Diagnostic and Preventive Services
2024 Plan Information
| MetLife Option A | MetLife Option B | Delta Dental |
|---|---|---|
| Note | ||
The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums, which employees pay. | ||
| Diagnostic and Preventive Care | ||
In-Network: Out-of-Network: | In-Network: Out-of-Network: | In-Network: Out-of-Network: 85% of allowed amount for Delta Premier; deductible waived |
| Individual Annual Deductible | ||
In-Network: Out-of-Network: | In-Network: Out-of-Network: | In-Network: Out-of-Network: |
| Family Annual Deductible | ||
In-Network: Out-of-Network: | In-Network: Out-of-Network: | In-Network: Out-of-Network: |
Dental Services
- Diagnostic and preventive services: X-rays and cleanings
- Restorative services: fillings, oral surgery, root canals and gum treatments
- Prosthodontics: crowns, bridges, dentures and implants
Note: Out-of-network reimbursements and maximums are based on reasonable and customary (R&C) charges as determined by each Dental Plan administrator. Please refer to the Health Benefits and Insurance Summary Plan Description for details.