| Georgetown Charter Township | |||||
| Dental Plan Illustration | |||||
| Current | Renewal | Option 1 | Option 2 | ||
| Humana | Humana | Assurant | Guardian | ||
| Type I - Preventative | |||||
| Deductible | $0 | $0 | $0 | ||
| Benefit | 100% of Reasonable & Customary Charges | 100% of Reasonable & Customary Charges | 100% of Reasonable & Customary Charges | ||
| Services | Routine Exams | Routine Exams | Routine Exams | ||
| Cleanings | Cleanings | Cleanings | |||
| X-Rays | X-Rays | X-Rays | |||
| Fluoride Treatment | Fluoride Treatment | Fluoride Treatment | |||
| Sealants | Sealants | Sealants | |||
| Type II - Basic | |||||
| Deductible | $50 per individual/$150 max per family - calendar year | $50 per individual/$150 max per family - calendar year | $50 per individual/$150 max per family - calendar year | ||
| Benefit | 80% of Reasonable & Customary Charges after deductible | 80% of Reasonable & Customary Charges after deductible | 80% of Reasonable & Customary charges after deductible | ||
| Services | Simple Extractions | Simple Extractions | Simple Extractions | ||
| Fillings | Fillings | Fillings | |||
| Periodontic Services | Periodontic Services | Periodontic Services | |||
| Endodontic Services | Endodontic Services | Endodontic Services | |||
| Type III - Major | |||||
| Deductible | $50 per individual/$150 max per family - calendar year | $50 per individual/$150 max per family - calendar year | $50 per individual/$150 max per family - calendar year | ||
| Benefit | 50% of Reasonable & Customary Charges after deductible | 50% of Reasonable & Customary Charges after deductible | 50% of Reasonable & Customary charges after deductible | ||
| Services | Crowns & Inlays | Crowns & Inlays | Crowns & Inlays | ||
| Dentures/Bridges | Dentures/Bridges | Dentures/Bridges | |||
| Type IV - Orthodontia | |||||
| Deductible | not a | not a | not a | ||
| Benefit | covered benefit | covered benefit | covered benefit | ||
| Types I, II, & III | |||||
| Calendar Year Max (per person) | $1,000 | $1,000 | $1,000 | ||
| Premium | |||||
| Employee Only | 8 | $29.33 | $36.25 | $28.88 | $30.72 |
| Employee/Spouse | 9 | $66.03 | $81.82 | $60.59 | $61.44 |
| Employee/Children | 0 | $56.55 | $69.85 | $71.37 | |
| Family | 10 | $94.31 | $116.74 | $103.08 | $104.48 |
| Monthly | $1,772.01 | $2,193.78 | $1,807.15 | $1,843.52 | |
| Annual | $21,264.12 | $26,325.36 | $21,685.80 | $22,122.24 | |
| Percentage Differential | 23.80% | 1.98% | 4.04% | ||
| Terms and Conditions | |||||
| 1 Premium illustration based on employee census provided. | |||||
| 2 All quotes are subject to final underwriting. | |||||
| 3 Additional quotes were obtained from Delta Dental but were not competitive. Documentation available upon request. | |||||
| 4 Rates illustrated for a renewal date of 11/1/2007. | |||||
| [1] | |||||