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Dental
Plan B: Moderate Option

Plan B offers a moderate level of dental coverage. This plan stresses preventive care to help you and your family avoid serious dental problems. The plan pays 100% of the covered cost (reasonable and customary charges) of preventive services. It also pays 80% of the covered cost (reasonable and customary charges) of basic restorative services, and 50% of major services and orthodontia care. The maximum benefit you can receive under this plan each year is $1,500 per person in-network, or $1,000 out of network. Orthodontia carries a separate $1,500 lifetime maximum in-network.

Plan B also includes a Preferred Provider Organization (PPO) feature, which gives you the option of receiving care from PPO participating dental care providers and paying less out-of-pocket.

Participating dentists agree to charge negotiated rates. These rates are typically lower than the rates charged by non-participating dentists. This means that when you visit a participating dentist, your out-of-pocket costs may be less. Here's an example of how you might save money using a participating dentist compared to a non-participating dentist.

Here's an Example
Let's assume you need a major procedure that's covered at 50%:

  Participating Dentist Non-participating Dentist
Provider's Regular Fee $600 $600
Negotiated Fee $375 N/A
Reasonable & Customary Limit N/A $500
Plan Pays 50% of $375 = $187.50 50% of $500= $250
You Pay 50% of $375 = $187.50

$350
($600-$250 = $350)

Savings obtained by using a participating provider: $162.50

NOTE: This chart is for illustrative purposes only.

To locate a participating provider in your area, visit www.metlife.com/dental or call 1-800-942-0854 to request a provider directory.

Plan Option B Benefit Summary:

Coverage Type: In-Network Out-of-Network
Type A - Preventive 100% of PDP Fee* 100% of R&C Fee**
Type B - Basic Restorative 80% of PDP Fee* 80% of R&C Fee**
Type C - Major Restorative 50% of PDP Fee* 50% of R&C Fee**
Type D - Orthodontia 50% of PDP Fee* 50% of R&C Fee**
 
Deductible*** In-Network Out-of-Network
Individual $25 $25
Family $50 $50
 
Annual Maximum Benefit: In-Network Out-of-Network
Per Person $1,500 $1,000
 
Orthodontia Lifetime
Maximum:
In-Network Out-of-Network
Per Person $1,500 $1,000
   
* PDP Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full.
** Reasonable & Customary charges are based on the research of a dentist's usual, actual & community average charge as determined by MetLife.
*** Applies only to Type B & C Services.

 

 

 

   
Dental
Plan A: High Option
Plan B: Moderate Option
What Is Covered
What Is Not Covered
When Coverage Ends for a Dependent Child
Orthodontia
When Coverage Ends
Glossary
MetLife Customer Service Call Instructions
   
Related Forms
MetLife Claim Form
MetLife Enrollment Form
Dental Certificate
Plan Overview
   
Related Links
MetLife
MetLife MyBenefits
   
Disclaimer: Colonial Benefits Online provides only an overview of your benefits from Colonial School District and The State of Delaware. Colonial School District and The State of Delaware reserve the right to amend or to terminate any benefit plan at any time, with or without notice. Review more important legal information about your benefits plans.

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