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Dental Benefit Comparison & Premium Rates
Reimbursement subject to Delta Dental’s Maximum Plan Allowance. (www.deltadentalwi.com, then select Delta Dental PPO or Premier) Deductible: Single $40/plan year Family $120/plan year Note: Deductible not applicable to diagnostic or preventive services. Annual maximum: $1,500/plan year (per person) (Does not include orthodontia)
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Health Insurance Employee Employer Total Per Pay Period ...
www.marshfieldclinic.orgEmployee +1 $231.49 $462.98 $1,349.43 $1,812.41 Employee + Children $245.34 $490.68 $1,418.19 $1,908.87 Family $267.37 $534.74 $1,569.18 $2,103.92 High Deductible Health Plan 3 Tier Plan Single $49.34 $98.68 $674.72 $773.40 Employee +1 $98.69 $197.38 $1,349.43 $1,546.81 Employee + Children $103.75 $207.50 $1,418.19 $1,625.69
Consent - Marshfield Clinic
www.marshfieldclinic.orgl I consent to care and treatment for my child related to his/her medical/dental/mental health treatment appointment at any of the following facilities: Marshfield Clinic, Inc., Family Health Center of Marshfield, Inc., Lakeview Medical
Consent Page 1 of 1 - Marshfield Clinic
www.marshfieldclinic.orgTo comply with Wisconsin law, Marshfield Clinic Health System requires that a parent (not step-parent/foster parent) or legal guardian (guardian appointed by a court) consent …
Health Insurance Employee Employer Total Per Pay Period ...
www.marshfieldclinic.orgWritten permission to reproduce or transmit this document in any form or by any means must be obtained from Marshfield Clinic Health System, Inc.Revised 02/01/22 Premium Rates (Level 1) 30+ Hours/week Plan year: April 1, 2022 – March 31, 2023. Health Insurance (Level 2) …