Restorative Services

2022 Plan 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.

Restorative Services

In-Network:
80% of discounted fee

Out-of-Network:
75% of R&C, after annual deductible

In-Network:
80% of discounted fee

Out-of-Network:
40% of R&C, after annual deductible

In-Network:
80% of discounted fee

Out-of-Network:
75% of R&C, after annual deductible

Individual Annual Deductible

In-Network:
No annual deductible

Out-of-Network:
$50

In-Network:
No annual deductible

Out-of-Network:
$100

In-Network:
No annual deductible

Out-of-Network:
$50

Family Annual Deductible

In-Network:
No annual deductible

Out-of-Network:
$150

In-Network:
No annual deductible

Out-of-Network:
$300

In-Network:
No annual deductible

Out-of-Network:
$150

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