MetLife Dental Copay Plan
The MetLife Dental Copay Plan is a dental plan in which you make a copay based on a fee schedule, called the Procedure Charge Schedule. The Procedure Charge Schedule is based on the ZIP code where your dentist’s office is located. Each time you need care, you can visit any licensed dentist you choose. However, if you visit a preferred network provider, you save money since providers in the network charge lower negotiated rates. If you visit an out-of-network provider you must meet an annual deductible, you pay a higher copay and your annual maximum benefit is reduced. You can can compare Metlife Dental Copay Plan benefits to the other dental plan to determine if it will meet your dental needs.
Your cost for the plan depends on the coverage you select. Enrolling in the plan is limited to certain times or events during your employment.
Select benefit design features are provided below, including the approximate copy percentage you may be asked to pay at the time dental services are rendered. The full details of the benefit are available in the Dental Summary Plan Description.
| In-network | Out-of-network | |
| Choice of Dentist | Network providers only | Any licensed provider |
| Deductible | None | $75 per covered individual (waived for Orthodontia) $225 per family (waived for orthodontia) |
| Annual Maximum Benefit | $5,000 per person | $1,000 per person |
| Preventive Care | You make a copayment (approximately 10% of the cost), then Plan pays the remainder (up to the annual maximum) – up to 2 visits per year separated by 6 months | You pay 30%; Plan pays 70% (up to the annual maximum); you pay any amount over the reasonable and customary charges – up to two visits per year separated by 6 months |
| Basic Care (e.g. fillings) | You make a copayment (approximately 30% of the cost), then Plan pays the remainder (up to the annual maximum) | You pay 60%; Plan pays 40% (up to the annual maximum); you pay any amount over the reasonable and customary charges |
| Major Care (e.g. crowns) |
You make a copayment (approximately 60% of the cost), then Plan pays the remainder (up to the annual maximum)
after deductible |
You pay 70%; Plan pays 30% (up to the annual maximum); you pay any amount over the reasonable and customary charges |
| Orthodontia (e.g. braces) | You pay 60%; Plan pays 40% (up to the lifetime maximum of $1,500) | You pay 60%; Plan pays 40% (up to the lifetime maximum of $500); you pay any amount over the reasonable and customary charges |
| Claim forms | None | You file your own claims |
| Negotiated fees | Yes | No |