How The MetLife PPO Dental Plan Works

How It Works

The MetLife Dental PPO Plan is a dental preferred provider organization (PPO). Each time you need care, you can visit any licensed dentist you choose. However, if you visit a preferred provider, you save money since providers in the network charge negotiated rates. After you meet your annual deductible, the plan covers a percentage of the cost of your necessary care, up to the maximum annual benefit.

For a listing of network providers, visit the MetLife website at: www.metlife.com/mybenefits. Provider information can also be obtained on our website at http://hr.uchicago.edu. A provider list may be obtained, without charge, through the website or by contacting MetLife directly.

The table below shows the deductible, coinsurance and maximum annual benefits. For a current list, visit our web site at: http://hr.uchicago.edu or contact the Benefits Office.

MetLife Dental PPO Plan
	In-network	Out-of-network
Choice of Dentist	Network providers only	Any licensed provider
Deductible	$60 per person. Does not apply to preventive care or orthodontia
Annual Maximum Benefit	Per covered individual: $1,500 Per Family: $3,000
Preventive Care	Plan pays 100% with no deductible	Plan pays 100% of reasonable and customary charges with no deductible
Basic Care (e.g. fillings)	Plan pays 80% after deductible	Plan pays 80% of reasonable and customary charges after deductible
Major Care (e.g. crowns)	Plan pays 50% after deductible	Plan pays 50% of reasonable and customary charges after deductible
Orthodontia (e.g. braces)	Plan pays 50% with no deductible up to a lifetime maximum of $1,000	Plan pays 50% of reasonable and customary charges with no deductible up to a lifetime maximum of $1,000
Claim forms	None	You file your own claims

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.