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Preferred Dentist Program
Savings Plus Plan
Savings Plus is designed to provide the features of a PPO ata price
comparable to other low cost dental benefit programs. The plan covers a
full range of sevices and provides greatest value when members receive
services from participating PDP dentists.
75% participation of
eligible employees is required.
A $10 co-pay applies for
eligible cleanings. Participating PDP dentists will extend MetLife's
negotiated rates when performing services not covered under the plan.
PLEASE NOTE: THE SAVINGS PLUS PLAN PROVIDES VERY LIMITED
BENEFITS WHEN UTILIZING OUT-OF-NETWORK PROVIDERS.
Benefit
|
In-Network
(Preferred Dentist) |
Out-of-Network*
(Any Dentist) |
| Deductible |
$50 Individual
$150
Family |
$50 Individual
$150
Family |
| Co-Insurance |
|
Paid by a set
Out-of-Network Reimbursement Schedule
(Available upon
Request) |
| Type A =
Preventive |
100%
($10 per visit for
prophylaxis services) |
| Type B = Basic |
70% |
| Type C = Major** |
40% |
| Type D =
Orthodontia |
0% |
| Calendar Year Maximum
Benefits per Person |
$1,000 |
$1,000 |
*Savings Plus is designed to provide significant savings to its
members through its extensive network of providers. Any services received
Out-Of-Network will be paid at a set reimbursement schedule. If you are
interested in reviewing the Out-of-Network Reimbursement Schedule please
call (800) 585-2392 or visit http://www.metlife.com/dental/.
**
- Subject to a twelve (12) month waiting period. May be waived with proof
of prior dental coverage. We strongly encourage that your dentist summits
a pre-authorization form for treatment plans totaling $300.00 or more.
The above information is only a summary of the features of
Preferred Dentist Program Option. The Policy/Certificate must be consulted
to determine the exact terms and conditions of benefits. Limitations and
exclusions apply.
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