Page 17 - Future Steps
P. 17
Dental 2017 Beneits Enrollment
Dental Benefits To
Find a
Access to good oral healthcare is important to your overall health. This is why GESM Dentist in the
offers dental insurance as a core part of your beneits package. You have the choice Met Network
between two options under the MetLife PPO plan. As with medical insurance, you will X Go to
almost always pay less if you visit an in-network dentist or specialist. In-network dentists metlife.com/dental
agree to charge a negotiated rate. When you see an out-of-network provider, the plan X Type in your ZIP Code
in the right hand side
will pay based on the 90th percentile of usual and customary. A charge is considered of the screen
“customary” if it is within a range of fees that most dentists in the area charge for a X Select the network:
given procedure. For your pocketbook, it pays to stay in-network. And, your participating PDP plus
dentist will submit claims for you! To locate an in-network provider, visit metlife.com.
Dental Benefits At-a-Glance
Base Plan Buy-Up Plan
In-Network In-Network
Annual Deductible $50/person $50/person
Waived for Type A Waived for Type A
(preventive) services (preventive) services
Annual Plan Maximum $1,000 $1,500
Lifetime Orthodontia Plan Maximum No coverage $1,500
Waiting Period N/A 6-month wait orthodontia
benefit
Type A: Plan pays 100% Plan pays 100%
Exams, Cleanings, Sealants, X-rays
Type B: Plan pays 80% Plan pays 80%
Amalgam Fillings, Root Canal, Scaling
and Root Planing, Resin Composite
Fillings, Simple Oral Surgery
Type C: Plan pays 50% Plan pays 50%
Periodontal Surgery, Crowns, Dentures,
Bridges, Implants
Orthodontia (available for children up to No coverage Plan pays 50%
age 19)
Please note: The difference between the two plans is that the buy-
up plan offers a higher annual beneit plan maximum—$1,500
versus $1,000 and an orthodontia beneit for dependent children.
Dental Plan Premiums—No Increase in 2017
Base Plan Buy-Up Plan
Bi-Weekly Bi-Weekly
Employee $10.60 $13.55
Employee + 1 $22.27 $28.45
Family $36.58 $46.75
17
Dental Benefits To
Find a
Access to good oral healthcare is important to your overall health. This is why GESM Dentist in the
offers dental insurance as a core part of your beneits package. You have the choice Met Network
between two options under the MetLife PPO plan. As with medical insurance, you will X Go to
almost always pay less if you visit an in-network dentist or specialist. In-network dentists metlife.com/dental
agree to charge a negotiated rate. When you see an out-of-network provider, the plan X Type in your ZIP Code
in the right hand side
will pay based on the 90th percentile of usual and customary. A charge is considered of the screen
“customary” if it is within a range of fees that most dentists in the area charge for a X Select the network:
given procedure. For your pocketbook, it pays to stay in-network. And, your participating PDP plus
dentist will submit claims for you! To locate an in-network provider, visit metlife.com.
Dental Benefits At-a-Glance
Base Plan Buy-Up Plan
In-Network In-Network
Annual Deductible $50/person $50/person
Waived for Type A Waived for Type A
(preventive) services (preventive) services
Annual Plan Maximum $1,000 $1,500
Lifetime Orthodontia Plan Maximum No coverage $1,500
Waiting Period N/A 6-month wait orthodontia
benefit
Type A: Plan pays 100% Plan pays 100%
Exams, Cleanings, Sealants, X-rays
Type B: Plan pays 80% Plan pays 80%
Amalgam Fillings, Root Canal, Scaling
and Root Planing, Resin Composite
Fillings, Simple Oral Surgery
Type C: Plan pays 50% Plan pays 50%
Periodontal Surgery, Crowns, Dentures,
Bridges, Implants
Orthodontia (available for children up to No coverage Plan pays 50%
age 19)
Please note: The difference between the two plans is that the buy-
up plan offers a higher annual beneit plan maximum—$1,500
versus $1,000 and an orthodontia beneit for dependent children.
Dental Plan Premiums—No Increase in 2017
Base Plan Buy-Up Plan
Bi-Weekly Bi-Weekly
Employee $10.60 $13.55
Employee + 1 $22.27 $28.45
Family $36.58 $46.75
17
