Page 6 - 2022 01 Benefits Guide Murata Flipbook Final 6.14.22
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Dental Plan Summary - MetLife
UsinganIn-Networkproviderisencouraged. Dental Plan
Out-of-Network benefits are reimbursed in the 90 th Dental Plan
percentile of the UCR (usual, customary, andreasonable)
Annual Deductible*
Individual $50
Family $150
Office Visit Copay N/A
Annual Maximum Benefit $3,000
Preventive Services: *oral exam, cleanings, 100%
bitewing x-rays, etc.
Basic Services: *composite fillings, 80%
prefabricated crowns, root canals, etc.
Major Services: *bridges, dentures, implant
services, etc. 50%
Orthodontic Services (Adult and Child) 50%
Orthodontic Deductible None
Orthodontic Lifetime Maximum $3,000
*There are frequency limitations in place
*Bi-weekly Deductions Metlife PDP Plus Dental Plan
Employee Only $7.36
Employee + Spouse $15.34
Employee + Child(ren) $17.85
Family $25.92
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