| Zip Code | *0277 |
| Age | 56 |
| # Children | 1 |
| Bronze Dental PPO | 50.40 | Brochure | |
| Silver Dental PPO | 79.50 | Brochure | |
| Gold Dental PPO | 101.50 | Brochure | |
| Platinum Dental PPO | 121.00 | Brochure | |
| Incentive Dental PPO | 115.50 | Brochure | |
| Blue View Vision Plan | 13.31 | Brochure | |
| Dental PPO | 85.30 | Brochure | |
| Dental PPO 50/1250 | 77.40 | Brochure | |
| Enhanced Dental PPO 50/2000 | 121.60 | Brochure | |
| Enhanced Dental PPO 50/2000 | 132.00 | Brochure | |
| Dental HMO | 49.60 | Brochure | |
| Dental Standard HMO | 28.00 | Brochure | |
| Duo Dental & Vision | 94.70 | Brochure | |
| Ultimate Vision 15/25/120 | 13.80 | Brochure | |
| Ultimate Vision 15/25/150 | 25.80 | Brochure | |