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Healthier savings for healthier smilesFrequently asked questions about MetLife Dental for State of Oklahoma employees

Dental Insurance

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Contents

Enrollment 3

Plan Design 4

Open Season & New Hires 5

Network/Dental 5

Rates and Plan Options 6

Frequency and Allocations 8

Exclusions 11

Plan Information 3

MetLife Dental for State of Oklahoma | Frequently Asked Questions 3

EnrollmentWho can enroll in the plan?You and your eligible family members. For example, your spouse and dependents.

When can I enroll?You can enroll during your open enrollment period.

How do I enroll?You may enroll in the MetLife Dental Plan by mail:• Contact your Benefits Coordinator to receive

the enrollment form.

• Then complete the requested information and send to the address provided.

Plan InformationHow do the MetLife Dental Plans work?With the MetLife Classic, MAC or PDP Dental Plans, you receive a wide range of benefits whether or not you and/or each eligible dependent visit an in-network dentist, plus referrals are not necessary for specialty care. But, when you visit an in-network dentist, you have the opportunity to make the most of your benefit plan because your out-of-pocket expenses may be lower.

Once you enroll in the MetLife Classic, PDP or Value Dental Plan, you and your eligible dependents must remain in the plan for a period of 12 months. The rates quoted at the time of enrollment are valid until the end of the calendar year.

Is my Employee ID required to receive Dental services?No. MetLife does not require your Employee ID to submit claim payments, use the MetLife call center or access the MetLife website. When seeing your dentist, present your ID card which has your MetLife unique ID number. MetLife does not require your SSN from your dentist to prove eligibility or to submit claims. The dentist may request your Employee ID for their own administrative recordkeeping.

Do my dependents have to visit the same dentist that I select?No. You and your dependents each have the freedom to choose any dentist, in or out-of-network, at any time.

What services are covered by the MetLife Dental Plans?The services covered by the MetLife Dental Plans are those defined under your group dental benefits described in the FAQ “Rates and Plan Options” and “Frequency, Allocations and Exclusions” sections for details concerning coverage, exclusions, limitations and waiting periods.

What is the MetLife Dental Health Manager?An online, easy to use, interactive program designed to help you understand your risk for oral disease and your current dental health status, with the goal of helping you improve your oral health. The MetLife Dental Health Manager is a proprietary program consisting of two primary components. The first is a report card that illustrates your risk and disease score — utilizing an interactive oral health risk assessment and data analysis derived from dental utilization (claim) data as well as systemic disease data — to help you understand and track changes in your dental risk and disease over time. The second component is the online MetLife Oral Health Library, which contains oral health educational articles and tools, designed to help you take a more active role in managing your oral health. The Library can also help you to ask informed questions about your benefits, dental care and risk for dental disease, and offers relevant information specific to your oral health needs.

MetLife Dental participants can access this online tool via the MyBenefits website. Just complete the Oral Health Risk Assessment questionnaire (OHRA) to get access to education that is relevant to you and receive an action plan that may help you make more informed oral health decisions.

How do I review my personal claim information?Please access/register for the MyBenefits site (metlife.com/oklahoma) from the home page. MyBenefits allows you to manage your benefits more easily. You may view your claims and personal information.

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What is the effective date of my coverage?• If you enrolled during Open Season your coverage will begin on January 1.

• If you are a new hire, you can enroll 60 days after you become eligible. Your enrollment will be effective the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment.

If I elect to stop receiving paper Explanation of Benefits (EOB) Statements at my home, how do I view my EOB Statements? And can I still print them?Once you turn off your paper Explanation of Benefits (EOB) Statements, you will receive email alerts to notify you when a Dental claim is processed. You can view and print your Dental EOB Statements from MyBenefits. Your Dental EOB Statement history will remain online for a minimum of two years plus the current year.

How long will it take to process my Dental claim?Most claims flow through our system quickly and efficiently, with 99% being processed within 10 business days. If additional information is needed for a claim, it may take longer.

