Page 17 - Technip Energies 2022 benefits guide

Dental Plan – MetLife

Technip Energies offers you a choice of two dental plans, Premier Plus or Premier. Choose the plan that best
meets your needs. Both dental plans are designed to encourage preventive treatment, allowing employees to
achieve oral health while striving to minimize dental costs. Dental coverage is provided through MetLife.

Keep in mind, when you are shopping for your dental professional, you are encouraged to use a MetLife
in-network dentist. MetLife network dentists have agreed to charge lower fees and file your claims. If you
choose to use a dentist who does not participate in your plan’s network, your out-of-pocket costs will be higher
and you will be responsible for any charges beyond your out-of-pocket costs will be higher and you will be
responsible for any charges beyond the Maximum Allowable Charge (MAC). To find a network dentist, visit
MetLife at www.metlife.com.

The teeth cleaning benefit includes two regular cleanings (covered at 100% coinsurance) and two
periodontal cleanings (covered at 80% coinsurance).

Premier Plus Premier

IN-NETWORK* OUT-OF-NETWORK** IN-NETWORK* OUT-OF-NETWORK**
Calendar Year Deductible †
Individual $50 $50 $25 $25

Family $150 $150 $75 $75
Annual Maximum Benefit
Per Person $2,500 $2,500 $1,000 $1,000
You pay You pay

Type A: Preventive
Cleanings, Exams, X-rays 100% 100% 100% 100%
Type B: Basic Restorative
Fillings, Extractions 80% 80% 80% 80%
Type C: Major Restorative

Bridges, Dentures 50% 50% 50% 50%
Orthodontia lifetime maximum
Per Child $2,500 $2,500 N/A N/A

* In-Network charges are a percentage of negotiated fees and refer to the fees that
participating dentists have agreed to accept as payment in full for covered services,
subject to any copayments, deductibles, cost sharing and benefits maximums.
Negotiated fees are subject to change.
** Out-of-Network charges are based on a Maximum Allowable Charge (MAC). MAC is the
maximum amount MetLife will pay for a covered dental service. Providers who are not
contracted with MetLife are not obligated to accept the MAC fee as full payment and may
bill you for any excess balance. This is known as balance-billing and is why you are
encouraged to utilize a MetLife contracted provider.
†
Applies only to Type B & C Services.

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