Terminology Explained
Please note that the following examples on this page are for educational purposes only.
For more specific information, please refer to your own dental plan summary.
| Coverage Type | In-Network: | Out-of-Network: |
|---|---|---|
| Type A - cleanings, oral examinations | 100% of PPO Fee | 100% of UCR FEE |
| Type B - fillings | 80% of PPO Fee | 80% of UCR FEE |
| Type C - bridges and dentures | 50% of PPO Fee | 50% of UCR FEE |
| Type D - orthodontia | 50% of PPO Fee | 50% of UCR FEE |
| Deductible: | In-Network | Out-of-Network |
| Individual | $50 | $50 |
| Family | $150 | $150 |
| Annual Maximum Benefit: | In-Network | Out-of-Network |
| Per Person | $1,500 | $1,500 |
| Orthodontia Lifetime Maximum: | In-Network | Out-of-Network |
| Per Person | $1,250 | $1,250 |
| 1. Coverage Types: Dental procedures are grouped into categories: Preventive and diagnostic (Type A) coverage type includes services like cleanings, exams and x-rays. Basic (Type B) coverage includes fillings and restorative treatments. Major (Type C) coverage includes more complicated treatments like crowns and bridges. Orthodontia (Type D) coverage includes braces. How each procedure or treatment is categorized (Type A, B, C, D) is determined by your group’s plan and will be detailed on your copy of the Dental Plan Benefit Summary. This can be accessed online at www.metlife.com/mybenefits. Generally, benefits for Type A procedures pay at the highest benefits level because they prevent and diagnose dental disease. It’s important to review and understand the ‘Services & Limitations’ and ‘Exclusions’ of your plan to understand what is covered, how covered procedures are categorized and any limitations and exclusions that apply. |
| 2. Co-insurance: The co-insurance percentage helps determine what your out-of-pocket costs will be for each coverage type. Each Type − A, B, C, and D − has a pre-set percentage that represents what your plan will reimburse for the services in each category. Your total out-of-pocket responsibility is subject to any deductibles, benefit maximums, plan provisions, if you receive services out-of-network, and your plan’s basis for reimbursement. Please see your Dental Plan Benefits Summary for more information. |
| 3. Deductible: This is the amount a covered person must incur in out-of-pocket costs during a benefit period before benefit payments will be made by the insurance plan. For most plans, the deductible amounts for in-network services are less than the amount for out-of-network services. Many plans do not require a deductible be met for Type A services. |
| 4. Annual Maximum Benefit: This is the total amount the plan will pay in the plan year. Once this amount is reached, no further benefits will be paid; however, you may still be eligible to receive services at the negotiated fees when visiting a participating dentist, depending on which state you live in. |
| 5. Orthodontia Lifetime Maximum Benefit: Not all plans cover Orthodontia Treatment. If your plan covers Orthodontia, there is a Lifetime Maximum Benefit that is applicable only to Orthodontia. This does not affect your Annual Maximum Benefit for Types A, B and C categories. The Lifetime Maximum Benefit is the total amount the plan will pay for orthodontic services for each covered person (subject to any plan age limitations). Once this amount is reached, no further benefits will be paid; however, you are still eligible to receive services at the negotiated fees when visiting a participating dentist, depending on which state you live in. |