May 25, 2019

Preferred Dentist Program Coverage Limits and Rates

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
$22.79
Member + Spouse $46.35
Member + Child(ren) $55.57
Member + Spouse + Children $88.30
Zone 2
Member Only $29.83
Member + Spouse $60.69
Member + Child(ren) $72.68
Member + Spouse + Children $115.51
Zone 3
Member Only $38.17
Member + Spouse $77.63
Member + Child(ren) $91.98
Member + Spouse + Children $146.24
Zone 4
Member Only $47.57
Member + Spouse $96.70
Member + Child(ren) $115.62
Member + Spouse + Children $183.81


* Applies only to Type B & C Services.