WebIND FAM Washington Family Plan 2024 Page 7 INDFAMWAFAM-EX 20240101 Adult Benefits The benefits listed below are covered for adults (age 19 and over) who are … WebSilver HMO A. Network: SignatureValue: Calendar Year Deductible: $2,400 / $4,800 (applies to Max OOP: Out-of-Pocket Max Ind/Fam: ... SignatureValue: Calendar Year …

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WebSilver fillings Covered 80% White fillings (front teeth) Covered 80% Temporary fillings Once per tooth 80% Stainless steel crowns Under age 19 – One per tooth in 60 months 80% … WebNetwork provider: $7,900 per ind. / $15,800 per fam.; Non-Network provider: Not applicable ind. / Not applicable fam. The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, the overall family out-of-pocket limit must be met. What is not included in . the ; out-of-pocket ... how big is a normal star

GA Individual Family High Benefit Summary 2024 - DentaQuest

WebSP980 Ind Fam Premier Val OON_HC (9.20) Delta Dental Individual and Family Premier Value Category / Procedure Qualifications for members ... Members age 19 and over In Network Out of Network In Network Out of Network* Restorative Silver Fillings One per tooth per surface each 12 months. Once every 24 months per surface per tooth. 75% … WebIND Deductible FAM Deductible IND MOOP FAM MOOP Coinsurance Preventive Primary Care Specialist Care Urgent Care Emergency Room Mental Health Inpatient Hospital Outpatient Hospital Tier 1: Preventive Rx Tier 2: Generics Tier 3: Pref Brands Tier 4: Non-Pref Brands Tier 5: Specialty Bronze Bronze 8550 Rx Copay $8,550 $17,100 $8,550 … WebSilver is the better choice than Bronze, if you can afford it, because of its lower deductible, more benefits before hitting the deductible, and the only plan that is eligible for cost … how big is a normal soccer goal