MetLife
Coverage period: January 1, 2024 – December 31, 2024
Base Plan
| Services | Base Plan | |
| In-Network Dentist | Non-Network | |
|
Diagnostic and Preventative Services |
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 |
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 | $25.24 |
