Page 8 - 2018 NextCare Enrollment
P. 8
Example Services Dental
Preventive—Oral NextCare offers dental insurance through MetLife Dental. MetLife does
Examinations, Prophylaxis, not issue ID cards for dental coverage. An insurance contact information
Bitewing x-rays, x-rays, topical
luoride applications, sealants, card can be found on the NextCare Intranet and coverage can be veriied
and space maintainers by using your social security number and the group number.
Basic—illings, injections of In-Network
antibiotic drugs, extractions, Deductible $50 individual
emergency palliative treatment, $150 family
anesthesia, consultations, Calendar Year Maximum $1,500 per member
repairs, relining and rebasing, Preventive 100% of participating dentist fee
endodontics, periodontics, and Basic Restorative
oral surgery 80% of participating dentist fee
Major Restorative 50% of participating dentist fee
Major—crowns, inlays, on lays, Orthodontia 50% of participating dentist fee
bridges, and dentures Orthodontia Eligibility Available only to those under age 19
Balance Billing Please see the plan documents on the NextCare Intranet beneits page for
Participating providers have agreed out-of-network beneits.
to speciic prices for procedures
in our plan . When you visit non-
participating providers your cost Employee Dental Cost Per Pay Period
for services may be more than our Employee Only $15 .46
negotiated rates and you will be Employee and Spouse $32 .47
billed for those higher costs . Employee and Child(ren) $34 .02
Family $52 .57
8 2018 Benefits Guide
Preventive—Oral NextCare offers dental insurance through MetLife Dental. MetLife does
Examinations, Prophylaxis, not issue ID cards for dental coverage. An insurance contact information
Bitewing x-rays, x-rays, topical
luoride applications, sealants, card can be found on the NextCare Intranet and coverage can be veriied
and space maintainers by using your social security number and the group number.
Basic—illings, injections of In-Network
antibiotic drugs, extractions, Deductible $50 individual
emergency palliative treatment, $150 family
anesthesia, consultations, Calendar Year Maximum $1,500 per member
repairs, relining and rebasing, Preventive 100% of participating dentist fee
endodontics, periodontics, and Basic Restorative
oral surgery 80% of participating dentist fee
Major Restorative 50% of participating dentist fee
Major—crowns, inlays, on lays, Orthodontia 50% of participating dentist fee
bridges, and dentures Orthodontia Eligibility Available only to those under age 19
Balance Billing Please see the plan documents on the NextCare Intranet beneits page for
Participating providers have agreed out-of-network beneits.
to speciic prices for procedures
in our plan . When you visit non-
participating providers your cost Employee Dental Cost Per Pay Period
for services may be more than our Employee Only $15 .46
negotiated rates and you will be Employee and Spouse $32 .47
billed for those higher costs . Employee and Child(ren) $34 .02
Family $52 .57
8 2018 Benefits Guide
