| Zip Code | 92021 |
| Age | 68 |
| Spouse age | 69 |
| Dental Net 3000D DHMO | 32.12 | Brochure | |
| Dental PPO | 92.40 | Brochure | |
| Dental PPO 50/1250 | 87.00 | Brochure | |
| Enhanced Dental PPO 50/2000 | 137.00 | Brochure | |
| Enhanced Dental PPO 50/2000 | 148.60 | Brochure | |
| Dental HMO | 51.80 | Brochure | |
| Dental Standard HMO | 31.00 | Brochure | |
| Duo Dental & Vision | 102.40 | Brochure | |
| Ultimate Vision 15/25/120 | 13.80 | Brochure | |
| Ultimate Vision 15/25/150 | 25.80 | Brochure | |