Page 22 - GLG Benefits Guide
P. 22
Dental Beneits (continued)
Types of Dental Services
Preventive and Diagnostic Care
The plan pays 100% of its maximum allowed cost for preventive and diagnostic care, and there is no deductible.
Covered expenses include routine oral exams and cleanings twice within twelve months. Bitewing x-rays are
once every 12 months. Fluoride treatments for children under age 16 twice every twelve months. Full-mouth
x-rays with an oral exam can be made once every three years. To qualify for coverage, sealants can only be used
on posterior tooth, once per tooth every three years for members under age 16.
Basic Restorative Care
There is a combined deductible for Basic Restorative Care and Major Restorative Care: $50 per individual for both
in- and out-of-network services; $150 per family. Basic Restorative Care includes illings, root canal treatment,
periodontics, endodontics, oral surgery, and emergency dental care.
Major Restorative Care
There is a combined deductible for Basic Restorative Care and Major Restorative Care: $50 per individual for both
in- and out-of-network services; $150 per family. Major Restorative Care includes crowns, dentures, bridges,
inlays, onlays, and implant services.
Why use a network dentist?
When you use dental providers who are members of MetLife’s network, you will only pay the predetermined
fee that applies to the services you receive. If you use out-of-network providers, they may charge more than the
network providers—and you are responsible for paying the full amount that they charge.
Will MetLife mail me an insurance ID Card?
MetLife will not mail you a personalized insurance ID card. Your provider can check both your and your family’s
coverage directly with MetLife with your Social Security Number. You can log onto www.metlife.com/mybeneits
and download your personalized insurance ID card or you can request a generic card from the GLG People Team
at HRsupport@glg.it.
Who pays for your Dental Beneits?
You and GLG share the cost of dental beneits. Your contribution is made by paying the premium through payroll
deduction.
MetLife Dental Plan—Monthly Contribution Effective January 1, 2020
Basic Dental Plan Premium Dental Plan
Employee Only $7.00 $32.00
Employee + Spouse $20.00 $72.00
Employee + Child(ren) $20.00 $67.00
Family $32.00 $106.00
22
Types of Dental Services
Preventive and Diagnostic Care
The plan pays 100% of its maximum allowed cost for preventive and diagnostic care, and there is no deductible.
Covered expenses include routine oral exams and cleanings twice within twelve months. Bitewing x-rays are
once every 12 months. Fluoride treatments for children under age 16 twice every twelve months. Full-mouth
x-rays with an oral exam can be made once every three years. To qualify for coverage, sealants can only be used
on posterior tooth, once per tooth every three years for members under age 16.
Basic Restorative Care
There is a combined deductible for Basic Restorative Care and Major Restorative Care: $50 per individual for both
in- and out-of-network services; $150 per family. Basic Restorative Care includes illings, root canal treatment,
periodontics, endodontics, oral surgery, and emergency dental care.
Major Restorative Care
There is a combined deductible for Basic Restorative Care and Major Restorative Care: $50 per individual for both
in- and out-of-network services; $150 per family. Major Restorative Care includes crowns, dentures, bridges,
inlays, onlays, and implant services.
Why use a network dentist?
When you use dental providers who are members of MetLife’s network, you will only pay the predetermined
fee that applies to the services you receive. If you use out-of-network providers, they may charge more than the
network providers—and you are responsible for paying the full amount that they charge.
Will MetLife mail me an insurance ID Card?
MetLife will not mail you a personalized insurance ID card. Your provider can check both your and your family’s
coverage directly with MetLife with your Social Security Number. You can log onto www.metlife.com/mybeneits
and download your personalized insurance ID card or you can request a generic card from the GLG People Team
at HRsupport@glg.it.
Who pays for your Dental Beneits?
You and GLG share the cost of dental beneits. Your contribution is made by paying the premium through payroll
deduction.
MetLife Dental Plan—Monthly Contribution Effective January 1, 2020
Basic Dental Plan Premium Dental Plan
Employee Only $7.00 $32.00
Employee + Spouse $20.00 $72.00
Employee + Child(ren) $20.00 $67.00
Family $32.00 $106.00
22
