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BENEFITS

DENTAL INSURANCE

METLIFE | DENTAL PLAN
With the MetLife Preferred Den st Program (PDP) you may visit a network den st or visit a non‐network den st. When you u lize
a network den st, your out‐of‐pocket expenses will be less. You may also obtain services using a non‐network den st; however,
you will be responsible for the difference between the Reasonable & Customary (R&C) amount and the actual charges and you may
be responsible for filing claims.

Employees Residing Outside Texas Texas Residents Only
METLIFE METLIFE
PLAN NAME PPO PPO
Network Name Network Non‐Network Network Non‐Network
Dental Benefits

Calendar Year Maximum $5,000 per individual $5,000 per individual
Calendar Year Deduc ble
‐ Individual $50 $50
‐ Family $150 $150
Type A
Preven ve (Plan Pays) 100% 100% of R&C 100% 100% of R&C
Exams, X‐Rays, Cleanings

Type B
Basic Services (Plan Pays) 90% a er Deduc ble 80% of R&C 90% 90% of R&C
Fillings, Oral Surgery, a er Deduc ble a er Deduc ble a er Deduc ble
Endodon cs, Periodon cs
Type C
Major Services (Plan Pays) 60% a er Deduc ble 50% of R&C 60% 60% of R&C
Crowns, Prosthe cs a er Deduc ble a er Deduc ble a er Deduc ble
Orthodon a
‐ Covered Members Children & Adults Children & Adults
‐ Copay N/A N/A
‐ Coinsurance 60% of R&C 60% of R&C
‐ Life me Benefit Maximum $2,000 per individual $2,000 per individual

LOCATING A DENTAL PROVIDER

Go to www.metlife.com/dental or download the MetLife mobile app, available on iTunes or the Google
Play Store. Refer to the PDP Plus network when prompted

Note

We strongly recommend you ask your den st for a predetermina on if total charges are expected to exceed $300.
Predetermina on enables you and your den st to know in advance what the payment will be for any service that may be in
ques on.

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