Page 13 - ABM 2021 Benefit Guide RDU
P. 13
DENTAL BENEFITS
Whether or not you join the medical plan, you may enroll in dental coverage administered through
MetLife. ABM has made some modernization changes to the dental beneits. Please see below for
an overview of the plan design. The percentages shown in this table are the amounts the plan pays.
Premium Dental Standard Dental
In-Network
In-Network
Calendar Year Deductible
Individual $25 $50
Family $75 $150
Calendar Year Maximum
$3,000 per person $1,500 per person
Coinsurance
Preventive—Type A 100% no deductible 100% no deductible
Basic—Type B 70% after deductible 70% after deductible
Major—Type C 50% after deductible 50% after deductible
Orthodontia
Coinsurance 50% after deductible 50% after deductible
Lifetime Maximum $2,500 $1,000
Beneit Applies To Adults and children Adults and children
Visits and Exams
Limitations 2 per year 2 per year
Prophylaxis, including Scaling and Polishing 100% no deductible 100% no deductible
Fluoride 100% no deductible 100% no deductible
Limitations 2 per year 2 per year
Sealants 100% no deductible 100% no deductible
Limitations 1 per every 3 years to 14 1 per every 3 years to 14
X-Rays
Bitewing X-Rays 100% no deductible 100% no deductible
Limitations 2 per year to 19, 1 per year thereafter 2 per year to 19, 1 per year thereafter
Full Mouth X-Rays 100% no deductible 100% no deductible
Limitations 1 every 5 years 1 every 5 years
Endodontics
Root Canal 70% after deductible 70% after deductible
Minor Restorations
Amalgam (silver) Fillings 70% after deductible 70% after deductible
Composite Fillings (anterior teeth only) 70% after deductible 70% after deductible
Stainless Steel Crowns 70% after deductible 70% after deductible
Crowns 70% after deductible 70% after deductible
Full and Partial Dentures 50% after deductible 50% after deductible
Denture Repairs 70% after deductible 70% after deductible
Notes Beneits are calendar year
To look for a provider to learn more about this coverage; visit: metlife.com/mybeneits.
MetLife Dental PPO
ABM ofers team members two dental plans. You can ind out how a dental procedure will be covered in advance. Ask your
provider for a predetermination of beneits to estimate plan coverage and out-of-pocket costs.
With the MetLife plans, you can receive care from any provider; however, you will receive a higher level of beneit if you stay
in-network. Even though the reimbursement percentages are the same for in- and out-of-network services, out-of-network
providers do not agree to discounted fees which can make out-of-network usage more expensive. Out-of-network charges are
subject to reasonable and customary charges. Download the free apps from the App Store (or Google Play for Android ) by
TM
SM
searching MetLife.
ABM 13
Whether or not you join the medical plan, you may enroll in dental coverage administered through
MetLife. ABM has made some modernization changes to the dental beneits. Please see below for
an overview of the plan design. The percentages shown in this table are the amounts the plan pays.
Premium Dental Standard Dental
In-Network
In-Network
Calendar Year Deductible
Individual $25 $50
Family $75 $150
Calendar Year Maximum
$3,000 per person $1,500 per person
Coinsurance
Preventive—Type A 100% no deductible 100% no deductible
Basic—Type B 70% after deductible 70% after deductible
Major—Type C 50% after deductible 50% after deductible
Orthodontia
Coinsurance 50% after deductible 50% after deductible
Lifetime Maximum $2,500 $1,000
Beneit Applies To Adults and children Adults and children
Visits and Exams
Limitations 2 per year 2 per year
Prophylaxis, including Scaling and Polishing 100% no deductible 100% no deductible
Fluoride 100% no deductible 100% no deductible
Limitations 2 per year 2 per year
Sealants 100% no deductible 100% no deductible
Limitations 1 per every 3 years to 14 1 per every 3 years to 14
X-Rays
Bitewing X-Rays 100% no deductible 100% no deductible
Limitations 2 per year to 19, 1 per year thereafter 2 per year to 19, 1 per year thereafter
Full Mouth X-Rays 100% no deductible 100% no deductible
Limitations 1 every 5 years 1 every 5 years
Endodontics
Root Canal 70% after deductible 70% after deductible
Minor Restorations
Amalgam (silver) Fillings 70% after deductible 70% after deductible
Composite Fillings (anterior teeth only) 70% after deductible 70% after deductible
Stainless Steel Crowns 70% after deductible 70% after deductible
Crowns 70% after deductible 70% after deductible
Full and Partial Dentures 50% after deductible 50% after deductible
Denture Repairs 70% after deductible 70% after deductible
Notes Beneits are calendar year
To look for a provider to learn more about this coverage; visit: metlife.com/mybeneits.
MetLife Dental PPO
ABM ofers team members two dental plans. You can ind out how a dental procedure will be covered in advance. Ask your
provider for a predetermination of beneits to estimate plan coverage and out-of-pocket costs.
With the MetLife plans, you can receive care from any provider; however, you will receive a higher level of beneit if you stay
in-network. Even though the reimbursement percentages are the same for in- and out-of-network services, out-of-network
providers do not agree to discounted fees which can make out-of-network usage more expensive. Out-of-network charges are
subject to reasonable and customary charges. Download the free apps from the App Store (or Google Play for Android ) by
TM
SM
searching MetLife.
ABM 13
