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Dental Plan Summary - MetLife

Metropolitan Life Insurance Company network : PDP PlusCoverage Type In- network % of Negotiated Fee* Out-of- network % of Negotiated Fee* Type A: Preventive (cleanings, exams, X-rays) 100% 100% Type B: Basic Restorative (fillings, extractions) 80% 80% Type C: Major Restorative (bridges, dentures, crowns, periodontics) 50% 50% Deductible Per Individual $50 $50 Annual Maximum Benefit Per Individual ( Dental exams, bitewing x-ray, fluoride, and prophy/cleanings do not apply to individual coverage limit) $2,000 $2,000 *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums.

Can my dentist apply for participation in the network? Yes. If your current dentist does not participate in the network and you would like to encourage him/her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application. †† The website and phone number are for use by dental professionals only.

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