| Zip Code | 15425 |
| Age | 58 |
| Spouse age | 59 |
| # Children | 0 |
| Blue Basic Dental PPO | Brochure | | |
| Blue Enhanced Dental PPO | Brochure | | |
| Prime Dental PPO Plan A | 0.00 | Brochure | |
| Prime Dental PPO Plan B | 0.00 | Brochure | |
| Prime Dental PPO Plan C | 0.00 | Brochure | |
| Blue View Vision Plan | 13.79 | Brochure | |
| Dental PPO | 82.20 | Brochure | |
| Dental PPO 50/1250 | 77.00 | Brochure | |
| Dental PPO 25/500 | 63.00 | Brochure | |
| Dental HMO | 46.60 | Brochure | |
| Dental Standard HMO | 26.40 | Brochure | |
| Duo Dental & Vision | 95.00 | Brochure | |
| Ultimate Vision 15/25/120 | 13.00 | Brochure | |
| Ultimate Vision 15/25/150 | 24.00 | Brochure | |