Dental Plans

DENTAL PLANS

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

High Plan
Mid Plan
Low Plan

Preventive services (cleanings and X-rays).

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

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 dropdown.) 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:

	HIGH PLAN		MID PLAN		LOW PLAN
	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 Plan) or $1,000 (High Plan) 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 High 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 High Plan, claims will be paid on a pro-rated basis up to plan maximums.