Dental Plan Choices
Employees may choose between the High Option or the Low Option…or waive coverage. Whichever plan is chosen, the employee must remain in the same plan until the next Open Enrollment period. At that time, employees will be able to switch from the High Plan to the Low Plan, or from the Low Plan to High Plan without penalty.
Rates
| Plan | Coverage | Monthly Rate |
| High Option | Employee Employee + 1 Family |
$34.25 $84.00 $129.73 |
| Low Option | Employee Employee + 1 Family |
$16.44 $40.01 $81.97 |
Eligible dependents include lawful spouse and children from birth to their 26th birthday. Dependents in military service are not eligible. Orthodontics is limited to dependent children under age 19.
Plan Design
Dental coverage is provided by MetLife with an annual maximum of $1,250 for the High Plan and $1,000 for the Low Plan.
Deductibles and Maximums
| Deductible | High Plan: $25 per person or $75 per family each calendar year Low Plan: $50 per person or $150 per family each calendar year |
| Deductible is waived for Diagnostic and Preventative | |
| Maximums | High Plan: $1,250 per person per calendar year Low Plan: $1,000 per person per calendar year |
| Diagnostic and Preventative counts toward Maximum |
Waiting Periods
If an employee does not elect coverage (either the High Plan or the Low Plan) when he or she is first eligible, and elects to enroll in the High Option at a later date, there will be a 12-month wait on orthodontic coverage. Enrollment in the Low Plan for one year and moving to the High Plan will satisfy the one year waiting period.
Benefits
| *Usual & Customary Charges are paid at 90% | LOW | PLAN | HIGH | PLAN |
| Services Covered | In Network |
Out of Network* |
In Network |
Out of Network* |
| Diagnostic and Preventative | 100% | 100% | 100% | 100% |
| Basic Services | 60% | 60% | 80% | 80% |
| Non-Surgical Periodontics | 60% | 60% | 80% | 80% |
| Oral Surgery | 60% | 60% | 80% | 80% |
| Endodontics | No Coverage |
No Coverage |
80% | 80% |
| Surgical Periodontics | No Coverage |
No Coverage |
80% | 80% |
| Major Services | No Coverage |
No Coverage |
50% | 50% |
| Orthodontic Benefits Dependent Children to age 19 |
No Coverage |
No Coverage |
50% | 50% |
| Orthodontic Benefits Lifetime Maximum (with Any Carrier) |
No Coverage |
No Coverage |
$1,000 | $1,000 |
Contact / ID Cards
Employees will receive ID cards after Annual Enrollment from MetLife prior to January 1. Employees can print additional cards online or print a non-personalized card below.
http://www.metlife.com/mybenefits
With or without a Dental Card, the Dentist must verify eligibility at time of service.
