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Indian River County BOCC-EMPLOYEES&CONSTITUTIONALS G EHRI.NG - R.OU�P'
<br /> PPO Dental Insurance RFP Evaluation 1 N s U R A N C E B R O K E R S s c o N s u c T A N T s
<br /> Effective Date:October 1, 2014
<br /> Current Alternate#4
<br /> SCHEDULEOf
<br /> illueDenial Choice Low Plan OlueDeatW Choice High Plan oppa low Plan oppo fth Plan
<br /> Plan Basics � ,�' Mi'., twortrr��� �Nart N1Ctw+xr#r� a9Netwark: .�'a�"%'lwtan�trtwirk� ��sfin'Networh yam,� Not=1'd!'twwi[ hfNr �1lettJ�Orfc�
<br /> Calendar Year M xanum, 7,t;)1C? SJ,=,€f0 $l;alts y ySGi€u
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<br /> Single $50 1 $100 $25 + $50 $50 1 $100 $25 1 $so
<br /> 1 1 1 1
<br /> Family $150 $300 $75 1 $150 $150 1 $300 $75 1 $15O
<br /> Deductible waived for Preventive a 1 1
<br /> Services? Yes 1 Yes Yes Yes Yes 1 Yes Yes 1 Yes
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<br /> z,/a�;a,_. ///�� x .., „F ,% „a,.... MINIMA-
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<br /> Preventative 100% 1 80% 100% 1 100% 100% 1 80% 100% 1 100%
<br /> Basic 80% ° 70% 100% 1 80% 80% a 70% 100% 1 80%
<br /> 1 1 1 t
<br /> Major 50% a 40% 60% 50% 50% 40% 60% 50%
<br /> Orthodontia(Up to age 19) N/A N/A 50% 50% N/A ; N/A 50% SOY
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<br /> service!s>forrt�atlon N a /a, � a ��a a,
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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 f_rpires 0914tl/n14 24 Months 24 Months
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<br /> EE Only 58 94 $27.92 _ $38.58 $29.04 $1.12 $44.73 $6.1s
<br /> EE+Spouse 18 37 $64.47 $90.58 $67.06 $2.59 $105.02 $14.44
<br /> Employee+Children 20 17 $58.60 $94.66 $60.95 $2.35 $109.75 $15.09
<br /> EE+Two or More 46 39 $95.16 $146.88 $98.98 $3.82 $170.29 $23.41
<br /> Monthly Premium $8,329.18 $14,315.52 $8,663.48 $16,597.42
<br /> Annual Premium $99,950.16 $171,786.24 $103,961.76 $199,169.04
<br /> $Increase N/A N/A $4,011.60 $27,382.80
<br /> %Increase N/A N/A 4.0% 15.9%
<br /> Annual Premium $271,736.40 $303,130.80
<br /> $Increase N/A $31,394.40
<br /> %Increase N/A 11.6%
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