Who do I contact if I have any additional questions about dental coverage from MetLife?MetLife is committed to making sure you have all the information you need to make the right decision for you and your family. If you’d like to know more about the MetLife Dental Plan call us at 1-855-676-9443. Customer service representatives are available Monday through Friday, 8am EST to 11pm EST.

What plan options are available to me and my family?Our plans always include access to one of the largest dental network and big benefits — from a trusted brand with competitive premiums.

Select the dental plan that’s right for you and your family, based on your needs and budget:• Classic — Highest benefit levels ($5,000 annual maximum)

• Value MAC — Lowest premiums (less than $330/year)

• Value PDP — Flexibility to see any dentist

What are the rates?Please refer to the “Rates” section.

Plan DesignWhat services are covered by the MetLife Dental Plans?The services covered by the MetLife Dental Plans are those defined under your group dental benefits plan described in the FAQ “Rates and Plan Options” and “Frequency, Allocations and Exclusions” sections for details concerning coverage, exclusions, limitations and waiting periods.

What is an Explanation of Benefits (EOB) Statement?An Explanation of Benefits (EOB) Statement is a summary of your processed claim or pretreatment estimate, including services rendered, costs, and benefits paid.

What is MetLife Claim Review (MCR) and how does it work?MetLife Claim Review is a review of certain types of dental claims that is conducted by licensed Dentist Consultants. The Dentist Consultants review the clinical information. These Dentist Consultants review this material checking for dental necessity for certain procedures such as crowns, bridges, onlays, implants, periodontal treatments, as well as other services. We recommend that you get a pre-treatment estimate for the types of services listed above, so that both you and your dentist are aware of what benefits will be paid for the services.


Open Season & New HiresAre Orthodontia benefits available?Yes, we have Adult (employee and spouse) and child/children orthodontia coverage with the Classic and MAC Plans and child/children orthodontia coverage with the PDP Plan.

Do you cover crowns?Yes. Crowns are covered under the Classic and Value MAC Plans. Please review the FAQ “Rates and Plan Options” and “Frequency, Allocations and Exclusions” sections for details.

Do different procedures have different age limitations?Yes. There are certain procedures with different age limitations. Please refer to the FAQ “Rates and Plan Options” and “Frequency, Allocations and Exclusions” sections for details.

Are implants covered under the plan?Yes. Implant Services are a covered expense subject to plan guidelines. Please refer to the FAQ “Rates and Plan Options” and “Frequency, Allocations and Exclusions” sections for a complete listing of covered implant services and precertification provisions. Prior to having implant services done, we recommend you submit a pre-treatment estimate since an alternate benefit may apply.

Network/DentalWhat is an in-network dentist and how do I find one?An in-network dentist is a general dentist or specialist who participates in MetLife’s Preferred Dental Provider (PDP) Plus Network and has agreed to accept a negotiated fee for covered services rendered to eligible plan members. This negotiated fee1 is typically 30% to 45% below the average fee charged by dentists for the same services in a given geographical area. There are over 360,000 in-network dentist locations nationwide, including over 82,000 specialists.

To access a list of MetLife’s in-network dentists use the Find a Dentist function on www.metlife.com/oklahoma, or call 1-855-676-9443. These lists include name, address, specialties, languages spoken, telephone numbers, and maps/driving directions.

Continued participation of any specific provider cannot be guaranteed. Thus, you should make coverage decisions based on the plan benefits, not based on a specific provider. When you call for an appointment, please remember to verify that the selected provider is currently in the MetLife PDP Plus Network.

What if my dentist is not in MetLife’s network?We encourage you to consider using a MetLife in-network dentist to help maximize the value of your plan. Of course, you can visit any dentist and still receive some benefits under your plan although your out-of-pocket expenses may be higher. If your current dentist does not participate in MetLife’s PDP Plus Network and you’d like to encourage him or her to participate, tell your dentist to visit www.metdental.com, or call 1-877-MET-DDS9. Note that this website and phone number are specifically for dentists and not accessible to employees/annuitants.

