Dental Benefits

Dental plans cover diagnostic and preventive care, plus basic and major services.

Premiums are calculated on 24 pay periods and deducted from the first two paychecks of each month.

Coverage Tier	Total Monthly Premium	Modera’s Monthly Contribution	Employee Monthly Premium	Employee Payroll Deduction per Pay Period
Employee	$64.30	$64.30	$0.00	$0.00
Employee + Spouse	$130.80	$97.54	$33.26	$16.63
Employee + Child(ren)	$137.86	$101.08	$36.78	$18.39
Family	$216.95	$140.63	$76.32	$38.16

Employee

Employee + Spouse

Employee + Child(ren)

Family

Feature	In and Out-of-Network Benefits
Calendar Year Deductible	$50 per individual / $150 per family (basic and major services only)
Calendar Year Maximum	$1,500 per individual
Preventive Care (cleanings, exams & x-rays)	100%
Basic Care (fillings, minor oral surgery & simple extractions)	80%
Major Care (crowns, bridges & dentures)	50%

Calendar Year Deductible

In and Out-of-Network Benefits: $50 per individual / $150 per family (basic and major services only)

Calendar Year Maximum

Preventive Care (cleanings, exams & x-rays)

Basic Care (fillings, minor oral surgery & simple extractions)

Major Care (crowns, bridges & dentures)

Although you can choose any dental provider, you will generally pay less when you visit an in-network dentist. If you choose an out-of-network provider, you may be billed the difference between what MetLife pays, and what your out-of-network provider charges for the services.
The $50 individual / $150 family calendar year deductible applies to basic and major services only; preventive care (cleanings, exams & x-rays) is covered at 100%.
The calendar year maximum is $1,500 per individual. Plan includes out-of-network benefits; see plan summary for additional details.