Page 11 - 2016 Enrollment
P. 11
11
Dental Plan
No change to the Dental Benefits Plan Design
Monthly Dental MetLife Dental Coverage
Premiums and Plan Coverage Type PDP In-Network Out-of-Network
Design for 2016 Type A: cleanings, oral 100% of PDP fee 100% of R&C fee
examinations
Type B: illings 90% of PDP fee 80% of R&C fee
MetLife PPO Plan
Type C: bridges and 60% of PDP fee 50% of R&C fee
The MetLife PPO Plan provides dentures 50% of PDP fee 50% of R&C fee
Type D: orthodontia
both in- and out-of-network In-Network Out-of-Network
options. Within this plan, the Deductible $50 per person $150 per $50 per person $150 per
amount of beneit you receive is family family
greater when you use the Preferred Annual maximum beneit $1,500 per person $1,500 per person
Dentist Program (PDP). You may Orthodontia lifetime $1,000 per person $1,000 per person
maximum
experience higher out-of-pocket
expenses when visiting a non-
participating dentist. Dental Premiums
Eligibility Options Monthly Rate Bi-weekly Rate
Dental beneits are available on Individual $42.31 $19.53
a voluntary basis for beneit- Individual + spouse $82.12 $37.90
eligible partners and employees Individual + child(ren) $90.66 $41.84
and their dependents. Dental Individual + family $130.56 $60.26
beneit deductions are taken on PDP fee refers to the fees participating PDP dentists have agreed to accept as payment in full,
a pre-tax basis. Find a dentist at subject to any copays, deductibles, cost sharing, and beneits maximums
www.metlife.com/mybeneits. R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest
of the dentist’s actual charge, the dentist’s usual charge for the same or similar services, or
the charge of most dentists in the same geographic area for the same or similar services as
The beneit levels available both determined by MetLife
inside and outside the network are Deductible applies only to Type B and C services
identiied in the following dental
plan summary.
2016 Benefits Guide
Dental Plan
No change to the Dental Benefits Plan Design
Monthly Dental MetLife Dental Coverage
Premiums and Plan Coverage Type PDP In-Network Out-of-Network
Design for 2016 Type A: cleanings, oral 100% of PDP fee 100% of R&C fee
examinations
Type B: illings 90% of PDP fee 80% of R&C fee
MetLife PPO Plan
Type C: bridges and 60% of PDP fee 50% of R&C fee
The MetLife PPO Plan provides dentures 50% of PDP fee 50% of R&C fee
Type D: orthodontia
both in- and out-of-network In-Network Out-of-Network
options. Within this plan, the Deductible $50 per person $150 per $50 per person $150 per
amount of beneit you receive is family family
greater when you use the Preferred Annual maximum beneit $1,500 per person $1,500 per person
Dentist Program (PDP). You may Orthodontia lifetime $1,000 per person $1,000 per person
maximum
experience higher out-of-pocket
expenses when visiting a non-
participating dentist. Dental Premiums
Eligibility Options Monthly Rate Bi-weekly Rate
Dental beneits are available on Individual $42.31 $19.53
a voluntary basis for beneit- Individual + spouse $82.12 $37.90
eligible partners and employees Individual + child(ren) $90.66 $41.84
and their dependents. Dental Individual + family $130.56 $60.26
beneit deductions are taken on PDP fee refers to the fees participating PDP dentists have agreed to accept as payment in full,
a pre-tax basis. Find a dentist at subject to any copays, deductibles, cost sharing, and beneits maximums
www.metlife.com/mybeneits. R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest
of the dentist’s actual charge, the dentist’s usual charge for the same or similar services, or
the charge of most dentists in the same geographic area for the same or similar services as
The beneit levels available both determined by MetLife
inside and outside the network are Deductible applies only to Type B and C services
identiied in the following dental
plan summary.
2016 Benefits Guide
