Dental Provider: | Lincoln Financial | www.lfg.com | 1-800-423-2765 |
|---|
(These rates are for 2016 and 2017.)
| Coverage level | Cost |
|---|---|
| Employee | $37.12 |
| Employee + One | $73.15 |
| Family | $112.98 |
Complete the following sections (Product Selection, Dependent and Other Insurance Information, Request for Coverage) and sign and date the form.
Other plan documents