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Dental Plan

Claims are processed by Web-TPA.


Schedule of Dental Benefits

Calendar Year Maximum

Class I, II, and III Expenses Combined

$1,500

Deductibles

INDIVIDUAL

$50

Family

$150

Plan Payment Percent

Class I-Preventive

100%
(Deductible Waived)

Class II-Basic

80%

Class III-Major

50%

Class IV-Orthodontia

Not Covered

Dental Coverage Costs

Dental Bi-Weekly Premium

Employee

12.60

Employee + Spouse

25.20

Employee + Children

23.94

Family

36.54

Submit claims to:

WEBTPA
P.O. Box 99906
Grapevine, TX 76099-9706