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Preferred Dentist Program
Metlife Standard Plan
Dental plans are available on a "Stand-alone"
basis. Medical coverage is not required. The program covers the
following services when they are provided by a licensed dentist and when
necessary and customary, as determined by the standards of generally
accepted dental practices. 100% participation of eligible employees is
required.
Dental
Benefits |
Preferred
Dentist* |
Any
Dentist |
Calendar Year
Deductible,
Type II & Type III Services
Only - per
person
(Max 3 per family) |
$50 |
$50 |
Calendar Year Maximum
Benefits - Per Person |
$1,000 |
$1,000 |
Type I -
Preventative
(Deductible Waived)
- Oral Examination
- X-Rays
- Topical Application of
Fluoride/Prophylaxis
- Cleanings
|
80% |
80% |
Type II -Basic
- Fillings
- Oral Surgery
- Endodontics
- Periodontics
|
80% |
80% |
| Type III -
Major**
|
50% |
50% |
* if you use a Preferred dentist, the Plan pays the percentage of
the negotiated rate, which is typically, less than the usual fee charged
by that Provider. your savings can be as much as 30%. There is no "Balance
Billing".
** - 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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