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Summary of Benefits Anthem Dental Essential Choice ...

Summary of BenefitsAnthem Dental Essential ChoiceCommonwealth of KY Bronze PlanAnthem Dental Complete NetworkWELCOME TO YOUR Dental PLAN!Powerful and easily accessible member in your plan Dental Benefits at a glanceIn-Network Out-of-Network Annual Benefit Maximum Calendar Year Per insured person$750$750D&P applies to Annual MaximumYesYesAnnual Maximum Carryover / Carry inNo/NoNo/NoOrthodontic Lifetime Benefit Maximum Per eligible insured personN/AN/AAnnual Deductible Per insured person/Family maximumCalendar Year$50/Unlimited $50/UnlimitedDeductible Waived for Diagnostic/Preventive ServicesYesYesOut-of-Network Reimbursement:Prime (MAC)QuoteID: 26157001 Page 1 of 3 Need to contact us?

Crowns, veneers, dentures, and bridges 1 per tooth per 84 months · Dental implants Not Covered · Cosmetic teeth whitening Not Covered. Prosthodontic Repairs/Adjustments.

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