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<br /> Indian River County BOCC-EMPLOYEES & CONSTITUTIONALS GEHRING ^ GROUP
<br /> PPO Dental Insurance RFP Evaluation IN5VRANCE 8R0KER5 & cON5ULrANT5
<br /> Effective Date:October 1, 2014
<br /> Current Alternate#3
<br /> SCHEDULE OF
<br /> Standard
<br /> OkwDentall ChakieHigh Plan OPPOLow Plan OPPO High Plan
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<br /> Plan Basica
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<br /> Calendar
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<br /> Calendar Year r' AAimarm $1„L ,5[7 dtt r
<br /> $f, �1,S,30
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<br /> Single $50 + $100 $25 c $50 $50 1 $100 $25 i
<br /> k $50
<br /> Family $150 $300 $7S $150 $150 $300 {
<br /> Deduct161e Waived for Preventive $75 I $150
<br /> Yes E Yes Yes Yes Yes i Yes Yes Yes
<br /> Services?
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<br /> Preventative 100% 1 80% 100% 1 100% 100% 1 80% 100% i 100%
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<br /> Basic 80% 1 70% 100% 1 80% 80% 1 70% 100% ' 80%
<br /> I i f I
<br /> Major 50% i 40% 60% � SO% 50% � 409/o 60% � 50%
<br /> Orthodontia(Up to age 19) N/A N/A 50% 50% N/A N/A 50% � 50%
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<br /> Serncelnformati�n
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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/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 $30.94 $3.02 $42.73 $4.15
<br /> EE+Spouse 18 37 $64.47 $90.58 $71.43 $6.96 $100.32 $9.74
<br /> Employee+Children 20 17 $58.60 $94.66 $64.91 $6.31 $104.83 $10.17
<br /> EE+Two or More 46 39 $95.16 $146.88 $105.39 $10222 $162.65 $15.77
<br /> Monthly Premium $8,329.18 $14,315.52 $9,226.40 $15,853.92
<br /> Annual Premium $99,950.16 $171,786.24 $110,716.80 $190,247.04
<br /> $Increase N/A N/A
<br /> $10,766.64 $18,460.80
<br /> %Increase N/A N/A 10.8% 10.7%
<br /> Annual Premium $271,736.40 $300,963.84
<br /> $Increase N/A $29,227.44
<br /> %Increase NIA
<br /> 10.8%
<br />
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