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Dental-800

DENTAL

The following is a summary of your dental benefits. For a more detailed explanation of benefits, please refer to your Summary Plan Description (SPD), certificate of coverage or benefit summary. You may access a list of participating providers through Metlife’s website.

Members will not receive an ID card in the mail for their dental benefits. In order to use your benefits, give your dentist the CMSD group number that is shown below. If you prefer to have a physical ID card, you can login to MyBenefits, and print the card, or show the electronic version on your phone.

Group Number: 105465

Dental-Circle-01
Dental-800

DENTAL

The following is a summary of your dental benefits. For a more detailed explanation of benefits, please refer to your Summary Plan Description (SPD), certificate of coverage or benefit summary. You may access a list of participating providers through Metlife’s website.

Members will not receive an ID card in the mail for their dental benefits. In order to use your benefits, give your dentist the CMSD group number that is shown below. If you prefer to have a physical ID card, you can login to MyBenefits, and print the card, or show the electronic version on your phone.

Group Number: 105465

Which Plan Fits? Thinking it through

  • Do you visit a dentist for regular cleanings and maintenance?
  • What kind of dental expenses will you have next year?
  • Do you expect to have certain dental procedures performed?
  • Do you have dependents who will require orthodontia services?
  • Does your dentist participate in the network?
1-800-942-0854
www.metlife.com/mybenefits

RESOURCES

Click to view documents below.

Dental Plan Summary
Dental PPO FAQ
Dental Mobile App

Basic Plan

  In-Network  Out-of-Network
Type I—Preventive Services: Oral examinations & cleanings
– 2 per plan year Topical fluoride applications (under 14)
Bitewing x rays (1 per year)
Full mouth x rays (1 every 60 months)
Space maintainers for children under age 14		 100% of *PDP 100% of **R&C
Type II—Basic Services:
Fillings, simple extractions, endodontics,
oral surgery, periodontics, general anesthesia & consultants		 80% of *PDP 80% of ** R&C
Type III—Major Services:
Bridges, dentures, inlays, onlays, crown & prosthetics
(once every 5 years), crown build-ups, veneers, harmful habit appliance, crown, denture & bridge repair, implants on
enhanced plan only		 20% of *PDP 20% of **R&C
Type IV—Orthodontics Up to age 19 20% of *PDP 20% of **R&C
Deductibles
Individual $25 $25
Family $50 $50
Maximum Benefit Limits
Annual Limit – Basic and Major Services $1,500 $1,500
Lifetime Limit – Orthodontics $1,500 $1,500

*PDP refers to the negotiated fees that Preferred Dentist Program (PDP) dentists have agreed to accept as payment.
**R&C refers to Reasonable & Customary charge based on the lesser: (1) the dentist’s actual charge for the same or similar services or (2) the usual charge of most dentists in the same geographical area for the same or similar service as determined by MetLife.

Enhanced Plan

  In-Network  Out-of-Network
Type I—Preventive Services: Oral examinations & cleanings
– 2 per plan year Topical fluoride applications (under 14)
Bitewing x rays (1 per year)
Full mouth x rays (1 every 60 months)
Space maintainers for children under age 14		 100% of *PDP 100% of **R&C
Type II—Basic Services:
Fillings, simple extractions, endodontics,
oral surgery, periodontics, general anesthesia & consultants		 80% of *PDP 80% of **R&C
Type III—Major Services:
Bridges, dentures, inlays, onlays, crown & prosthetics
(once every 5 years), crown build-ups, veneers, harmful habit appliance, crown, denture & bridge repair, implants on
enhanced plan only		 80% of *PDP 80% of **R&C
Type IV—Orthodontics Up to age 19 80% of *PDP 80% of **R&C
Deductibles
Individual $25 $25
Family $50 $50
Maximum Benefit Limits
Annual Limit – Basic and Major Services $2,500 $2,500
Lifetime Limit – Orthodontics $2,500 $2,500

*PDP refers to the negotiated fees that Preferred Dentist Program (PDP) dentists have agreed to accept as payment.
**R&C refers to Reasonable & Customary charge based on the lesser: (1) the dentist’s actual charge for the same or similar services or (2) the usual charge of most dentists in the same geographical area for the same or similar service as determined by MetLife.