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Benefit	In-Network	Out-of-Network Plans
		96 1A(2) 96 1B(3)	97 1A(2) 97 1B(3)	97 2A(2) 97 2B(3)
Yearly deductible	None	$25 per person $75 per family		$50 per person $150 per family
Maximum yearly benefit	$1,200	$1,200
Orthodontia maximum	$1,000 per course of treatment separated by 2 years	$1,000 per course of treatment separated by 2 years*
Diagnostic and preventive services	No cost	Paid at 80% of usual and prevailing fee*
Basic restorative services, endodontics, periodontics, maintenance of prosthodontics, and oral surgery	Paid at 80% of fee schedule	Paid at 80% of usual and prevailing fee*
Major restorative services, installation of prosthodontics, and orthodontics	Paid at 50% of fee schedule	Paid at 50% of usual and prevailing fee*
* After participant or dependent meets deductible (2) Reimbursed at 90th percentile of HIAA (3) Reimbursed at 70th percentile of HIAA

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