DENTAL INSURANCE
M.E. Wilson Company offers dental coverage through MetLife. The Dental PPO Plans allow you to use in-network or out-of- network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between MetLife’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plans.
OPTION 1 - LOW Dental PPO Plan
OPTION 2 - HIGH Dental PPO Plan
In-Network
Out-of Network*
In-Network
Out-of Network*
Calendar Year Deductible Individual
$50
$50
$150
$150
Family
Annual Maximum
$1,250
$1,750
Diagnostic & Preventive
Exams
Cleanings Fluoride X-Rays Sealants Regular Restorative Services Amalgam Fillings Extractions - Single Tooth Endodontics (Root Canal) Periodontics (Gum Disease) Major Services Crowns
Covered in full
Covered in full
Covered in full
Covered in full
Covered 80% after deductible
Covered 60% after deductible
Covered 90% after deductible
Covered 80% after deductible
Covered 50% after deductible
Covered 50% after deductible
Covered 60% after deductible
Covered 50% after deductible
Bridges Dentures Orthodontia Services
Covered 50%
Covered 60%
Children only under the age of 19
Orthodontia Lifetime Maximum
$1,000
$1,000
* Subject to balance billing. Please refer to your plan document for specific details.
** M.E. Wilson contributes $12.14 monthly towards elected dental plan
OPTION 1 - LOW Dental PPO Plan
OPTION 2 - HIGH Dental PPO Plan
Bi-Weekly Rates
Employee Only
$ 5.60
$ 9.12
Employee + Spouse
$ 16.75
$ 23.93
Employee + Child(ren)
$ 20.96
$ 27.86
Family
$ 34.95
$ 46.15
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