Dental Benefits

Name: Heartland Community Health Center
Address: United States

	In-Network	Out-of-Network
Type I - Preventive Services	100%	100%
Type II - Basic Services	80%	80%
Type III - Major Services	50%	50%
Type IV - Orthodontia Services (Dependents to age 19)	Plan pays 50% up to $1,500 Lifetime Max	Plan pays 50% up to $1,500 Lifetime Max
Deductible (Individual/Family)	$50/$150	$50/$150
Annual Maximum Per Person	$1,500 per calendar year	$1,500 per calendar year

	Per Pay Period Rate (24 Pay Periods)
Employee	$3.02
Employee + Spouse	$10.77
Employee + Child(ren)	$14.86
Family	$25.55

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Provided By

Lincoln Financial

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