Page 9 - 2018 Turnberry Associates Guide Boston

Dental Benefits That

Keep You Smiling

Strong teeth and gums are an important part of good health, which is
why Turnberry is very excited to offer you and your eligible dependents
comprehensive dental coverage through MetLife.

Our dental plans help you pay for most necessary dental services and
supplies, including diagnostic and preventative care (such as exams,
cleanings and x-rays), basic and major restorative services (such as fillings,
crowns and dentures), as well as orthodontic services for both children
and adults. (Adult orthodontia covered under Florida DMO option only).

Dental Plan Highlights Option 1: DMO Option 2: PPO—Low Option 3: PPO—High
(FL Only)

Out-of-
Out-of-
Summary of Services In-Network In-Network Network In-Network Network
Annual Deductible¹
• Individual None $50 $50 None $50
• Family None $150 $150 None $150
MAC* UCR**

Annual Benefit None $2,000 $5,000
Maximum 2

Preventative
• Oral Examinations Fee Schedule 100% 100% 100% 100%
• Prophylaxis/Cleaning

Basic
• Minor Restorations
• Endodontics Fee Schedule 80% 50% 100% 80%
• Periodontics

Major
• Crowns Fee Schedule 50% 25% 60% 50%
• Bridges
• Dentures

50% 50%

Fee Schedule
Orthodontia Children & Adults $1,000 $1,000
Lifetime Maximum Lifetime Maximum
Children Up to Age 19 Children Up to Age 19

1 Annual deductible only applies to basic and major services and is waived for preventative services.
2 Annual deductible and maximum are based on calendar year (January 1 through December 31).
* Out-of-Network Coverage is based on fee schedule.
**Out-of-Network Coverage is based on 80% of the reasonable and customary fee.
The above chart is for illustrative purpose only; actual benefits described in the Certificate of Coverage will prevail. 6