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<br /> Indian River County BOCC-EMPLOYEES ONLY G!f�.�L tRIN GRO U�"
<br /> PPO Dental Insurance RFP Evaluation INSURANCE 8 B 0 KE R SfJ C CONS U LT A N T S
<br /> Effective Date:October 1,2014
<br /> Current Alternate 03
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<br /> 11110toontall Choice,Low Plaft, blueDental Choice"igh Plan OPPO tow Plan OPPO Wgh Plan
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<br /> Calendar Year Maxirnum "+1 llp`I ;:.500 $1,000 x -rIii
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<br /> Single $SO 1 $100 $25 1 $50 $50 1 $100 $25 1 $50
<br /> Family $150 $300 $75 $150 $150 i $300 $75 $150
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<br /> Deductible Waived for Preventive
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<br /> Preventative 100% i 80% 100% 1 100% 100% 1 80% 100% 1 100%
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<br /> Basic 80% : 70% 100% 1 80% 80% 1 70% 100% 1 80%
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<br /> Major 50% 40% 60% i 50% 50% i 40% 60% i 50%
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<br /> Orthodontia(Up to age 19) N/A i N/A 50% 1 50% N/A i N/A 50% ! 50%
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<br /> Out of Network Benefits Level Fee Schedule Fee Schedule Fee 5chedule 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/Major Basic/Major
<br /> Rate Guarantee Expires 09/30/2014 Expires 09/30/2014 12 Months 12 Months
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<br /> EE Only 58 94 $27.92 $38.58 $31.16 $3.24 $43.04 $4.46
<br /> EE+Spouse 18 37 $64.47 $90.58 $71.92 $7.45 $101.04 $10.46
<br /> Employee+Children 20 17 $58.60 $94.66 $65.40 $6.80 $105.60 $10.94
<br /> EE+Two or More 46 39 $95.16 $146.88 $106.16 $11.00 a i^0
<br /> Monthly Premium $8,329.18 $14,315.52 $9,293.20 $15,967.64
<br /> Annual Premium $99,950.16 $171,786.24 $111,518.40 $191,611.68
<br /> $Increase N/A N/A $11,568.24 $19,825.44
<br /> V.Increase N/A N/A 11.6% 11.5%
<br /> Annual Premium $271,736.40 $303,130.08
<br /> $Increase N/A $31,393.68
<br /> %Increase N/A 11.6%
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