The Dental Plan is
administered through Metropolitan Life Insurance Company, generally known as MetLife. The Plan offers
three coverage choices: Option 1, Option 2, and Option 3. The three Dental Plan options have differing
features. If you are eligible, you may select the option most suited to your needs.
| Option |
Advantages |
Consider
This |
| Option
1 |
The
University pays the full cost of this Option beginning
on the first anniversary of your service date.
This
Option covers basic services (cleaning, oral exam,
and bite-wing x-rays) twice in a calendar year at
100% of usual and customary fees.
|
If
you expect to have primarily preventive dental work
during the next year, this Option would be a good choice
for you.
Option 1 is intended as a plan that
promotes good dental health by providing full coverage
for preventive care at an affordable cost.
Restorative,
major and orthodontic services are reimbursed according
to a very limited fee schedule.
|
|
Option 2 |
This
Option offers two levels of coverage depending on
whether you receive services from an In-Network or
Out-of-Network provider. |
You
and the University share the cost of this Option, but
your cost is less than for Option 3.
Each time you have dental services performed, you
can choose an In-Network or Out-of-Network dentist. |
| Option
2
In-Network |
There
are no claim forms to fill out.
You receive a higher level of reimbursement for dental
services when you use a dentist participating in MetLife's
Preferred Dentist Program (PDP).
Network Dentists must go through MetLife's credentialing
process. |
Services
are reimbursed according to an amount agreed upon between
MetLife and the provider.
There are a limited number of some specialty practitioners,
such as endodontics, participating in the PDP program.
Depending on the specialty care you need, you may need
to see an Out-of-Network dentist. |
| Option
2
Out-of-Network |
You
can also have services performed by a dentist who is
not in the Network. |
You
will have to pay a larger portion of the bill when you
see an Out-of-Network dentist. Services are reimbursed
according to usual and customary fee allowances, but
you are responsible for any amounts your dentist may
charge in excess of usual and customary fee allowance. |
| Option
3 |
Select
any dentist you choose.
You receive a high level of reimbursement based on usual
and customary charges. |
You
and the University share the cost of this Option. Your
cost is highest for Option 3.
This is a good choice if you expect to have a lot of
dental work done, especially specialty work, and your
dentist is not in the Option 2 Network. As with Option
2 Out-of-Network services, you are responsible for any
amounts your dentist may charge in excess of usual and
customary fee allowance. |
About the
Providers in Option 2
Option 2 is a preferred provider organization (PPO). This means that you should
choose a dentist who is a member of the MetLife dental network to realize the
maximum benefits from the plan. The dentist you choose can join or separate from
the network at any time. Before you enroll, check with your dentist to see if
he or she is a plan provider, or call 1-800-474-7371 to obtain a list of current
providers in your preferred zip code. You can also obtain a list from the MetLife
Web site http://www.metlife.com/Dental/Find/find.html
If your current dentist did not join the MetLife provider network, you will have
to choose another dentist for in-network services. Since you must remain in the
plan for a full year, we urge you to check the provider list or call your dentist
to see if he or she joined the MetLife network before you enroll.
If
You Do Not Live in the Southeast Michigan Coverage Area
You can benefit from all the options. Dentists for Options 1 and 3 are not limited
to the provider network, so you can choose a dentist in any location. But, you
can also choose Option 2 because the MetLife PDP network covers the entire United
States.
You Should Know
Participation cannot be split between plans. For example, if you participate in
Option 1 (or 2 or 3), then all covered dependents must participate in the same plan. If
you and your spouse or other qualified adult are both employed by the University,
you each can select a different option, and you my add your dependent children to one
or the other option, but not to both.
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