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Plan Summaries
Dental Plan Summaries for Metropolitan Life and Delta Dental are provided below. Employees and retirees can choose between these two plans. Under these are links to Adobe PDF files covering the dental and vision plan offered by United HealthCare to retiress over 65 years of age.
Metropolital Life and Delta Dental Plans
Click on a link below to reveal summary information on the Metropolitan Life or Delta Dental plans. Click again to close. To view information on both of these plans, click here. To print this page, first click the link to one or both plans; then use your browser print command (File/Print or Control-P).
| Services Covered | Amount of Coverage |
|---|---|
| Calendar Year Maximum | $1500 |
| Lifetime Orthodontic Maximum | $1500 |
| Lifetime Maximum | $20,000 |
| Annual Deductible per member (applies to basic and major services) | $50 |
| Diagnostic and Preventive Services | 100% |
| Oral Examinations | Once every 6 months |
| Prophylaxis (cleanings) | Once every 6 months |
| X-Rays | |
|
Full mouth Bite-wing |
Once every 24 months One set every 6 months |
| Fluoride | Under age 19 |
| Space Maintainers | No age limit |
| Basic Services [restorative (fillings), general anesthesia, occlusal guards, extractions and oral surgery, periodontics, endontics (root canal therapy)] |
80% |
| Sealants | N/A |
| Major Services | 50% |
| Crowns | No age limit |
| Bridges | No age limit |
| Partial Dentures/Full Dentures | No age limit |
| Orthodontics | Per fee schedule for dependents to age 24 |
| Reimbursements | Freedom to choose any provider; benefits are the same, regardless of the provider you see. MetLife has no required network, but if you use a network provider, you will not be balance billed. (Note: Hourly employees may use any network provider, but they may be balance billed.)
Charges are based on the reasonable and customary charges of all providers within a 3-digit zip code for each procedure, and Met's negotiated rate. |
Note: Every attempt has been made to ensure the accuracy of this summary. However, its contents are not legally binding nor should it be considered as a substitute for the actual contract language, company policies, or Your Book of Benefits.
| Services Covered | Amount of Coverage |
|---|---|
| Calendar Year Maximum | $1500 |
| Lifetime Orthodontic Maximum | $1500 |
| Lifetime Maximum | N/A |
| Annual Deductible per member (applies to basic and major services) | $50 |
| Diagnostic and Preventive Services | 100% |
| Oral Examinations | Two in a 12-month period |
| Prophylaxis (cleanings) | Two in a 12-month period |
| X-Rays | |
|
Full mouth Bite-wing |
Once every 3 years Two sets every 12 months |
| Fluoride | Under age 19 |
| Space Maintainers | Under age 15 |
| Basic Services [restorative (fillings), general anesthesia, occlusal guards, extractions and oral surgery, periodontics, endontics (root canal therapy)] |
80% |
| Sealants | Under age 16, one benefit per tooth. Chewing surfaces for permanent first and second molars only. |
| Major Services | 50% |
| Crowns | Porcelain, gold or veneer crowns for children under age 12 are not a benefit |
| Bridges | Fixed bridges or cast partials for children under the age of 16 are not a benefit |
| Partial Dentures/Full Dentures | |
| Orthodontics | 50% for dependents to age 24 |
| Reimbursements | Freedom to choose either a participating dentist or, for a higher cost, a non-network dentist. In-network charges are paid based on Delta Dental's maximum fee schedule, which providers agree to accept, with no balance billing.
Out-of-network providers are generally reimbursed at the 51st percentile of Delta Dental's prevailing fee schedule as submitted by all providers (based on an overall scale of 100, the maximum payment is paid at or below the 51st percentile). |
Note: Every attempt has been made to ensure the accuracy of this summary. However, its contents are not legally binding nor should it be considered as a substitute for the actual contract language, company policies, or Your Book of Benefits.
United HealthCare Retirees Over 65 Dental/Vision Plan
Options PPO/covered dental services — Dental Plan P3742 (.pdf)
Vision Benefit Communication (.pdf)