Access to the insurance plans and large group pricing on this website is predicated upon joining Elevate Wellness, a national association with over 80,000 members. Learn more
KEY BENEFITS
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MetLife Dental Platinum | MetLife Dental Gold | MetLife Dental Silver | ||||
Network | ||||||
Enrollment Deadline | 18th of month Prior to Effective date | 18th of month Prior to Effective date | 18th of month Prior to Effective date | |||
Network | PDP Plus | PDP Plus | PDP Plus | |||
Provider Search | Click here | Click here | Click here | |||
States Not Available | ||||||
AK, ID, LA, ME, MD, MT, NH, NM, OR, SD, WA | ||||||
Coverage Type* | In-Network | Out-of- Network | In-Network | Out-of- Network | In-Network | Out-of- Network |
Type A – Preventive | 100% of Negotiated Fee* | 100% of Negotiated Fee* | 100% of Negotiated Fee* | 100% of Negotiated Fee* | 100% of Negotiated Fee* | 100% of Negotiated Fee* |
Type B – Basic | 80% of Negotiated Fee* | 80% of Negotiated Fee* | 70% of Negotiated Fee* | 70% of Negotiated Fee* | 50% of Negotiated Fee* | 50% of Negotiated Fee* |
Type C – Major | 50% of Negotiated Fee* | 50% of Negotiated Fee* | 40% of Negotiated Fee* | 40% of Negotiated Fee* | Not Covered | Not Covered |
Type D – Orthodontia | 50% of Negotiated Fee* | 50% of Negotiated Fee* | Not Covered | Not Covered | Not Covered | Not Covered |
Deductible** | ||||||
Individual | $25** | $25** | $50** | $50** | $50** | $50** |
Family | $75** | $75** | $150** | $150** | $150** | $150** |
Annual Maximum Benefit | ||||||
Per Person | $3,000 (Annual Combined) | $1,500 (Annual Combined) | $1,000 (Annual Combined) | |||
Orthodontia Lifetime Maximum | ||||||
Per Person | $2,000 (Annual Combined) | Not Covered | Not Covered | |||
List of Primary Covered Services & Limitations | How Many/How Often – All Plans | |||||
Type A - Preventive | ||||||
Oral Examinations | One time in 6 months. | |||||
Prophylaxis (cleanings) | One time in 6 months. | |||||
Sealants | One application of sealant material every 3 years for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to 19th birthday. | |||||
Space Maintainers | One in 3 years for dependent children up to 14th birthday . | |||||
Topical Fluoride Applications | Two times in 12 months for a dependent child under age 19. | |||||
X-rays | Full mouth X-rays: one per 5 calendar years. Bitewing X-rays: one set per calendar year for adults and one set per calendar year for dependent children under age 19. | |||||
Type B - Basic Restorative | ||||||
Amalgam Fillings | One replacement per surface in 24 months | |||||
Resin Composite Fillings (excludes coverage for composite fillings on molars) | Unlimited. | |||||
Examinations-Problem Focused | Combined with Examinations Limit. | |||||
Periodontics | Periodontal scaling and root planing once per quadrant, every 24 months. Total number of periodontal maintenance treatments and prophylaxis cannot exceed four treatments in 12 months. Non-Surgical procedures | |||||
Endodontics | Pulpotomy, Pulp Capping, Pulp Therapy | |||||
Oral Surgery | Simple and Surgical Extractions. | |||||
Prefabricated Crowns | One per tooth in 10 calendar years. | |||||
Type C - Major Restorative | ||||||
Periodontics | Periodontal Surgery: one per quadrant in any 36 month period. | |||||
Full Mouth Debridement | One per lifetime | |||||
Endodontics | Root Canal treatment limited to one per tooth per lifetime. | |||||
Crown Buildups/Post Core | One per tooth in 10 calendar years. | |||||
Crowns/Inlays/Onlays | Replacement: one every 10 calendar years per tooth. | |||||
Dentures | Rebases/Relines: one in 36 months. Adjustments: one in 12 months. Repairs: one in 12 months. Recementations: one in 12 months. | |||||
Bridges and Dentures | Dentures and bridgework replacement: one every 10 calendar years. Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed. | |||||
Tissue Conditioning | One in 36 months. | |||||
Implants | Replacement: one per tooth position every 10 calendar years. Repairs: one per tooth in 12 months. Supported Prosthetic: one per tooth every 10 calendar years. | |||||
Occlusal Adjustments | One in 12 months. | |||||
Consultations | Two in 12 months. | |||||
General Anesthesia | When dentally necessary in connection with oral surgery, extractions or other covered dental services. | |||||
Type D - Orthodontia (Platinum Plan only) | Your Children, up to age 19, are covered while Dental Insurance is in effect. All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia. Payments are on a repetitive basis. 20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the Plan Summary. Orthodontic benefits end at cancellation of coverage. | |||||
*Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. ** Applies only to Type B & C Services. |