DENTAL PLANS
Children’s Mercy provides dental coverage through MetLife. You may elect one of the following plans:
- PPO Plus
- Mid PPO
- Low PPO
All three dental plan choices provide coverage for:
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 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:
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Deductible | ||||||
| Maximum benefit (per person, per plan year, excluding orthodontia) | $2,000* | $1,000* | $1,500* | $500* | ||
| Preventive services | 100% | 80% | 100% | 80% | 100% | 80% |
| Basic services | ||||||
| Major services | ||||||
| Orthodontia | 50%, up to a separate $2,000 lifetime benefit** | 50% up to a separate $1,000 lifetime benefit** | ||||
* 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.
** 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, claims will be paid on a pro-rated basis up to plan maximums.