Page 28 - 2020 Benefits Guide

Dental Plan

The Company offers two dental plans through MetLife. Both plans let you go to any
dentist you choose - but you’ll pay less when you visit one who is a member of MetLife’s
Preferred Dental Program network.

Pre-treatment Estimate How to Access Benefits
To assist you in budgeting for dental out-of- When you enroll for dental coverage,
pocket costs, it is recommended that you or you will receive an ID card from
your dentist request a pre-treatment estimate MetLife. Register for MyBenefits on
for any services that may cost more than $300. MetLife’s website, www.metlife.com/
This often applies to services such as crowns, mybenefits. On this website, you can
bridges, inlays and periodontics. To get an also find a provider, print an ID card,
estimate, have your dentist submit a request learn about plan benefits and check
online at www.metdental.com or call 1-877- the status of a claim. You can also
638-3379. You and your dentist will receive a call MetLife’s Customer Service at
benefits estimate – for most procedures – while 1-800-474-7371.
you’re still in the dentist’s office.

Plan Provisions Basic Dental Plan Enhanced Dental Plan
Deductible (Applies to Non- $75 per Individual $75 per Individual
Preventive Services) $225 Family Limit $225 Family Limit
Preventive Type A Services – You pay: $0 You pay: $0
checkups, cleanings, x-rays
Basic Type B Services – You pay: Deductible You pay: Deductible +
fillings, extractions + 30% 20%
Major Type C Services – You pay: Deductible You pay: Deductible +
crowns, implants, root canals, + 60% 50%
etc.
Annual Plan Limit per Covered $1,000 $2,000
Individual
Orthodontia (available to Not covered You pay: 50% of
dependent children under age allowable charges up
26 only) to the plan’s lifetime
maximum of $1,500;
100% of charges in
excess of plan’s lifetime
maximum.*
* A child must be covered under the dental plan prior to the commencement of an
orthodontia treatment program.

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