Diagnostic and Preventive Services

2024 Plan Information

MetLife Option AMetLife Option BDelta Dental
Diagnostic and Preventive Care

In-Network:
100%

Out-of-Network:
80% of R&C; deductible waived

In-Network:
100%

Out-of-Network:
50% of R&C; deductible waived

In-Network:
100%

Out-of-Network:
80% of R&C; deductible waived

85% of allowed amount for Delta Premier; deductible waived

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

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.