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TWO Benefit Plans for ONE Premium

This is only a sample of Dental and Vision benefits. For a complete list, view the Coverage page.

For the most current updates, please contact EHIS, Inc. at (858) 481-8990

DENTAL

ADA Code

Non-Member
UCR Charge

VIP Advantage
Member Pays

Premium Plan
Member Pays

Basic Plan
Member Pays

Office Visit

D9430

$35.00

$0.00

$0.00

$8.00

Oral Exam

D0150

$47.00

$0.00

$0.00

$0.00

X-Rays

D0210

$90.00

$0.00

$0.00

$0.00

Porcelain Crown

D2751

$600.00

$105.00

$156.00

$275.00

Cleaning

D1110

$60.00

$0.00

$0.00

$0.00

Ant. Root Canal (EFR)

D3310

$380.00

$45.00

$80.00

$125.00

Amalgam One Surface Filling

D2140

$60.00

$2.00

$4.00

$10.00

Denture Upper

D5110

$820.00

$90.00

$160.00

$350.00

Denture Lower

D5120

$820.00

$90.00

$160.00

$350.00

VISION


Non-Member
UCR Charge

VIP Advantage
Member Pays

Premium Plan
Member Pays

Basic Plan
Member Pays

Complete Eye Exam

 

$85.00

$0.00

$36.00

$36.00

Standard Single

Vision Lenses

Every 12 months if needed

$79.00

$0.00

$42.00

$42.00

Lined Bi-Focals

Every 12 months if needed

$129.00

$0.00

$55.00

$55.00

Lined Tri-Focals

Every 12 months if needed

$159.00

$0.00

$79.00

$79.00

Progressive Lenses

 

$215.00

$115.00 (generic)

$139.00

$139.00

Thin Lens

 

$60.00 and up

$45.00 sv

20% off

20% off

Tint #1 Plastic Lenses Only

 

$20.00

$0.00

$0.00

$0.00

Scratchcote

 

$35.00 and up

$20.00

$20.00

$20.00

Frames

Every 24 months if needed

UCR

Up to $100.00
Retail Allowance

25.00%

25.00%

Contact Lenses

 

UCR

Various Co-pays

Various discounts

Various discounts

LASIK

 

UCR

Co-pays apply. See Terms of Agreement

Co-pays apply. See Terms of Agreement

Co-pays apply. See Terms of Agreement

Annual Deductible

$25.00 per person

$10.00 per person

$10.00 per person

$10.00 per person

 

 

VIP Advantage

Premium Plan

Basic Plan

Monthly Premium

Member Only
Member + 1
Family

$39.00
$59.00
$81.00

$29.00
$41.00
$52.00

$18.00
$29.00
$35.00

Annual Premium

Member Only
Member + 1
Family

$440.00
$655.00
$920.00

$320.00
$440.00
$570.00

$220.00
$320.00
$390.00

* UCR = The Usual, Customary and Reasonable fees.

Application for Membership

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