Dental Care Plans

Overview

Plan Provision
MetLife Basic Option PPO Dental Plan3 Pays....
Aetna DMO Plan1 Pays...
MetLife High Option PPO Dental Plan Pays3...
In Network
Out of Network
Preventive/Diagnostic Services
  • Examinations/Visits
  • X-rays
  • Prophylaxis, cleanings
  • Fluoride treatments
You may use in– or out–of–network providers.
 
Reimbursement is based on 100% of the in-network charge.
100%
 
You may use in-network DMO providers only
100%
100%
Basic Services
  • Amalgam (silver) fillings
  • Root canal therapy, anterior teeth
  • Composite fillings, anterior teeth only
  • Stainless steel crowns
  • Uncomplicated extractions
You may use in- or out-of-network providers.
 
Reimbursement is calculated based on 50% of the in - network charge.
100%
 
You may use in–network DMO providers only.
80%
70%
Major Services
  • High noble metal and porcelain Inlays
  • High noble metal restorations
  • Crowns
  • Root canal therapy, molar teeth2
  • Implants4
Out-of-network providers are not covered.
 
You will receive up to a 35% discount off average charges from a participating provider.
60%
 
You may use in- network DMO providers only.

 
60%
50%
Orthodontia
Out-of-network providers are not covered.
 
You will receive up to a 35% discount off average charges from a participating provider.
 
Covers children and adults
50%
 
No lifetime maximum

You may use in- network DMO providers only.

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
In-network: None

Out-of-network:
$50 single
$150 family
None
$50 single
 
$150 family for basic and major services
$50 single
 
$150 family for basic & 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 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.
 
2 Included in the basic services category for MetLife Basic and High Option Dental Plan
 
3 Please search under the PDP Plus network when searching for participating providers
 
4 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.