| |
Rates for Individual Plans
| |
Option 1 |
Option 2 |
| Annual Benefit Maximum |
$1,000 |
$1,000 |
| Coinsurance - Type 1 |
100% |
100% |
| Coinsurance - Type 2 |
80% |
50% |
| Coinsurance - Type 3 |
50% |
40% |
Deductible -
Type 2 and Type 3 |
Individual Plan $50 / Family Plan $150 |
Individual Plan $50 / Family Plan $150 |
| * Waiting periods |
6 months on Type 2,
12 months on Type 3 |
6 months on Type 2,
12 months on Type 3 |
| Monthly premium for subscribers that are age 50 and older |
| Single |
$54.00 |
$46.00 |
| Single + 1 |
$108.00 |
$89.00 |
| Family |
$167.00 |
$137.00 |
| Monthly premium for subscribers that are under the age of 50 |
| Single |
$51.00 |
$43.00 |
| Single + 1 |
$96.00 |
$78.00 |
| Family |
$163.00 |
$134.00 |
Above rates are valid for applications postmarked by
November 20, 2011.
Applications postmarked by the 20th of the month will become effective the
1st of the following month. Example - an application postmarked
November 20 will have an
effective date of
December 1. An application postmarked
November 21 will have an effective date of January 1.
* The waiting period may be waived for former Delta Dental of Massachusetts
members under limited circumstances. In order for the waiting period to be waived, your coverage on a
comparable Delta Dental of Massachusetts plan would need to have terminated for no more than 60 days prior to
the effective date of your Premier Individual Plan. A comparable plan must include substantially similar coverage. Members with
an in-force dental plan will be subject to the waiting periods under this policy.
Note: No benefits are available for the replacement of teeth missing prior to the member’s effective date of coverage.Back to Individual Plan Main Page
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Individual Plan