DeltaCare USA Individual/Family Dental HMO Program: My Costs




	How much do I pay? What are my payment choices? Mailing instructions Copayments and other charges

HOW MUCH DO I PAY?

The annual Premium for the initial Contract Term is:

Enrollee only (one person): plus a onetime enrollment fee of $15	$97
Enrollee and one dependent (spouse or child): plus a onetime enrollment fee of $15	$155
Enrollee and two or more dependents: plus a onetime enrollment fee of $15	$225

HIPAA Notice of Privacy Practices | Web Site Privacy Notice
© 2008 Delta Dental