TradeGlobal Hourly Non-Exempt

DENTAL INSURANCE

TradeGlobal offers dental coverage through MetLife. The PPO Dental Plan allows 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 plan.

BRONZE Dental PPO Plan

GOLD Dental PPO Plan

In-Network

Out-of Network*

In-Network

Out-of Network*

Calendar Year Deductible Individual

$50

$100

$25

$25

$150

$300

$75

$75

Family

Annual Maximum

$1,250

$2,250

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 50% after deductible

Covered 90% after deductible

Covered 80% after deductible

Covered 50% after deductible

Covered 25% after deductible

Covered 60% after deductible

Covered 50% after deductible

Bridges Dentures Orthodontia Services

50% $500 Lifetime Maximum

50% $2,000 Lifetime Maximum

Children only under the age of 19

• Subject to balance billing. Please refer to your plan document for specific details.

Employee Costs Per Pay Period Employee Only Employee + Spouse Employee + Child(ren)

BRONZE PPO

GOLD PPO

$ 3.54 $ 7.18 $ 9.43 $14.27

$ 5.81 $11.79 $15.39 $22.84

Family

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