CORENROLL - Enrollment System - Brokers - Members - Billing

Preventive oral care not only provides benefits for your overall health, it also helps avoid unexpected expenses like oral surgery. Our large network and flexible coverage options help keep your out-of-pocket costs down.

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	MetLife Dental Platinum		MetLife Dental Gold		MetLife Dental Silver
Network
Enrollment Deadline	18th of month Prior to Effective date		18th of month Prior to Effective date		18th of month Prior to Effective date
Network	PDP Plus		PDP Plus		PDP Plus
Provider Search	Click here		Click here		Click here
States Not Available
AK, ID, LA, ME, MD, MT, NH, NM, OR, SD, WA
Coverage Type*	In-Network	Out-of- Network	In-Network	Out-of- Network	In-Network	Out-of- Network
Type A – Preventive	100% of Negotiated Fee*	100% of Negotiated Fee*	100% of Negotiated Fee*	100% of Negotiated Fee*	100% of Negotiated Fee*	100% of Negotiated Fee*
Type B – Basic	80% of Negotiated Fee*	80% of Negotiated Fee*	70% of Negotiated Fee*	70% of Negotiated Fee*	50% of Negotiated Fee*	50% of Negotiated Fee*
Type C – Major	50% of Negotiated Fee*	50% of Negotiated Fee*	40% of Negotiated Fee*	40% of Negotiated Fee*	Not Covered	Not Covered
Type D – Orthodontia	50% of Negotiated Fee*	50% of Negotiated Fee*	Not Covered	Not Covered	Not Covered	Not Covered
Deductible**
Individual	$25**	$25**	$50**	$50**	$50**	$50**
Family	$75**	$75**	$150**	$150**	$150**	$150**
Annual Maximum Benefit
Per Person	$3,000 (Annual Combined)		$1,500 (Annual Combined)		$1,000 (Annual Combined)
Orthodontia Lifetime Maximum
Per Person	$2,000 (Annual Combined)		Not Covered		Not Covered

List of Primary Covered Services & Limitations				How Many/How Often – All Plans
Type A - Preventive
Oral Examinations				One time in 6 months.
Prophylaxis (cleanings)				One time in 6 months.
Sealants				One application of sealant material every 3 years for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to 19th birthday.
Space Maintainers				One in 3 years for dependent children up to 14th birthday .
Topical Fluoride Applications				Two times in 12 months for a dependent child under age 19.
X-rays				Full mouth X-rays: one per 5 calendar years. Bitewing X-rays: one set per calendar year for adults and one set per calendar year for dependent children under age 19.
Type B - Basic Restorative
Amalgam Fillings				One replacement per surface in 24 months
Resin Composite Fillings (excludes coverage for composite fillings on molars)				Unlimited.
Examinations-Problem Focused				Combined with Examinations Limit.
Periodontics				Periodontal scaling and root planing once per quadrant, every 24 months. Total number of periodontal maintenance treatments and prophylaxis cannot exceed four treatments in 12 months. Non-Surgical procedures
Endodontics				Pulpotomy, Pulp Capping, Pulp Therapy
Oral Surgery				Simple and Surgical Extractions.
Prefabricated Crowns				One per tooth in 10 calendar years.
Type C - Major Restorative
Periodontics				Periodontal Surgery: one per quadrant in any 36 month period.
Full Mouth Debridement				One per lifetime
Endodontics				Root Canal treatment limited to one per tooth per lifetime.
Crown Buildups/Post Core				One per tooth in 10 calendar years.
Crowns/Inlays/Onlays				Replacement: one every 10 calendar years per tooth.
Dentures				Rebases/Relines: one in 36 months. Adjustments: one in 12 months. Repairs: one in 12 months. Recementations: one in 12 months.
Bridges and Dentures				Dentures and bridgework replacement: one every 10 calendar years. Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed.
Tissue Conditioning				One in 36 months.
Implants				Replacement: one per tooth position every 10 calendar years. Repairs: one per tooth in 12 months. Supported Prosthetic: one per tooth every 10 calendar years.
Occlusal Adjustments				One in 12 months.
Consultations				Two in 12 months.
General Anesthesia				When dentally necessary in connection with oral surgery, extractions or other covered dental services.
Type D - Orthodontia (Platinum Plan only)				Your Children, up to age 19, are covered while Dental Insurance is in effect. All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia. Payments are on a repetitive basis. 20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the Plan Summary. Orthodontic benefits end at cancellation of coverage.
Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. * Applies only to Type B & C Services.

This hypothetical example** shows how receiving services from a participating dentist can help save you money.

Your Dentist says you need a Crown, a Type C service

IN-NETWORK-Platinum Plan When you receive care from a participating dentist		OUT-OF-NETWORK-Platinum Plan When you receive care from a non-participating dentist
In this example, you save $792.00 ($1,127 minus $335.00)… by using a participating dentist.
Dentist’s Usual Fee is:	$1,462.00	Dentist’s Usual Fee is:	$1,462.00
The Negotiated Fee is:	$670.00	The Negotiated Fee is:	$670.00
Your Plan Pays:		Your Plan Pays:
50% X $670 Negotiated Fee:	- $335.00	50% X $670 Negotiated Fee:	- $335.00
Your Out-of-Pocket Cost:	$335.00	Your Out-of-Pocket Cost:	$1,127.00

