Page 9 - Marcus & Millichap Benefit Guide 2019-2020 (revised 01.02.2020)
P. 9

Dental Benefits



         SIPs are not eligible for this coverage

         MetLife | DHMO Dental Plan - Select states only (CA, FL, NJ, NY, and TX)
         With the Dental Health Maintenance Organization (DHMO) plan through MetLife, 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, you do need a 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.

         MetLife | PPO Dental Plan - All States
         With  the  MetLife    Preferred  Provider  Organization  (PPO)  dental  plan,  you  may visit  a  PPO  dentist  and  benefit  from  the
         negotiated rate or visit a non‐network dentist. When you utilize a PPO 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                               MetLife
         Plan Features
                                                     DHMO Plan                               PPO Plan
                                                                                MetLife  Dental
         Network                                      Network                                        Non-Network
                                                                                   Network
         Dental Benefits

         Calendar Year Maximum                        Unlimited                               $2,350
         Office Visit Copay                           $5 Copay                                None

         Deductible (Annual)                                                        Waived for Preventive Services
          - Individual                                   $0                          $75                $100
          - Family                                       $0                    Max 3 per Family    Max 3 per Family

         Preventive  (Plan Pays)                  See Copay Schedule                100%                100%
         Exams, X-Rays, Cleanings

         Basic Services (Plan Pays)               See Copay Schedule                 80%                 80%
         Fillings, Oral Surgery,
         Endodontics, Periodontics

         Major Services (Plan Pays)               See Copay Schedule                 50%                 50%
         Crowns, Prosthetics

         Orthodontia
          - Covered Members                        Children & Adults                     Children & Adults
          - Copay                              $1,850 Child  / $1,850 Adult                    N/A
          - Coinsurance                                 N/A                                    50%
          - Lifetime Benefit Max                        N/A                                   $2,000
         -  Dependent Age                             Up to 26                               Up to 26




          Note: We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300.
          Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be
          in question.




                                                              9
   4   5   6   7   8   9   10   11   12   13   14