Page 18 - Centennial Enrollment
P. 18
Dental Benefit Coverage—MetLife
In-Network Out-of-Network
Deductible
Individual $0 $50
Family $0 $150
Calendar Year Maximum $2,500 per person
Coinsurance
Group I 100% no deductible 100% no deductible
Group II
100% no deductible 80% after deductible
Group III
60% no deductible 60% after deductible
Orthodontia
Coinsurance 50% no deductible 50% no deductible
Lifetime maximum $1,500 per person
17
In-Network Out-of-Network
Deductible
Individual $0 $50
Family $0 $150
Calendar Year Maximum $2,500 per person
Coinsurance
Group I 100% no deductible 100% no deductible
Group II
100% no deductible 80% after deductible
Group III
60% no deductible 60% after deductible
Orthodontia
Coinsurance 50% no deductible 50% no deductible
Lifetime maximum $1,500 per person
17
