Dental
Dental Insurance is designed to offer you coverage for common dental care issues and to help you budget for dental services.
You pay for a certain amount out-of-pocket for services covered by your plan before your insurance starts paying (known as your deductible). Under this plan, the deductible is waived for preventive services like exams, cleanings, and x-rays. After you meet your deductible, you’re responsible for a percentage of covered expenses, which is called co-insurance. Below is a benefit summary of your annual deductible and co-insurance costs.
The Green Company offers two dental plan options with MetLife: Standard and Premium. The Standard plan has lower rates and a lower annual maximum with no orthodontia coverage. The Premium plan has a higher premium and annual maximum and includes orthodontia coverage. Both plans have the same coinsurance and deductibles, and dependent children can be covered up to age 26 regardless of student status.
The MetLife dental PDP Plus plan provides coverage both in and out-of-network. However, you will make the most of your dental plan benefits if you visit participating MetLife PDP Plus dentists. We encourage you to use a MetLife participating dental provider to reduce your out-of-pocket costs and help manage the long term costs of the plan. Participating dentist information can be found on the Resources page.
Below is a benefit summary of your annual deductible and co-insurance costs.
| MetLife PDP Plus Coverage | Standard Plan | Premium Plan |
|---|---|---|
|
Deductible
|
$75 individual | $225 Family | $75 individual | $225 Family |
|
Type A - Preventive Services (Deductible Waived): Cleanings, exams, fluoride, bitewing x-rays, periodontal maintenance and more
|
Plan pays 100% | Plan pays 100% |
|
Type B - Basic Services (After Deductible): Fillings, simple extractions, sealants, full mouth x-rays, general anesthesia, and more
|
Plan pays 80% | Plan pays 80% |
|
Type C - Major Services (After Deductible): Periodontal surgery, scaling / root planing, crowns, bridges, dentures, pulp therapy
|
Plan pays 50% | Plan pays 50% |
|
Type D - Orthodontia (After Deductible): Adults and children
|
Not Covered | Plan pays 50% |
|
Orthodontia Lifetime Maximum
|
Not Covered | $1,500 per person |
|
Annual Maximum (per person)
|
$1,000 per person | $5,000 per person |
Important Notes
- No age limitations for coverage
- $75 Employee deductible / $225 Family deductible (waived for preventive); differing annual maximums depending on plan
- 100% Preventive Coverage / 80% Basic Coverage / 50% Major Services / 50% Orthodontia (Premium Plan only)
- Members utilizing MetLife participating dentists will enjoy discounted dental fees in addition to protection from balance billing for charges above the dentist’s maximum allowable charges. Members utilizing non-participating dentists will have the same benefits but may be subject to balance billing.
Claims Process
In-Network
- Participating MetLife dentists file the claim and accept payment from MetLife
- Employees should not need to pay at the time of service for participating providers
Out-of-Network
- For out-of-network dentists, if the dentist does not agree to file the claim as out-of-network with MetLife, employee pays at the time of service and files a claim for reimbursement
- The plan reimburses at the 90th percent of Usual and Customary (U&C) for out-of-network providers. Charges by out-of-network providers that exceed U&C are the member’s financial responsibility. (Member pays the difference between the actual charge and the plan’s U&C reimbursement level.)
