Orthodontia

2021 and 2022 Plan Year Information

MetLife Option AMetLife Option BDelta 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.

Orthodontics

In-Network:
50% of discounted fee, up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults)

Out-of-Network:
50% of R&C, up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults)

In-Network:
50% of discounted fee, up to a $2,000 lifetime benefit maximum per child (children to age 19)

Out-of-Network:
Not covered

In-Network:
50% of discounted fee, up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults)

Out-of-Network:
50% of R&C or Allowed Amount (Delta Premier), up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults)

Orthodontics Lifetime Maximum Benefit

The orthodontics lifetime benefit maximum is combined across plan options.