Maryland Dental Insurance Individual Select Dental HMO Rate Quotes Blue Cross

-See the Summary of Benefits and Get the Application Form

Coverage Type	Annual Rate Full Annual Payment Due with Enrollment Application

Individual	$120
Individual & Child	$204
Individual & Adult	$240
Family	$360

Coverage Type	Semi-Annual Rate Second Payment Due by the 1st of the fifth month from the effective date of coverage
	1st Payment	2nd Payment
Individual	$65	$65
Individual & Child	$107	$107
Individual & Adult	$125	$125
Family	$185	$185

Please note that when selecting the semi-annual payment, a $5.00 administration fee is already included into each payment. You pay an additional $10/year when you select the semi-annual payment option. The first payment (of the semi-annual rate) is due with the enrollment application. The second payment is due by the 1st of the fifth month from the effective date of coverage.

The Dental Network is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association.

CUT7490-2N (7/08) HMOrates