What is the difference between in and out-of-network benefits?• An in-network dentist is a general dentist or specialist who participates in MetLife’s PDP Plus Network and has agreed to

accept a negotiated fee for services rendered to eligible plan members. This negotiated fee1 is typically 30% to 45% below the average fee charged by dentists for the same services in a given geographical area. There are over 360,000 in-network dentist locations nationwide, including over 82,000 specialists. To access a list of MetLife’s in-network dentists use the Find a Dentist function on www.metlife.com/oklahoma or call 1-855-676-9443. These lists include name, address, specialties, languages spoken, telephone numbers, and maps/driving directions.

Continued participation of any specific provider cannot be guaranteed. Thus, you should make coverage decisions based on the plan benefits, not based on a specific provider. When you call for an appointment, please remember to verify that the selected provider is currently in MetLife’s PDP Plus Network.

1. Negotiated Fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Occasionally, there may be a service for which the dentist’s fee is the same or less than the MetLife negotiated fee for that service.

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• An out-of network Provider is a dental provider who does not belong to the MetLife Network. Not all dental practices join a dental network. This may be due to their unique circumstances or a philosophical difference. However, remember you are always free to select a dentist of your choice. We encourage you to consider using a MetLife in-network dentist to help maximize the value of your plan. Of course, you can visit any dentist and still receive some benefits under your plan although your out-of-pocket expenses may be higher. If your current dentist does not participate in MetLife’s network and you’d like to encourage him or her to participate, tell your dentist to visit www.metdental.com, or call 1-877-MET-DDS9. Note that this website and phone number are specifically for dentists and not accessible to employees/annuitants.

What is a negotiated fee2?A negotiated fee refers to the maximum charge for a covered service that an in-network dentist may charge to MetLife Dental Plan participants. These fees are typically 30% to 45% below the average fee charged by a dentist for the same services in your area. Your plan may reimburse you for all or part of this fee. When you use an in-network dentist, you are responsible only for the difference between MetLife’s benefits payment amount and the negotiated fee for the services rendered.

Why aren’t there any in-network dentists in my area?Not all dental practices join a dental network. This may be due to their unique circumstances or a philosophical difference. However, remember you are always free to select a dentist of your choice.

• The MetLife provider network varies by area. MetLife cannot guarantee the availability of every type of specialist in all areas. If you require the services of a specialist, and one is not available in your area, please contact MetLife at 1-855-676-9443.

Rates and Plan OptionsMetLife Dental Plans for the State of Oklahoma employees include competitive monthly rates3, access to one of the largest dental networks and big benefits administered by a trusted brand. We offer three dental plan options, the Value MAC, Value PDP or the Classic Dental Plan. Select the one that’s right for you and your family, based on your needs and budget.

For example:• Have a family and want the most affordable plan offered to State of Oklahoma employees and educators?

— Select the MetLife Value MAC Plan, offering the lowest premiums (less than $330/year)

• Not anticipating lots of dental work, visit the dentist ~2x/year, and looking for an affordable plan? — Select the MetLife Value PDP Plan, offering the flexibility to see any dentist adult orthodontia of $2,000)

• Anticipate seeing more specialists or a bit more dental work, but want to minimize extra charges? — Select the MetLife Classic Plan, offering the highest benefit levels ($5,000 annual maximum and lifetime

Competitive Monthly Rates:3

MetLife Classic MetLife Value MAC MetLife Value PDP

Employee $36.98 $27.24 $29.48

Spouse* $36.98 $27.24 $29.48

1 Child* $31.68 $23.34 $25.24

2+ Children* $78.78 $58.02 $62.80

And, each plan also includes:• No cost for in-network cleanings,

x-rays and exams4

• No waiting periods

• Cost savings for other in-network services: — Basic Care (fillings, extractions, oral surgery): 85% covered — Major Care (dentures, bridge work, implants): 60% covered

2. Negotiated fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Occasionally, there may be a service for which the dentist’s fee is the same or less than the MetLife negotiated fee for that service.

