Page 33 - NAPA 2021-2022
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Dental Summary (Continued)


                                                                           CareFirst Preferred Dental
                                 Benefits
                                                                                    Plan 3
                                                      Annual Maximum
              Referral Needed                                                         No

              Class I, II, III & IV                                                 $2,000

                                                       Internet Sites


              Doctor Provider Site                                            www.carefirst.com

                                                       Monthly Rates
                Individual                                                            $33.39
                Parent/Child                                                          $80.14
                Employee/Spouse                                                       $66.78
                Family                                                               $130.22

            Effective Date: 06/01/2021


            Changes, census corrections or geographic changes. This description of benefits is intended for summary
            and comparison purposes only and based on our interpretation.
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