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DENTAL

DENTAL

  Network / Non-Network
Administrator/Network MetLife
Annual Deductible $50 per person
$150 family max
Preventive Care
Exams and Cleanings (once every 6 months) X-rays		 100%
Basic Care
Fillings
Extraction
Repair of crowns, bridges, dentures		 80%
Major Care
Single crowns
Bridges & dentures		 50%
Orthodontia 50%
Lifetime Orthodontia Maximum $1,500 per person
Annual Maximum Benefit $1,500 per person

*Out of network providers may balance bill based on contracted amount paid.

Resources
Employee Bi-Weekly Costs:
Employee Only $5.45
Employee + 1 $14.70
Employee + 2 or more $16.76
  Network / Non-Network
Administrator/Network MetLife
Annual Deductible $50 per person
$150 family max
Preventive Care
Exams and Cleanings (once every 6 months) X-rays		 100%
Basic Care
Fillings
Extraction
Repair of crowns, bridges, dentures		 80%
Major Care
Single crowns
Bridges & dentures		 50%
Orthodontia 50%
Lifetime Orthodontia Maximum $1,500 per person
Annual Maximum Benefit $1,500 per person

*Out of network providers may balance bill based on contracted amount paid.

Resources
Employee Bi-Weekly Costs:
Employee Only $55.91
Employee + 1 $131.96
Employee + 2 or more $106.24