First Health Dental PPO

First Health Dental PPO Option II
Non-PPO Annual Deductible:	$50	Individual
	$150	Family
Annual Benefit Maximum:	$1,500	Individual
	Non-PPO	PPO	Non-PPO
	Annual	Plan	Plan
	Deductible	Pays	Pays	Additional Limitations
Benefit Description
Preventive Services	NO	100%	100%	Subject to the annual
				benefit maximum
Basic Services	YES	85%	85%	Subject to the annual
				benefit maximum
Major Services	YES	50%	50%	Subject to the annual
				benefit maximum
Orthodontic Services	Not covered under this plan
Dental Enrollment Code - DD50
Rates:
Single                    $45/mo
Employee +1           81/mo
Family                   126/mo