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Dental

Base Plan

Services Base Plan
In-Network Dentist Non-Network

Diagnostic and Preventative Services
– exams, cleanings, fluoride, and space maintainers

100% 100%
Emergency Palliative Treatment
– to temporarily relieve pain
100% 100%
Sealants – to prevent decay of permanent teeth 100% 100%
Brush Biopsy– to detect oral cancer 100% 100%
Radiographs – X-rays 100% 100%
Minor Restorative Services – fillings and crown repair  80% 80%
Endodontic Services – root canals 80% 80%
Periodontic Services – to treat gum disease 80% 80%
Oral Surgery Services
– extractions and dental surgery
80% 80%
Major Restorative Services – crowns 80% 80%
Other Basic Services – misc. services 80% 80%
Relines and Repairs – to bridges, implants, and dentures 80% 80%
TMD Treatment
– treatment of the disorder of the temporomandibular joint
80% 80%
Prosthodontic Services – bridges, implants, and dentures 80% 80%
Orthodontic Services – braces 60% 60%
Orthodontic Age Limit No Age Limit
Orthodontic Lifetime Benefit Maximum (per eligible person) $1,500 $1,500
Plan Year Max $2,500 $2,500

Base Plan Monthly Employee Contributions

  Base Plan
Employee $0
Family $0

The in-network benefits for the base and buy-up plans are the same. The main difference between the plans is how non-network dentists are reimbursed. If your dentist is out-of-network with MetLife, they may balance bill you. The buy-up plan can help reduce or eliminate the balance billing.

Buy Up Plan

Services Buy Up Plan
In-Network Dentist Non-Network

Diagnostic and Preventative Services
– exams, cleanings, fluoride, and space maintainers

100% 100%
Emergency Palliative Treatment
– to temporarily relieve pain
100% 100%
Sealants – to prevent decay of permanent teeth 100% 100%
Brush Biopsy– to detect oral cancer 100% 100%
Radiographs – X-rays 100% 100%
Minor Restorative Services – fillings and crown repair  80% 80%
Endodontic Services – root canals 80% 80%
Periodontic Services – to treat gum disease 80% 80%
Oral Surgery Services
– extractions and dental surgery
80% 80%
Major Restorative Services – crowns 80% 80%
Other Basic Services – misc. services 80% 80%
Relines and Repairs – to bridges, implants, and dentures 80% 80%
TMD Treatment
– treatment of the disorder of the temporomandibular joint
80% 80%
Prosthodontic Services – bridges, implants, and dentures 80% 80%
Orthodontic Services – braces 60% 60%
Orthodontic Age Limit No Age Limit
Orthodontic Lifetime Benefit Maximum (per eligible person) $1,500 $1,500
Plan Year Max $2,500 $2,500

The in-network benefits for the base and buy-up plans are the same. The main difference between the plans is how non-network dentists are reimbursed. If your dentist is out-of-network with MetLife, they may balance bill you. The buy-up plan can help reduce or eliminate the balance billing.

Buy Up Monthly Employee Contributions

  Buy Up Plan
Employee $9.66
Family $25.51
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