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Dental Beneits
GLG offers you dental beneits from MetLife. Your dental services will be provided through MetLife’s PPO
(Preferred Provider Organization) dental network. When you use a dental provider through MetLife’s network,
you can save money—these dentists and other service providers have agreed to accept a discounted fee
schedule. You may also obtain services from non-network providers, but you will have to pay more out of pocket.
GLG offers you two dental plan options so that you To ind network providers in your area, go to
can choose a plan that its your needs. For more www.metlife.com/dental and click on “Find a
comprehensive beneits that include orthodontia, you Participating Dentist” Network: PDP Plus or call
can elect the Premium Plan. For those looking for Member Services at +1 800.942.0854
basic coverage, GLG also offers a basic dental plan.
Summary of Dental Beneits
The amounts shown in the Summary of Dental Beneits Chart below relect what you and the plan will pay for
services under the plan, based on whether you use in-network or out-of-network providers.
Feature Premium Plan Basic Plan
In-Network In-Network
Annual Deductible (Calendar year) $50 Individual $50 Individual
(Type II and III services combined) $150 Family $150 Family
Annual Maximum Beneit (Calendar year) $2,000 per person $1,250 per person
Type I—Diagnostic and Preventive Care 100% 100%
(Not subject to annual deductible)
Type II—Basic Restorative Care 90% 80%
Type III—Major Restorative Care 60% 50%
Orthodontia (Child and Adult) 50% No coverage
Orthodontia Maximum
(Lifetime individual maximum) $1,000 No coverage
Out-of-Network Out-of-Network
Annual Deductible (Calendar year) $50 Individual $50 Individual
(Type II and III services combined) $150 Family $150 Family
Annual Maximum Beneit (Calendar year) $2,000 per person $1,250 per person
Type I—Diagnostic and Preventive Care 100% 100%
(Not subject to annual deductible)
Type II—Basic Restorative Care 90% 80%
Type III—Major Restorative Care 60% 50%
Orthodontia 50% No coverage
Orthodontia Maximum $1,000 No coverage
(Lifetime individual maximum)
Out-of-Network UCR Level 90th percentile 90th percentile
Annual Maximum Beneit is the maximum dollar amount a dental plan will pay toward the cost of dental
care within a speciic beneit period (January through December). The patient is personally responsible
for paying costs above the annual maximum.
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GLG offers you dental beneits from MetLife. Your dental services will be provided through MetLife’s PPO
(Preferred Provider Organization) dental network. When you use a dental provider through MetLife’s network,
you can save money—these dentists and other service providers have agreed to accept a discounted fee
schedule. You may also obtain services from non-network providers, but you will have to pay more out of pocket.
GLG offers you two dental plan options so that you To ind network providers in your area, go to
can choose a plan that its your needs. For more www.metlife.com/dental and click on “Find a
comprehensive beneits that include orthodontia, you Participating Dentist” Network: PDP Plus or call
can elect the Premium Plan. For those looking for Member Services at +1 800.942.0854
basic coverage, GLG also offers a basic dental plan.
Summary of Dental Beneits
The amounts shown in the Summary of Dental Beneits Chart below relect what you and the plan will pay for
services under the plan, based on whether you use in-network or out-of-network providers.
Feature Premium Plan Basic Plan
In-Network In-Network
Annual Deductible (Calendar year) $50 Individual $50 Individual
(Type II and III services combined) $150 Family $150 Family
Annual Maximum Beneit (Calendar year) $2,000 per person $1,250 per person
Type I—Diagnostic and Preventive Care 100% 100%
(Not subject to annual deductible)
Type II—Basic Restorative Care 90% 80%
Type III—Major Restorative Care 60% 50%
Orthodontia (Child and Adult) 50% No coverage
Orthodontia Maximum
(Lifetime individual maximum) $1,000 No coverage
Out-of-Network Out-of-Network
Annual Deductible (Calendar year) $50 Individual $50 Individual
(Type II and III services combined) $150 Family $150 Family
Annual Maximum Beneit (Calendar year) $2,000 per person $1,250 per person
Type I—Diagnostic and Preventive Care 100% 100%
(Not subject to annual deductible)
Type II—Basic Restorative Care 90% 80%
Type III—Major Restorative Care 60% 50%
Orthodontia 50% No coverage
Orthodontia Maximum $1,000 No coverage
(Lifetime individual maximum)
Out-of-Network UCR Level 90th percentile 90th percentile
Annual Maximum Beneit is the maximum dollar amount a dental plan will pay toward the cost of dental
care within a speciic beneit period (January through December). The patient is personally responsible
for paying costs above the annual maximum.
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