THE STANDARD REIMBURSEMENT PLAN

This plan provides you with scheduled dollar benefits for many covered services when rendered by any licensed dentist. Benefits have a calendar year maximum of $1000.00. Predeterminations must be used when the cost of services is expected to exceed $250.00, and payment for completed treatment will only be made to the insured. This plan does not cover fixed bridgework, orthodontics, or periodontal surgery.


ELIGIBILITY

Coverage is available on a payroll deduction basis to members of the American Federation of Government Employees and their dependents. Dependents are your lawful spouse and unmarried children to age 19 (23 if full time student). Children include stepchildren and adopted children, provided such children are dependent upon the member for support.