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2016 Benefits Guide
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MetLife Dental
Benefit/Service
In-Network
Out-of-Network
Benefit
Preventive
100%
100%
Basic
90%
80%
Major
60%
50%
Ortho
50%
50%
Deductibles & Maximums
Deductible Individual *
$50
Deductible Family
$150
Annual Maximum Per Person
$2,000
Lifetime Orthodontia Maximum **
$2,000
* Does not apply to preventive services.
** Orthodontic services are available for children up to age 19 and the annual
deductible does NOT apply.
Dental Insurance
You will have coverage both in-network and out-
of-network. It is to your advantage to utilize a
network dentist to take advantage of contracted
fees. You will experience the deepest discounts
when seeing an in-network dentist. If you go out-
of-network, you will be responsible for any
amount exceeding MetLife’s negotiated rates
plus any deductible and co-insurance associated
with your procedure.
Out-of-Network Services
All out-of-network claims are paid at the 90th
Percentile of UCR. The provider will bill the
insured for any charges that exceed the 90th
Percentile of UCR. (Usual and Customary
Reimbursement)
Dental Employee Cost
Monthly
Employee
$19.40
Employee & Spouse
$37.51
Employee & Child(ren)
$40.11
Employee & Family
$69.85
2016 Employee Dental