DENTAL INSURANCE
Mezrah Consulting offers dental coverage through Lincoln Financial . 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 Aetna’s allowed amount and what the dentist may charge, also known as “balance billing”. The charts below provides a brief overview of the plans.
LOW Dental PPO Plan
In-Network
Out-of Network*
Calendar Year Deductible Individual
$25 $75
$75
$225
Family
Annual Maximum
$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 80% after deductible
Covered 80% after deductible Covered 70% after deductible
Covered 50% after deductible Covered 40% after deductible
Bridges Dentures Orthodontia Services
Not covered
Children only under the age of 19
• Subject to balance billing. Please refer to your plan document for specific details.
Dental PPO Plan Employee Cost Per Pay Period
Employee Only
$ 0.00
Employee + Spouse
$13.76
Employee + Child(ren)
$14.84
Family
$31.36
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