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ADMINISTRATORS
Deductible is 50/100 - 90% paid after deductible is met Prescription co-pay - $5.00 generic/$10.00 name brand Includes $10,000. basic Term Life with $10,000. AD&D Benefit year is July 1 through June 30 b sit for PPOM Provider Benefit year is calendar year Basic Benefit Percentage begins at 50% increasing 10% each year to 100% Includes 2 cleanings per year. Each person must go to the dentist at least 1 time per year or percentage decreases back to 50%. Orthodontic Expense Percentage covered 50% - deductible $50.00 Lifetime Maximum Benefit is $1500.00 Vision examination, lenses & frames: one service every 12 months. Policy year is defined as the 12-month period July 1 through June 30
SET Ultra-Vision Plans provide benefits for eligible expenses at 100% of reasonable & customary fees or at follows: Single-vision lenses $73.00 Bifocal-vision lenses $84.00 Trifocal-vision lenses $100.00 Lenticular-vision lenses $124.00 contacts prescribed after cataract surgery or when vision is not correctable to 20/70 in the better eye except by their use. $175.00 Contact lenses in lieu of glasses not to exceed: $110.00
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