Oct 22, 2019

Preferred Dentist Program Coverage Limits and Rates

Untitled Document

AIChE Dental Plan
Network: PDP Plus

Benefit Summary

Coverage Type
In-Network
Out-of-Network
Type A, B, C, and D Services
Schedule Plan (Zones 1-4)
Schedule Plan (Zones 1-4)
Deductible*
In-Network
Out-of-Network
Individual
$50
$50
Family
$150
$150
Annual Maximum Benefit
In-Network
Out-of-Network
Per Person
$2,000
$2,000
Lifetime Orthodontic Maximum
In-Network
Out-of-Network
Per Child under age 19
$2,000
$2,000


* Applies only to Type B & C Services.


Monthly Rates

The following monthly rates are effective through the renewal date.

Click here to find your zone.

Zone 1
Member Only
$24.50
Member + Spouse $49.83
Member + Child(ren) $59.74
Member + Spouse + Children $94.92
Zone 2
Member Only $32.07
Member + Spouse $65.24
Member + Child(ren) $78.13
Member + Spouse + Children $124.17
Zone 3
Member Only $41.03
Member + Spouse $83.45
Member + Child(ren) $98.88
Member + Spouse + Children $157.21
Zone 4
Member Only $51.14
Member + Spouse $103.95
Member + Child(ren) $124.29
Member + Spouse + Children $197.60


* Applies only to Type B & C Services.