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Indian River County BOCC-EMPLOYEES&CONSTITUTIONALS GEHRI G
<br /> PPO Dental Insurance RFP Evaluation ���R�U
<br /> IN S U R ANC E BROKE RS1A @ CON 5 ULTANTS
<br /> Effective Date: October 1,2014
<br /> Current alternate Renawal
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<br /> 0o; Owlice,Low Plan
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<br /> Single $50 1 $100 $r5 $50 $50 1 $100 $25 5 $50
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<br /> Family $1so $300 5 � ' $150 $150 1 $300 $7s $1SO
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<br /> Deductible Waived for Preventive I :
<br /> Services? Yes Yes Q'i I Yes Yes Yes Yes Yes
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<br /> Preventative 100% 1 80% 100% 1 100% 100% 1 SO% 100% r 100%
<br /> I I I ,
<br /> Basic 80% 1 70% 100% 1 80% 80% 1 70% 100% 1 80%
<br /> 1 1 1 4
<br /> Major SO% i 40% 60% 50% 50% 40% 60% 50%
<br /> Orthodontia(Up to age 19) N/A i N/A ) 50% y 50% N/A i N/A 50% 50%
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<br /> Information
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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 /> .,. A/, ,;,
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<br /> r
<br /> EE Only 58 94 $27.92�� $38.58 $27.92 $0,00 $38.58 $0.00 "
<br /> EE+Spouse 18 37 $64.47 $90.58 $64.47 $0.00 $90.58 $0.00
<br /> Employee+Children 20 17 $58.60 $94.66 $58.60 $0.00 $94.66 $0.00
<br /> EE+Two or More 46 39 $95.16 $146.88 $95.16 $0.00 € $146.88 $0.00
<br /> Monthly Premium $8,329.18 $14,315.52 y8,329.18 $14,31S.52
<br /> Annual Premium $99,950.16 $171,786.24 $99,950.16 $171,786.24
<br /> $Increase N/A N/A $0.00 $0.00
<br /> %Increase N/A N/A 0.0% 0.0%
<br /> Annual Premium $271,736.40 $271,736.40
<br /> $Increase N/A $0.00
<br /> Increase N/A 0.0%
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