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

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:

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* $1,250* $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.

** 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.

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Confirm your eligibility and when you can enroll for dental coverage.