DENTAL INSURANCE
Pilot Bank 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 charts below provides a brief overview of the plans.
Met 1000
Met 1500
Met 3000
Out-of- Network*
Out-of- Network*
Out-of- Network*
Network
In- Network
In- Network
In- Network
Calendar Year Deductible Individual
$50
$50
$50
$150
$150
$150
Family
Annual Maximum
$1,000
$1,500
$3,000
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
100%
80%
100%
80%
100%
100%
80%
60%
80%
60%
80%
80%
50%
40%
50%
40%
50%
50%
Bridges Dentures Orthodontia Services Adult & Child Lifetime Maximum
50% $1,500
50% $1,500
Not Covered
*Subject to balance billing. Please refer to your plan document for specific details.
Met 1000 Employee Cost Semi-Monthly
Met 1500 Employee Cost Semi-Monthly
Met 3000 Employee Cost Semi-Monthly
Employee Only
$14.46 $29.46 $31.97 $50.69
$19.98 $40.70 $44.15 $70.02
$24.78 $50.42 $58.78 $90.42
Employee + Spouse
Employee + Child(ren)
Family
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