Plan Benefit

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An arrangement that apportions expenses between health plan participants and an insurer. The member shares in the cost of covered services, generally on a percentage basis. For example, when the plan benefit is written in the dental plan as a 100/80/50, the insurer pays 100% of Type 1 (Preventive) procedures, 80% of Type 2 (Basic), and 50% of Type 3 (Major).

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