MetLife High Plan
With the MetLife High Plan you will only have access to the PDP Plus Network and you must work at least 20 hours each week to be eligible.

Out-of-network coverage
A dentist who is “out-of-network” means the provider hasn’t agreed to negotiated rates. The plan pays benefits based on the reasonable & customary charge for a particular service. If the out-of-network provider charges more, you’ll be responsible for paying the amount that exceeds the reasonable & customary limit plus the applicable coinsurance and deductible.

 

AD: After Deductible
R&C: Reasonable & Customary Fees
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.

This information is designed to help you choose a benefit plan for 2024 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.

 

Visit a dentist. Any dentist.

No matter who your dentist may be, with the MetLife High Plan Preferred Dentist Program, the power to choose and save is yours.

Here are the facts:

• You can go to any licensed dentist, in or out of the network.
• Reimbursement for your out-of-network dental care is based on the 99th percentile of “reasonable and customary” R&C fee. We look at what dentists in your area actually charge for services, and we calculate reimbursement based on the 99th percentile of those charges.
• The way we determine allowable charges for the R&C fee means your eligible benefit amount for out-of-network care is high relative to average dental charges in the community. This helps you pay less out of pocket.
• Sometimes when you visit an out-of-network dentist you may have to pay part of the bill. This is called balance billing. But with a 99% R&C plan, in the case of most covered services you won’t be balance billed above your typical out-of-pocket costs — your deductible, coinsurance amount and your plan maximum.

Savings Example
This hypothetical example shows that whether you get a cleaning from a participating or non-participating dentist, you can still save money.

 

Take charge of your dental care
Before you get any major dental work, you should talk to your dentist about getting a pre-treatment estimate. That’s when your dentist sends the plan for your care to MetLife.
For most procedures, you and your dentist will receive the estimate — online or by fax — during your visit. The statement shows amounts for what your plan covers. Then you and your dentist can talk about your care and costs before your treatment. It’s a great way to be prepared and plan ahead.

Get your plan information — fast!
Managing your dental benefits has never been easier. You’ve got MyBenefits — your secure member website. Just log on at metlife.com/mybenefits. With the 24/7 website you can:

• Review your plan information, including what’s covered and your coinsurance
• Track your deductible and plan maximums
• Find a dentist or view your claim history
• Read up on the oral health information you need to make informed decisions about your care