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BENEFITS

Dental Insurance

MetLife & Total Dental Administrators (TDA) | DHMO Dental Plans
With the Dental Health Maintenance Organization (DHMO) plans through MetLife and TDA, you are required to select a general
dentist to provide your dental care. You will contact your general dentist for all of your dental needs, such as routine check‐ups and
emergency situations. If specialty care is needed, your general dentist will provide the necessary referral. For covered procedures,
you'll pay the pre‐set copay or coinsurance fee described in your DHMO plan booklet. Please keep a copy of your booklet to refer
to when utilizing your dental care. This will show the applicable copays that apply to all of the dental services that are covered
under this plan. Please note the TDA plan is only for Arizona employees.

MetLife | DPPO Dental Plans
With the MetLife Dental Preferred Provider Organization (DPPO) dental plans, you may visit a DPPO dentist and benefit from the
negotiated rate or visit a non‐network dentist. When you utilize a DPPO dentist, your out-of-pocket expenses will be less. You may
also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount
and the actual charges and you may be responsible for filing claims.

MetLife TDA MetLife MetLife
Plan Name DHMO DHMO Low DPPO High DPPO
Location CA Only AZ Only All Locations All Locations

Network Network Network Network Non- Network Non-
Network Network
Dental Benefits SGX100-CA A500S PDP Plus PDP Plus

Calendar Year Maximum Unlimited Unlimited $1,500 $1,750
Deductible (Annual)
- Individual $0 $0 $50 $100 $50
- Family $0 $0 $150 $300 $150

Preventive No Charge for No Charge for No Charge No Charge No Charge No Charge
Most Services Most Services

Basic Services See Copay See Copay Deductible, Deductible, Deductible, Deductible,
Schedule Schedule 20% 50% of PDP 10% 20% of R&C
Major Services See Copay See Copay Deductible, Deductible, Deductible, Deductible,
Schedule Schedule 50% 75% of PDP 40% 50% of R&C
Orthodontia Benefits

Covered Members Children/Adults Children/Adults Children/Adults Children/Adults
Copay $725-$1,450 $700-$3,700 N/A N/A
Coinsurance N/A N/A 50% 50%

Lifetime Benefit Maximum N/A N/A $1,000 $1,000

Finding a Dental Provider
• California DHMO: Call (800) 275-4638 or go to www.metlife.com/mybenefits. Refer to the “Dental HMO/
Managed Care” network when prompted.
• Arizona DHMO: Call (888) 422-1995 or go to www.tdadental.com. Refer to the “DHMO/Pre Paid/ Total
Care” network when prompted.
• Low and High DPPO: Call (800) 275-4638 or go to www.metlife.com/mybenefits. Refer to the “PDP”
network when prompted.

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