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Fortis Dental Plan January 1, 2004 - December 31, 2004 |
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Information provided is in summary format. We strongly encourage you to review the employee handbook for contract details. Any difference between the summary provided and actual contract will be settled in favor of the contract. |
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In-Network |
Out-of-Network |
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| Network |
Fortis Preferred Providers |
Non-Preferred Providers |
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Deductible |
$25 Individual/$75 Family |
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Waived Preventive |
Yes |
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100% |
100% |
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90% |
80% |
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60% |
50% |
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Annual Maximum |
$1,000 |
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Dependent Age Limit |
20; 26 if full-time student |
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Predetermination Recommended For: |
Extensive procedures |
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Orthodontia |
Not covered |
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