Dental Care Plans

Overview

The dollar or percentage amounts in the chart below reflect the patient-paid portion of the incurred dental costs.

Plan Provision

Basic Option PPO1

DMO2

High Option PPO1 

In-Network or Out-of-Network In-Network Only

In Network

Out of Network3

Preventive/Diagnostic Services4

  • Examinations/Visits

  • X-rays

  • Prophylaxis, cleanings

  • Fluoride treatments

Reimbursement is based on 100% of the in-network charge.

$0

 

 

$0

$0

Basic Services

  • Amalgam (silver) fillings

  • Root canal therapy, anterior teeth

  • Composite fillings, anterior teeth only

  • Stainless steel crowns

  • Uncomplicated extractions

Reimbursement is calculated based on 50% of the in - network charge.

$0

 

20%

30%

Major Services5

  • High noble metal and porcelain Inlays

  • High noble metal restorations

  • Crowns

  • Root canal therapy, molar teeth6

  • Implants7

Not covered 

May receive up to 35% discount from in-network provider.

40%

 

 

40%

50%

Orthodontia5

Not covered

May receive up to 35% discount from in-network provider.
 

50% 

No lifetime maximum


Covers children and adults

50% 

Lifetime maximum benefit of $2,000
 
Covers children and adults

 

50%
 
Lifetime maximum benefit of $1,500

Covers children and adults

Annual Deductible
(Individual/Family)

$50/$150

(out-of network only)

None

$50 / $150 

for basic and major services

$50 / $150 

for basic and major services

Calendar Year Maximum

$2,000 for
basic and preventive

None

$2,000 for basic, major, and preventive

$1,500 for
basic, major, and preventive

Basis of Reimbursement

Maximum allowable charge

Negotiated fee

Negotiated fee

80th percentile of reasonable and customary
(R & C)

 

1 If you elect a plan with MetLife, you must remain in that plan for two years, unless you experience a qualifying status event. 

2 Election of the Aetna DMO plan requires the completion of an additional vendor enrollment form. Please click here for a copy of the enrollment form. You may use in-Network DMO providers only.

3 Reimbursement is based on reasonable and customary charges so you may be balance billed.

4 Visit limitations may apply. Consult the Certificates of Coverage on our website for more details.

5 If you began treatment under the MetLife Basic Option PPO Plan for major or orthodontic services and are considering moving to the Aetna DMO Plan, these services will not be covered by Aetna. The lifetime maximum includes amounts paid through all other plans.

6 Included in the basic services category for MetLife Basic and High Option Dental Plans.

7 The Aetna DMO coverage for implants is limited to two paid occurrences per year. Coverage is limited to an endosteal implant, prefabricated abutment, and implant maintenance procedures. Other rules may apply. The MetLife High Option PPO also has limitations on coverage for implants. Request a predetermination of benefits from Aetna or MetLife prior to services being rendered.

You can count on support from knowledgeable and responsive HR staff when you have a benefits question or problem. Just call or e-mail us. We’re here to help!

While the University intends to continue each of the benefit plans, the University reserves the right to terminate or amend any plan, at any time, and for any reason.