Dental Complete Classic 2ZGE Rates

Size: px

Start display at page:

Download "Dental Complete Classic 2ZGE Rates"

Curtis Townsend
5 years ago
Views:

1 Dental Complete Classic 2ZGE Rates 80%/60%/50% $150 Diagnostic and $1,000 Maximum Allowed Zip Codes: Low $40.40 $82.42 $ $ N/A $34.59 $70.56 $75.92 $ N/A Zip Codes: High $44.79 $91.38 $ $ N/A $38.35 $78.23 $84.17 $ N/A Zip Codes: Low $36.88 $75.23 $94.27 $ N/A $31.57 $64.40 $69.30 $ N/A Zip Codes: High $40.88 $83.40 $ $ N/A $35.00 $71.40 $76.84 $ N/A Diagnostic and Basic Services Major Services o Groups with 2-4 employees require 100% participation. All other occupations are Low Occupations 05770NYBENEBS_2ZGE Rev 09/2017

Dental Complete Classic 2ZGF Rates 100%/80%/50% $50 Diagnostic and $1,500 Maximum Allowed 100%/80%/50% $150 Diagnostic and $1,500 90 th Percentile of Zip Codes: 100-101-102 Low $73.61 $150.17 $188.

2 Dental Complete Classic 2ZGF Rates 100%/80%/50% $50 Diagnostic and $1,500 Maximum Allowed 100%/80%/50% $150 Diagnostic and $1, th Percentile of Zip Codes: Low $73.61 $ $ $ N/A $63.02 $ $ $ N/A Zip Codes: High $81.62 $ $ $ N/A $69.87 $ $ $ N/A Zip Codes: Low $60.57 $ $ $ N/A $51.85 $ $ $ N/A Zip Codes: High $67.15 $ $ $ N/A $57.49 $ $ $ N/A Diagnostic and Basic Services Major Services - Space maintainers o Groups with 2-4 eligible employees require 100% participation. All other occupations are Low Occupations 05770NYBENEBS_2ZGF Rev 09/2017

3 Dental Complete Classic 2ZGG Rates 100%/80%/50% $150 Diagnostic and $1, th Percentile of Zip Codes: Low $64.01 $ $ $ N/A $54.80 $ $ $ N/A Zip Codes: High $70.97 $ $ $ N/A $60.76 $ $ $ N/A Zip Codes: Low $52.67 $ $ $ N/A $45.09 $91.98 $99.04 $ N/A Zip Codes: High $58.39 $ $ $ N/A $49.99 $ $ $ N/A Diagnostic and Basic Services Major Services o Groups with 2-4 employees require 100% participation. All other occupations are Low Occupations 05770NYBENEBS_2ZGG Rev 09/2017

4 Dental Complete Voluntary 2ZGK Rates 100%/80%/50% $150 Diagnostic and $1, th Percentile of Zip Codes: Low $71.00 $ $ $ N/A $58.78 $ $ $ N/A Zip Codes: High $78.72 $ $ $ N/A $65.17 $ $ $ N/A Zip Codes: Low $58.41 $ $ $ N/A $48.36 $98.66 $ $ N/A Zip Codes: High $64.77 $ $ $ N/A $53.62 $ $ $ N/A Diagnostic and Basic Services Major Services Voluntary dental sold stand-alone or with medical: A minimum of two eligible employees must enroll in the stand-alone dental products. Twelve month waiting period for voluntary major services (waived if prior comparable coverage). All other occupations are Low Occupations 05770NYBENEBS_2ZGK Rev 09/2017

5 Dental Complete Voluntary 2ZGL Rates 100%/80%/50% $50 Diagnostic and $1,500 Maximum Allowed 100%/80%/50% $150 Diagnostic and $1, th Percentile of Zip Codes: Low $81.65 $ $ $ N/A $67.60 $ $ $ N/A Zip Codes: High $90.52 $ $ $ N/A $74.95 $ $ $ N/A Zip Codes: Low $67.18 $ $ $ N/A $55.62 $ $ $ N/A Zip Codes: High $74.48 $ $ $ N/A $61.66 $ $ $ N/A Diagnostic and Basic Services Major Services Voluntary dental sold stand-alone or with medical: A minimum of two eligible employees must enroll in the stand-alone dental products. Twelve month waiting period for voluntary major services (waived if prior comparable coverage). All other occupations are Low Occupations 05770NYBENEBS_2ZGL Rev 09/2017

Dental Complete Classic 2ZGF Rates

Dental Complete Classic 2ZGF Rates Rates are valid for 4/1/18 to 6/30/18 effective dates 100%/80%/50% $50 Diagnostic and $1,500 Maximum Allow ed 100%/80%/50% $150 Diagnostic and $1,500 90 Zip Codes: 100-101-102