[ home ] :: [ two for one ] :: [ three for one ] :: [ coverage ] :: [ dental providers ] :: [ vision providers ] :: [ applications ]
|
[ home ] :: [ two for one ] :: [ three for one ] :: [ coverage ] :: [ dental providers ] :: [ vision providers ] :: [ applications ] |
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 |
VIP Advantage |
Premium Plan |
Basic Plan |
|
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 |
VIP Advantage |
Premium Plan |
Basic Plan |
|
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 |
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 |
$39.00 |
$29.00 |
$18.00 | |
|
Annual Premium |
Member Only |
$440.00 |
$320.00 |
$220.00 | |
* UCR = The Usual, Customary and Reasonable fees.
|
[ home ] :: [ two for one ] :: [ three for one ] ::[ coverage ] :: [ dental providers ] :: [ vision providers ] :: [ applications ] |