Transcription of Dental - MetLife
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Dental - MetLife
Metropolitan Life Insurance Company Network: PDP Plus PLAN OPTION 1 Dental Plus PLAN OPTION 2 Dental Coverage Type In-Network % of Negotiated Fee* Out-of-Network% of R&C Fee** In-Network % of Negotiated Fee* Out-of-Network % of Scheduled Amount** Type A: Preventive (cleanings, exams, X-rays) 100% 100% 100% 100% Type B: Basic Restorative (fillings, extractions) 80% 80% 45% 45% Type C: Major Restorative (bridges, dentures) 50% 50% 30% 30% Type D: Orthodontia 50% 50% 50% 50% Deductible Individual $50 $50 $50 $50 Family $150 $150 $150 $150 Annual Maximum Benefit Per Person $1,500 $1,500 $1,500 $1,500 Orthodontia Lifetime Maximum Per Person $1,500 $1,500 $1,500 $1,500 Child(ren) s eligibility for Dental coverage is from birth up to age 26.
Space Maintainers Space Maintainers for dependent children up to 19th birthday. Sealants One application of sealant material every 60 months for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to 19th birthday. Sealants One application of sealant material every 60 months for each non-restored, non-
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