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.
Crowns/Inlays/Onlays Replacement: once every 5 years. Crowns/Inlays/Onlays Replacement: once every 5 years. Endodontics Root canal treatment limited to once per tooth per 24 months. General Anesthesia When dentally necessary in connection with oral surgery, extractions or other covered dental services. Oral Surgery Periodontics
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