Dental

Basic Dental Plan and Dental Copay Plan

Just as you have a choice of dental plans, you also have two alternatives for dental coverage. Smart Options offers you a Basic Dental Plan and a Dental Copay Plan. You also may waive dental coverage.

Both dental options use a MetLife PDP network. Visit a network dentist and take advantage of the discounted fees to lower your out-of-pocket costs. Save between 10% and 30% for both covered services and non-covered services, such as cosmetic dentistry.

Pre-Treatment Estimate

If you expect your dental expenses to exceed $300, it’s a good idea to have your dentist submit a description of the proposed treatment to MetLife. This way you know ahead of time how much will be covered. If you visit a network dentist, your dentist can submit a request for a pre-treatment estimate online or over the phone. In just a few minutes, you’ll know how much the dental procedures and services will cost you, and you can discuss your treatment options with your dentist.

MetLife Dental Copay Schedule

The Dental Copay Schedule from MetLife is the plan-specific breakdown of your out-of-pocket costs for various dental services. These may change from year to year, so it’s a good idea to check the most up-to-date schedule on the benefits portal, in addition to obtaining a Pre-Treatment Estimate for any dental services you need.

You may contact MetLife for more information.

Basic Dental Plan

With the Basic Dental Plan, you may visit any dentist of your choice and still receive benefits. However, you will lower your out-of-pocket costs when you visit a provider who participates in MetLife’s PDP network. Although your coinsurance (the percentage of the cost you pay) is the same, you’ll benefit from the discounted fees when you choose a network dentist, and your annual maximum benefit will go further. In addition, when you visit a network dentist, you are not responsible for any charges in excess of the negotiated fee.

If you visit a dentist who is not in the PDP network, you are responsible for any charges that exceed the Reasonable and Customary allowance.

Dental Copay Plan

With the Dental Copay Plan, you also have the option to visit any dentist you choose. However, you’ll receive a higher level of reimbursement when you visit a dentist who participates in MetLife’s PDP network. You do not need to select a primary care dentist; simply visit a network dentist and pay the applicable copayment.

When you visit a network dentist, your copayment is based on the dental service and the scheduled copayments for your area. Since dentists’ charges vary based on location, your copayments also vary based on the dentist’s ZIP code.

If you visit an out-of-network dentist, you’ll be reimbursed a percentage of the dentist’s charges, up to the Reasonable and Customary allowance. You are also responsible for any charges that exceed the Reasonable and Customary allowance.

Dental Plan Comparison

Features	Basic Dental Plan	Dental Copay Plan
Deductible	$50 per person (major services only)	$50 per person/$150 per family (basic and major services)
Preventive Care	100% of PDP fee (in-network)	100% after copayment (in-network)
Basic Services	100% of PDP fee (in-network)	100% after copayment (in-network)
Major Restorative	50% of PDP fee (in-network)	100% after copayment (in-network)
Orthodontia	100% of PDP fee (children under 19)	40% of PDP fee
Annual Maximum	$2,500 individual/$5,000 family	$1,000 individual
Orthodontia Maximum	$1,500 per child (lifetime)	$2,000 per member (lifetime)