Restorative Services

2024 Plan Information

MetLife and Delta Dental Options AMetLife and Delta Dental Options B
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. The Premier Network is for Delta Dental only.  If you use a Premier Network provider, your dental plan benefits will generally mirror the out-of-network plan design (except as otherwise noted).
Individual Annual Deductible
In-Network: No annual deductibleIn-Network: No annual deductible
Delta Dental Premier Network and Out-of-Network: $50Delta Dental Premier Network and Out-of-Network: $100
Family Annual Deductible
In-Network: No annual deductibleIn-Network: No annual deductible
Delta Dental Premier Network and Out-of-Network: $150Delta Dental Premier Network and Out-of-Network: $300
Diagnostic and Preventive Care
In-Network: 100%In-Network: 100%
Delta Dental Premier Network and Out-of-Network: 80% of R&C; deductible waived
85% of allowed amount for Delta Premier; deductible waived
Delta Dental Premier Network and Out-of-Network: 50% of R&C; deductible waived
Restorative Services
In-Network: 80% of discounted feeIn-Network: 80% of discounted fee
Delta Dental Premier Network and Out-of-Network: 75% of R&C, after annual deductibleDelta Dental Premier Network and Out-of-Network: 40% of R&C, after annual deductible
Prosthodontics
In-Network: 50% of discounted feeIn-Network: 50% of discounted fee
Delta Dental Premier Network and Out-of-Network: 50% of R&C, after annual deductibleDelta Dental Premier Network and Out-of-Network: 25% of R&C, after annual deductible
Orthodontics
In-Network: 50% of discounted fee, 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 person (children to age 19)
Delta Dental Premier Network and 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)Delta Dental Premier Network and Out-of-Network: Not covered
Annual Benefit Maximum per Person
In-Network: $3,000In-Network: $2,000
Delta Dental Premier Network and Out-of-Network: $2,000Delta Dental Premier Network and Out-of-Network: $1,000