| Issue Ages | 0 – 90 |
| Benefit Levels | $1,000, $1,500 or $2,000 per year |
| Annual Deductible | $100* |
| Dental – Preventative | 100% in all Years |
| Waiting Period | None |
| Deductible | Not Applicable |
| Dental – Basic | 60% / 70% / 80%** |
| Waiting Period | 9 Months |
| Deductible | Applicable |
| Dental – Major | 60% / 70% / 80%** |
| Waiting Period | 9 Months |
| Deductible | Applicable |
| Vision | Exam: 100% |
| Hardware: 60% | 70% | 80%** | |
| Annual Maximum | $200 (every two years) |
| Waiting Period | 9 Months, Hardware Only |
| Deductible | Applicable for Hardware Only |
| Hearing | Exam: 100% up to $75 |
| Hardware: 60% | 70% | 80%** | |
| Annual Maximum | $500 (every two years) |
| Waiting Period | 9 Months, Hardware Only |
| Deductible | Applicable for Hardware Only |
| * Deductible is waived for diagnostic and preventative dental, eye and hearing exams. | |
| ** Eligible expenses paid at 60% during policy year 1; 70% during policy year 2; and 80% during policy year 3 and thereafter. | |
In NC, for costs and further details of the coverage, including exclusions, any reductions or limitations and terms under which the policy may be continued in force, see your agent or write to the company.