Dental Plans

DENTAL PLANS

We provide dental coverage through MetLife. You may elect one of the following plans:

PPO Plus
Mid PPO
Low PPO

Preventive services (cleanings and X-rays),

Basic services (fillings, tooth extraction, root canals and most gum-related work), and

Posterior composite fillings (white fillings on back teeth).

When you use in-network providers, your dentist files the claims for you. (Under Find a Dentist, select PDP from the Select your network drop down.) When you use out-of-network providers, you may pay more and may have to file your own claims.

Here’s how the plans work:

	PPO PLUS		MID PPO		LOW PPO
	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network
Deductible	$50 employee; $100 family
Maximum benefit (per person, per plan year, excluding orthodontia)	$2,000*	$1,000*	$1,500*	$500*	$500
Preventive services**	100%	80%	100%	80%	100%	80%
Basic services	80%
Major services	50%				Not covered
Orthodontia	50%, up to a separate $2,000 lifetime benefit***	50% up to a separate $1,000 lifetime benefit***	Not covered

* In-network maximum represents the most the plan will pay. If you use an out-of-network provider, the first $500 (Mid PPO) or $1,000 (PPO Plus) paid by the plan may be paid to an out-of-network provider. If the plan has already paid that amount to any provider, no out-of-network benefit is available.

** Preventive services, such as biannual cleanings, exams and X-rays, do not reduce the annual benefit maximum.

*** You must stay enrolled in the PPO Plus plan for the duration of your (or your dependent’s) orthodontic care to receive full orthodontia benefits. For orthodontia claims already in progress prior to your enrollment in the PPO Plus Plan, claims will be paid on a pro-rated basis up to plan maximums.