Page 11 - First Presbyterian Church Benefit Guide

Dental Plan Choices

MetLife | PPO Plan
This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will maximize your
benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the MetLife PDP Plus net-
work. When you utilize a network dentist, your out-of-pocket expenses will be less, however, you will usually pay the
lowest amount for services when you visit a PPO dentist. If you obtain services using a non-network dentist, you will
be responsible for the difference between the covered amount and the actual charges and you may be responsible for
filing claims. The chart below provides a high-level overview of your dental plan.

MetLife
Plan Name PPO

Network Name Network Non-Network

Dental Benefits

Calendar Year Maximum Benefit $1,500

Annual Deductible
- Individual $50
- Family $150

Preventive Services No Charge No Charge

Basic Services 20%; after deductible 20%*; after deductible

Major Services 50%; after deductible 50%*; after deductible

Tier Payroll Deduction
Employee Only $0.00
Employee + Spouse $32.83
Employee + Child(ren) $38.29
Employee + Family $78.21

Finding a Dental Provider
• Go to www.metlife.com/insurance/dental-insurance PPO (800) 942-0854
*Dentists who are out-of-network have not agreed to pricing, and may bill you for the
difference between what MetLife pays them and what the dentist usually charges.

Employee Benefits 11