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<br /> Indian River County BOCC-EMPLOYEES& CONSTITUTIONALS b�E
<br /> PPO Dental Insurance RFP Evaluation ���II��lG ,AGR UP
<br /> I N S U R A N C E 0 R O K E R SA & C O N S U L T ANT 5
<br /> Effective Date: October 1, 2014
<br /> Current Alternate#1
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<br /> CalendarYeat wttm�ar nk, ifs: $1500 $1,000
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<br /> Single $50 4 $100 $25 i $50 $50 ' 1 $100 $25 I $50
<br /> Family $150 $300 $75 $150 $150 t $300 $7S $150
<br /> Deductible Waived for Preventive
<br /> Yes Yes Yes Yes Yes Yes Yes Yes
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<br /> Benefitsnyy � i ✓' i i ��
<br /> Preventative 100% P 100% 100% 100% 1 80% 100% 100%
<br /> Basic 80% 7f_= 100% 80% 80% 70% 100% 80%
<br /> Major 50% 40% 60% 50% 50% 40% 60% 50%
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<br /> Orthodontia(Up to age 19) N/A N/A SO% SO% N/A i N/A SO% 50%
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<br /> Service lnforinat�on g ��
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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(80/7014 24 Months 24 Months
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<br /> EE Only 56 9-4 $27.92 $38.58 $25.66 ($2.26) $36.47 ($2.11)
<br /> EE+Spouse 18 37 $64.47 $90.58 $52.95 ($11.52) $75.39 ($15.19)
<br /> Employee+Children 2+ 17 $58.60 $94,66 $62.52 $3.92 $90.97 ($3.69)
<br /> EF+Two or More 46 .'3,1 $95..16 $146.88 $89.81 $S.3'a) $129.88 (ai TOO)
<br /> Monthly Premium $8,329.18 s $14,315.52 ) 57,823.04 $12,829.42
<br /> Annual Premium $99,950.16 $171,786.24 $93,876.48 $153,953.04
<br /> $Increase N/A N/A -$6,073.68 -$17,833.20
<br /> %Increase N/A N/A -6.1% -10.4%
<br /> Annual Premium $271;736.40 $247,829.52
<br /> $Increase N/A -$23,906.88
<br /> %Increase N/A -8.8%
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