In-Network Out-of-Network 2023 Calendar Year Maximum per Member $1,500 Calendar Year Deductible $50 per Person, up to $150 per Family DENTAL PLAN (Type II & III only) Type I – Preventive Care 100% Covered 100% Covered (Exams, X-rays, Cleanings, etc.) deductible does not apply deductible does not apply to preventative services to preventative services Type II – Restorative Care 85% Covered (Fillings, Oral Surgery, Root Canals, etc.) * 80% Covered* Type III – Major Care 55% Covered* 50% Covered* (Crowns, Dentures, Bridges, etc.) **New Benefit effective 10.1.2023: White Fillings covered on all teeth** * after deductible [ 13 ]