10
Hughston Benefits Guide
DENTAL | METLIFE
Dental Plan
Premium Plan
Basic Plan
Annual Deductible Individual Family Maximum Preventive Service s
$50 $150 100%
$50 $150 100%
Your dental coverage is offered through MetLife for the 2024 plan year. Please review your plan summaries or policy for coverage information and full plan details.
Basic Services Major Services
80% 50% 50%
80% N/A N/A
Orthodontia (Child up to age 26)
Annual Benefit Maximum
$3,000 $1,500
$1,500
Orthodontia Lifetime Maximum
N/A
Out-of-Network Reimbursement
90th UCR Premium Plan $41.93 $81.04 $78.58 $123.98
90th UCR
Basic Plan
Dental Rates (Monthly)
Employee Employee + Spouse Employee + Child(ren) Family
$22.51 $40.08 $39.00 $59.37
Vision Plan
In-Network
Out-of-Network Reimbursement
Eye Exam
$10 Copay
Up to $45
Lenses Single Vision
$20 Copay $20 Copay $20 Copay
Up to $30 Up to $50 Up to $65
Bifocals Trifocals
VISION | METLIFE
$130 Allowance after $20 Copay
Frames
Up to $70
Contacts Disposable Medically Necessary
Up to $105 Up to $210
$130 Allowance $20 Copay
Frequency Exam
Once every 12 months Once every 12 months One every 24 months
Your vision coverage is offered through MetLife for the 2024 plan year. Please review your plan summaries or policy for coverage information and full plan details.
Lenses or Contacts
Frames
Vision Rates (Monthly) Employee Employee + Spouse Employee + Child(ren)
* Costco, Walmart and Sam’s Club: $70 allowance after $20 eyewear copay.
$ 7.38 $12.07 $11.82 $19.45
Family
EMPLOYEE ASSISTANCE PROGRAM | BHS & METLIFE Hughston provides a confidential Employee Assistance Program (EAP) to you and members of your household. Examples of services provided by the EAP include financial counseling, professional help with drug/alcohol dependence and grief counseling. Services provided are completely confidential and available 24 hours a day, 7 days a week.
Made with FlippingBook - professional solution for displaying marketing and sales documents online