IN-NETWORK-Gold Plan When you receive care from a participating dentist		OUT-OF-NETWORK-Gold Plan When you receive care from a non-participating dentist
In this example, you save $792.00 ($1,194.00 minus $402.00)… by using a participating dentist.
Dentist’s Usual Fee is:	$1,462.00	Dentist’s Usual Fee is:	$1,462.00
The Negotiated Fee is:	$670.00	The Negotiated Fee is:	$670.00
Your Plan Pays:		Your Plan Pays:
50% X $670 Negotiated Fee:	- $268.00	50% X $670 Negotiated Fee:	- $268.00
Your Out-of-Pocket Cost:	$402.00	Your Out-of-Pocket Cost:	$1,194.00

IN-NETWORK-Silver Plan When you receive care from a participating dentist		OUT-OF-NETWORK-Silver Plan When you receive care from a non-participating dentist
In this example, you save $792.00 ($1,462.00 minus $670.00)… by using a participating dentist.
Dentist’s Usual Fee is:	$1,462.00	Dentist’s Usual Fee is:	$1,462.00
The Negotiated Fee is:	$670.00	The Negotiated Fee is:	$670.00
Your Plan Pays:		Your Plan Pays:
50% X $670 Negotiated Fee:	$0.00	50% X $670 Negotiated Fee:	$0.00
Your Out-of-Pocket Cost:	$670.00	Your Out-of-Pocket Cost:	$1,462.00

Who is a participating dentist?
A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members. Negotiated fees typically range from 15%-45% below the average fees charged in a dentist’s community for the same or substantially similar services.*

*Based on internal analysis by MetLife. Negotiated Fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.

How do I find a participating dentist?
There are thousands of general dentists and specialists to choose from nationwide — so you are sure to find one who meets your needs. You can receive a list of these participating dentists online at www.metlife.com/mybenefits or by calling 1-855-700-7993 (Option 1) to have a list faxed or mailed to you on or after your effective date.

What services are covered by my plan?
All services defined under your group dental benefits plan are covered.

May I choose a non-participating dentist?
Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. He or she hasn’t agreed to accept negotiated fees. So you may be responsible for any difference in cost between the dentist's fee and your plan's benefit payment.

Can my dentist apply for participation in the network?
Yes. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use by dental professionals only.

* Due to contractual requirements, MetLife is prevented from soliciting certain providers.

How are claims processed?
Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-855-700-7993 (Option 1) on or after your effective date.

Can I find out what my out-of-pocket expenses will be before receiving a service?
Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums,
deductibles, frequency limits and other conditions at time of payment.

Can MetLife help me find a dentist outside of the U.S. if I am traveling?
Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits. Please remember to hold on to all receipts to submit a dental claim.

*Travel Assistance services are administered by AXA Assistance USA, Inc. Certain benefits provided under the Travel Assistance
program are underwritten by Virginia Surety Company, Inc. AXA Assistance and Virginia Surety are not affiliated with MetLife, and the
services and benefits they provide are separate and apart from the insurance provided by MetLife.

**Refer to your dental benefits plan summary for your out-of-network dental coverage.

How does MetLife coordinate benefits with other insurance plans?
Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law.

Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature.
Services for which a covered person would not be required to pay in the absence of dental insurance.
Services or supplies received by a covered person before the insurance starts for that person.
Services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for scaling or polishing of teeth or fluoride treatment.
Services which are primarily cosmetic. (For residents of Texas: Services which are primarily cosmetic unless required for the treatment or correction of a congenital defect of a newborn child).
Services or appliances which restore or alter occlusion or vertical dimension.
Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease.
Restorations or appliances used for the purpose of periodontal splinting.
Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco.
Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss.
Initial installation of a Denture to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
Decoration or inscription of any tooth, device, appliance, crown or other dental work.
Missed appointments.
Services covered under any workers’ compensation or occupational disease law.
Services covered under any employer liability law.
Services for which the employer of the person receiving such services is not required to pay.
Services received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital.
Services covered under other coverage provided by the Policyholder.
Temporary or provisional restorations.
Temporary or provisional appliances.
Prescription drugs.
Services for which the submitted documentation indicates a poor prognosis.
Services, to the extent such services, or benefits for such services, are available under a government plan. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first.
The following when charged by the dentist on a separate basis - Claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non intravenous conscious sedation or analgesia such as nitrous oxide.
Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing and biting of food.
Caries susceptibility tests.
Precision attachments associated with fixed and removable prostheses.
Adjustment of a denture made within 6 months after installation by the same dentist who installed it.
Duplicate prosthetic devices or appliances.
Replacement of a lost or stolen appliance, cast restoration or denture.
Intra and extraoral photographic images.
Fixed and removable appliances for correction of harmful habits.
Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards.
Treatment of temporomandibular joint disorder. This exclusion does not apply to residents of Minnesota.

Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Procedure charge schedules are subject to change each plan year. You can obtain an updated procedure charge schedule for your area via fax by calling 1-855-700-7993 (Option 1) and using the MetLife Dental Automated Information Service. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.

Cancellation/Termination of Benefits: Coverage is provided under a group insurance policy (Policy form GPNP99 TRUST (7/10)) issued by MetLife. Coverage terminates when your membership ceases, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 90 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms
for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.

MetLife Dental PDP Plus

Preventive oral care not only provides benefits for your overall health, it also helps avoid unexpected expenses like oral surgery. Our large network and flexible coverage options help keep your out-of-pocket costs down.