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MetLife Dental Plan

If you are eligible for Medicare, you and your spouse, if he or she is also Medicare-eligible, can enroll in the MetLife Dental Plan if you enroll in either the HOP Medical Plan or the Value Medical Plan. The MetLife Dental Plan is not available on a standalone basis or with a Medicare Advantage plan.

Note for current Health Options Program members: If you did not enroll in the Dental Plan when you were first eligible or if you are currently enrolled and drop your coverage, you will not be able to re-enroll in dental coverage in the future, unless the PSERS Board declares an Open Enrollment or if you experience a Qualifying Event.

Highlights of the Dental Plan:

  • Visit any dentist you want, but choosing one that's part of the MetLife network
    (an in-network dentist) saves you money.
  • There’s no annual deductible for in-network care.
  • You pay nothing for preventive care (exams and cleanings) from an in-network dentist and less than half the cost for all other services.
  • If you use an in-network dentist after you receive the maximum annual benefit, you'll continue to pay discounted rates.

Find a Dentist

Visit the MetLife website to find a participating dentist near you. To find a dentist, enter your ZIP code at the bottom of the "Dental Benefits" box at the top of the page. You can also do an advanced search and find participating dentists by name, distance and specialty.

Watch our short video to learn more about the MetLife Dental Plan.

To watch the video, push the "play" button.

(Read a transcript of the video)

The Plan at a Glance

What's Covered

Here’s how much you pay for in-network and out-of-network dental care in 2019.

Also review the “Covered Services and Limitations” section on page 3 of the MetLife Dental Plan brochure (PDF 347K).

MetLife Dental Plan at a Glance

 

In-Network

Out-of-Network*

Preventive Services
(Oral exams, cleanings, X-rays, fluoride treatments (for dependent child(ren) up to age 14))

$0; no deductible

20% of MetLife’s discounted rate plus 100% of the difference between the actual and discounted rates; no deductible

Basic and Major Restorative Services

Deductible

$0

$100

Basic Services
(Diagnostic casts, sealants, space maintainers, fillings, non-surgical periodontics, simple extractions, oral surgery)

30% of MetLife’s discounted rate

50% of MetLife’s discounted rate plus 100% of the difference between the actual and discounted rates

Major Services
(Recementations and repairs, rebases/relines, general anesthesia, consultations, inlays/onlays, crowns, dentures, bridges, endodontics/root canal, surgical periodontics, placement of implants)

40% of MetLife’s discounted rate

50% of MetLife’s discounted rate plus 100% of the difference between the actual and discounted rates

* These out-of-network reimbursement levels do not apply in Texas, Mississippi, Louisiana, Montana, Massachusetts or Alaska. If you live in one of these states, call the HOP Administration Unit (1-800-773-7725) for reimbursement levels.

Understanding In-Network and Out-of-Network Dental Benefits

Each time you need dental care, you decide whether to use an in-network dentist or one that is not part of the MetLife network. While you are free to go out of network whenever and as often as you like, using a MetLife dental provider is your lower-cost option.

Here's why:

  • With in-network providers, you never pay a deductible. If you use out-of-network dentists, you must satisfy a $100 deductible before the Plan pays any benefits for basic or major restorative services.
  • Your percentage of the cost is always lower with an in-network provider.
  • MetLife negotiates discounted rates with in-network dentists. This means they are under contract to accept a specific amount for each service. Out-of-network dentists can charge any amount, but MetLife will pay benefits based only on the amount it has established for in-network providers. This means, if you use an out-of-network dentist, you pay 100% of the difference between what the dentist charges and MetLife's discounted rate.

When You Go to the Dentist

You are not required to show an ID card to your dentist as proof of coverage. Just tell your dentist's office that MetLife is your dental carrier when you schedule an appointment. Dentists may submit claims for you, which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed.

Pre-treatment Estimates

You can find out what your out-of-pocket expenses will be before receiving a service by asking for a pre-treatment estimate. It is recommended that you request a pre-treatment
estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. (The phone number and website are for use by dental professionals only.) You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

For questions about the MetLife Dental Plan, call the HOP Administration Unit at 1-800-773-7725 or MetLife at 1-855-700-7997.

For More Information

Use the links below to get more information on the Dental Plan, including a list of what is and isn't covered:

 

 

Last modified April 2, 2019