Page 12 - GXO 2022 OE Guide-Active
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Two dental plans
Simple. One covers orthodontia. The other doesn’t. 12
Dental Basic
The Dental Basic plan covers preventive care for free and shares the cost of basic and restorative services with you, up to a maximum of $1,000. It doesn’t cover orthodontia.
Dental Choice
The Dental Choice plan covers preventive care for free and shares the cost of basic and restorative services with you, up to a maximum of $2,000. It also covers orthodontia for children up to age 19, with a lifetime maximum of $1,500.
What you pay for services
12
DEDUCTIBLE
Per Person
DENTAL SERVICES
Preventive
Covered Expenses
Dental Basic
$50
0%; no deductible
Not Applicable
Dental Choice
$50
0%; no deductible
50%; no deductible
Basic
20% after deductible
20% after deductible
Major
50% after deductible
50% after deductible
Annual Maximum
$1,000
$2,000
ORTHODONTIA
Lifetime Maximum
Not Applicable
$1,500
10 I Dental
