yes Yes 1 Yes
<br /> Services?
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<br /> Preventative 100% 1 80% 100% 1 100% 10(% 1 80% 100% 1 100%
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<br /> Basic 80% 1 70% 100% 1 80% 80% t 70% 100% 1 80%
<br /> 1 t i 1
<br /> Major 50% 1 40% 60% i 50% 50% 1 40% 60% 1 50%
<br /> I I 1 t
<br /> Orthodontia(Up to age 19) N/A 1 N/A 50% 1 50% N/A 1 N/A 50% 1 50%
<br /> Servrce lnformatron« r /
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<br /> Out of Network Benefits Level Fee Schedule Fee Schedule Fee Schedule Fee Schedule
<br /> Waiting Period{Timely Entrants) None None None None
<br /> Orthodontia-Lifetime Max N/A $1,000 N/A $1,000
<br /> Endodontics/Periodontics Basic Basic Basic Basic
<br /> Rate Guarantee Expires 09/30/2014 Expires 09/30/2014 24 Months 24 Months
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<br /> EF Only S8 94 �� $27.92 $38.58 $29.32 $1.40 $40.51 $1.93
<br /> EE+Spouse 18 37 $64.47 $9058 $67.69 $3.22 $95.11 $4.53
<br /> Employee+Children 20 17 $58.60 $94.66 $61.53 $2.93 $99.39 $4.73
<br /> EE+Two or More 46 39 $95.16 $146.88 $99.92 $4.76 $154.22 $7.34
<br /> Monthly Premium $8,329.18 $14,315.52 $8,745.90 $15,031.22
<br /> Annual Premium $99,950.16 $171,786.24 $104,950.80 $180,374.64
<br /> $Increase N/A N/A $5,000.64 $8,588.40
<br /> %Increase N/A N/A 5.0% 5.0%
<br /> Annual Premium $271,736.40 $285,325.44
<br /> $Increase N/A $13,589.04
<br /> %Increase N/A 5.0%
<br />
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