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<br /> Indian River County BOCC-EMPLOYEES ONLY GEFI C ITAT G -A IROU P
<br /> PPO Dental Insurance RFP Evaluation i N s U R A N C E OR O K E R SIA. x CONSULTANTS
<br /> Effective Date: October 1,2014
<br /> Current Alternate til
<br /> SCHEDULE O. SENERTS Florida Combined Ofe Florida Combined We Ameritas Ameiitas
<br /> SlueDemal Choice Low Plan Slue0enW Choice High Plan appo Low Plan +..y High Plan
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<br /> Calendar YeWrMaximum
<br /> Deducti tel a��'q
<br /> Single $50 [ $100 $25 I $50 $50 1 $100 $25 i $50
<br /> Family $150 $300 $75 k $150 $150 i $300 $75 i $150
<br /> Deductible Waived for Preventive
<br /> t Yes ` Yes Yes � Yes Yes t Yes Yes Yes
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<br /> Preventative 100% 1 80% 100% a 100% 100% t 80% 1001y. t 100%
<br /> Basic 80% c 70% 100% i 80% 80% 70% 100% i 80%
<br /> Major 50% 40•/0 60% 50% 50% 40% 60% 50%
<br /> Orthodontia(Up to age 19) N/A N/A 50% 1 50% NJA t N/A 50% 1 50%
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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
<br /> / / o, 1ftC �Ctr CIIt
<br /> � �
<br /> EE Only S8 94 $27.92 $38.58 $26.48 ($1.44) $37.64 ($0.94)
<br /> EE+Spouse 18 37 $64.47 $90.58 $54.64 ($9.83) $77.80 ($12.78)
<br /> Employee+Children 20 17 $58.60 $94.66 $64.52 $5.92 $93.88 ($0.78)
<br /> EE+Two or More 46 39 $95.16 $146.88 $92.68 ($2.48) $134.04 ($12.84)
<br /> Monthly Premium $8,329.18 $14,315,52 $8,073.04 $13,240.28
<br /> Annual Premium $99,950.16 $171,786.24 $96,876.48 $158,883.36
<br /> $Increase N/A N/A -$3,073.68 -$12,902.88
<br /> %Increase N/A N/A -3.1% -7.5%
<br /> Annual Premium $271,736.40 $255,759.84
<br /> $Increase N/A -$15,976.56
<br /> %Increase N/A -5.9%
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