MetLife Dental Insurance (Rates cited below are for the 2018 calendar year.)
When you consider how important good oral health is to your general health, your need for good dental benefits should not be ignored. MetLife has offered dental insurance coverage for over 40 years and is the single largest dental plan administrator among single commercial carriers in the U.S., currently serving nearly 21 million people. MetLife’s Preferred Dentist Program (PDP) network is one of the largest in the industry, exceeding 100,000 participating dentist locations and over 22,000 Specialist locations nationwide.
MetLife Dental Plan – Rate Guide
01/01/2018 – 12/31/2018
|Member Only||$ 49.00 per month|
|Member + Child||$ 76.32 per month|
|Member + Spouse||$110.24 per month|
|Member + Family||$137.13 per month|
Being enrolled in the MetLife PDP plan means lower out-of-pocket expenses when you visit a PDP dentist. Whether or not the service is covered by your plan, you will always receive the MetLife PDP negotiated fee. The negotiated fee is typically 15-45% less than the average fee at a dentist in the same geographical area.
In North Carolina there are nearly 1,000 General Dentists and almost 200 Specialists in the MetLife PDP Network. Members living or traveling outside the state of North Carolina can visit any dentist in the MetLife PDP nationwide network. Of course, members have the freedom of choice to visit any dentist, in- or out-of-network. If a dentist is out-of-network, Usual & Customary Fees apply.
MetLife Dental Program Benefit Summary
|Annual Deductible: Individual||$0.00|
|Total Annual Maximum: Individual||$2,000|
Preventative – Procedures covered at 100%**
Oral Cancer Screening
|Oral Exams||2 per calendar year|
|Cleanings||2 per calendar year|
|Topical Fluoride Application||1 per calendar year (Child & Adult)|
|Bitewing X-rays||1 set per calendar year|
|Full Mouth X-rays||1 per 60 months|
|Palliative (Emergency) Treatment|
|Oral Cancer Screening||2 per calendar year|
Minor Restorative – Procedures Covered at 60%**
|Amalgam Restorations (Fillings)|
|Resin Restorations (Fillings)|
|Crown & Bridge Repairs|
|Periodontal Scaling/Root Planing||1 per 24 months per quadrant|
|Periodontal Maintenance Therapy||4 per calendar year, including (1110)|
|Periodontal Surgery||Once per quadrant every (36) months|
|Simple Surgical Extractions|
|Oral Surgery||Some limits apply (see Certificate)|
|Endodontics/Root Canals||Once per tooth per 24 months|
|General Anesthesia||When dentally necessary or in connection with complex surgery, max up to 2 hours|
|Consultations||1 per 12 months|
Major Restorative – Procedures Covered at 50%**
|Bridges||Replace once every 5 years|
|Dentures***||Replace once every 5 years|
|Adjustments to Dentures***|
|Denture Relining & Rebasing***|
|Crowns||1 per tooth every 5 years|
|Implants||Once every 5 years per tooth|
** Percentages of usual & customary fees
*** Relining or Rebasing of existing Removable Dentures will be a covered dental expense not more frequently than once every 36 months (covered only after a minimum of six months after the initial installation of the device.) NCRGEA members can find a participating dentist through the MetLife website at www.metlife.com.
Frequently Asked Questions
How does the NCRGEA Dental Plan work?
You and your dependents have complete freedom of choice to visit any dentist, in or out of the MetLife network, and still receive benefits. When you choose a participating dentist, you can maximize the value of the NCRGEA dental plan. Reimbursements for non-participating dentists are based on Percentages of Usual & Customary Fees.
Who is a participating dentist and how do I find one?
A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as a payment in full for services provided to plan members. Negotiated fees typically range from 15-45% below the average fees charged in a dentist’s community for the same or substantially similar services.4 There are thousands of general dentists and specialists to choose from nationwide – so you can find one who meets your needs. You can receive a list of these participating dentists online at www.metlife.com/dental or you can call 1-888-466-9073 to have a list faxed or mailed to you.
What if my dentist isn’t a MetLife participating dentist?
You can visit any dentist, in or out of the network, and still receive benefits under the NCRGEA dental plan. However, if you choose a non-participating dentist, your out-of-pocket cost may be higher. He/she has not agreed to accept the negotiated fees. You may be responsible for any difference in cost between the dentist’s fee and the NCRGEA dental plan’s benefit payment.
How do I file a claim?
Your dentist will usually file your claims for you. If you need a claim form, you can download one at www.metlife.com/dental or call MetLife at 1-888-466-9073. After each claim submission, unless charges are covered in full, you will receive a concise explanation of benefits (EOB) statement.
Should I find out how much services will cost and obtain an estimate of what the plan will cover prior to treatment?
Yes, have your dentist submit a pretreatment estimate to MetLife if the cost is expected to exceed $300. Your dentist should submit a request at www.metdental.com or call 1-877-MET-DDS9; he/she needs to provide the proposed treatment plans, supporting documents (including applicable x-rays) and estimated charges to MetLife. An Explanation of Benefits (EOB) will be sent to you detailing an estimate of what services will be covered and at what payment level.
What should I do if I am currently receiving Periodontal Maintenance Therapy and want to enroll in the NCRGEA dental plan?
Your dentist should submit a request online at www.metdental.com or call 1-877-MET-DDS9; he/ she needs to provide information on these periodontal treatments, such as prior dates of service and supporting documents.
Is it necessary to have my premiums and NCRGEA dues deducted from my retirement check?
Yes, premiums and NCRGEA dues must be deducted from your retirement check.
When will I have access to MetLife’s MyBenefits website?
Once you enroll in the NCRGEA dental plan, you can access your secure online service website, at www.metlife.com/mybenefits and enter NCRGEA’s name. You can download a claim form, find a participating dentist, see plan information and more. You can also stay up-to-date with your claims – receive immediate notification your claim has been processed and other important information!
Questions about NCRGEA membership dues deductions or NCRGEA dental plan premium deductions?
Call NCRGEA at 1-800-356-1190, Monday – Friday, 8 AM until 5 PM ET. If your dues have been paid for the current year, no deduction will be made for dues until the month prior to your renewal date. For other questions about the NCRGEA dental plan, call MetLife at 1-888-466-9073, Monday – Friday, 8 AM until 11 PM ET.
NCRGEA sponsors this plan strictly as a benefit to our members, so we will be happy to discuss the plan with you. If you would like additional information, please call NCRGEA at 1-800-356-1190.