| |
Symetra
Premier Plan
|
Symetra
Select Plan |
Symetra
Secure Plan |
Class A - Preventative |
NO WAITING PERIOD |
| Initial & Periodic Exams |
|
| Year One |
100% |
75% |
80% |
| Year Two |
100% |
85% |
80% |
| Year Three |
100% |
100% |
80% |
| Lifetime Deductible |
$50 |
$50 |
$75 |
| Class B - Basic X-Rays, Fillings, Simple Extractions, Sealants |
NO WAITING PERIOD |
| Year One |
35% |
25% |
25% |
| Year Two |
50% |
35% |
35% |
| Year Three |
65% |
50% |
50% |
| Yearly Deductible |
$50 |
$50 |
$75 |
| Class C - Major, Oral Surgery, Endodontics, Periodontics, Crowns, Bridges, Dentures |
NO WAITING PERIOD |
| Year One |
10% |
10% |
10% |
| Year Two |
25% |
25% |
25% |
| Year Three |
50% |
50% |
50% |
| Yearly Deductible |
$50 |
$50 |
$75 |
| Class D - Orthodontics |
24 Months |
Not Available |
Not Available |
| Year One |
0% |
Not Available |
Not Available |
| Year Two |
0% |
Not Available |
Not Available |
| Year Three |
50% |
Not Available |
Not Available |
| Calendar Year Maximum Class A, B, and C combined |
$1,000 |
$1,000 |
$750 |
| Calendar Year Maximum for Class C Major Services |
$500 |
$500 |
$350 |
| Calendar Year Maximum for Class D |
$500 |
N/A |
N/A |
| Lifetime Maximum per child for Class D |
$1,000 |
N/A |
N/A |
| Optional Calendar Year Maximum Buy-Up |
$1,500 |
$1,500 |
N/A |
| Optional Calendar Year Maximum Buy-Up (Class C) |
$750 |
$750 |
N/A |
|