3. Savings may vary based on numerous factors including premium cost, type and frequency of services provided, the cost of services rendered, and provider type (network or non-network).

4. Subject to frequency limitations.

* An employee cannot enroll a dependent unless the employee is also enrolled.


Plan Options Overview

MetLife Classic MetLife Value MAC MetLife Value PDP

In-Network Out of Network5 In-Network Out of Network5 In-Network Out of Network5

Reimbursement Negotiated Fee Schedule

R&C 70th Percentile

Negotiated Fee Schedule

Negotiated Fee Schedule — MAC

Negotiated Fee Schedule

R&C 70th Percentile

Diagnostic — Type Acleanings and oral examinations

100% covered

Routine Exams and Cleanings — 2 in 12 months

Fluoride — 2 in 12 months (up to age 16)

100% covered



100% covered



100% covered



100% covered



100% covered



Basic — Type B Extractions, Oral Surgery

85% covered

Root Canal — 1 per tooth per lifetime

85% covered


85% covered


70% covered


85% covered


70% covered


Major — Type Ccrowns, bridges, root canal treatment and dentures

60% covered

Dentures — 1 in 5 years

Fixed Bridges/Inlays/Onlays — I in 5 years

Implants — 1 per tooth in 5 years

60% covered




60% covered




50% covered




60% covered




50% covered




Orthodontia — Type Dcomprehensive orthodontic treatment, fixed appliance

60% covered

Offered for Adults (employee/spouse) and child/children

60% covered

Offered for Adults (employee/spouse) and child/children

60% covered

Offered for Adults (employee/spouse) and children

50% covered

Offered for Adults (employee/spouse) and children

60% covered

Offered for child/children

50% covered

Offered for child/children

Annual Deductible Per Person

$25/person, $75/ family

Applies to Basic and Major services











Annual Maximum Per Person

$5,000, applies to Preventive, Basic and Major services






Orthodontia Lifetime Maximum

$2,000 lifetime maximum, applies to Adult and Child




$2,000 lifetime maximum, applies to Child

$2,000 lifetime maximum, applies to Child

Implant Lifetime Maximum

$1,000 lifetime maximum






5. Out of Network benefits are payable for services rendered by a dentist who is not a participating provider. The 70th percentile Reasonable and Customary charge is based on the lowest of (1) the dentist’s actual charge (the ‘Actual Charge’), (2) the dentist’s usual charge for the same or similar services (the ‘Usual Charge’) or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the ‘Customary Charge’). Services must be necessary in terms of generally accepted dental standards.

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Frequency and Allocations MetLife Classic, Value MAC and Value PDP Plans available to all Active Full Time Employees (30 Hours)

Type A:

Benefits are payable immediately from the start date of an individual’s benefits MetLife Classic MetLife Value MAC MetLife Value PDP

Examinations 2 times in 12 months 2 times in 12 months 2 times in 12 months

Examinations — Problem Focused

Combined with Examinations Limit



Prophylaxis: Cleanings 2 times in 12 months 2 times in 12 months 2 times in 12 months

Sealants 1 per molar in 60 months for a child under age 16

1 per molar in 60 months for a child under age 16

1 per molar in 60 months for a child under age 16

Space Maintainers 1 per lifetime for a child under age 14

1 per lifetime for a child under age 14

1 per lifetime for a child under age 14

Fluoride 2 times in 1 calendar year for a dependent child under age 16

2 times in 1 calendar year for a dependent child under age 16

2 times in 1 calendar year for a dependent child under age 16

Full Mouth X-Rays Once in 3 calendar years Once in 3 calendar years Once in 3 calendar years

Bitewing X-Rays For a child under 19: 1 time in 12 months

For a child under 19: 1 time in 12 months

For a child under 19: 1 time in 12 months

Labs & Other Tests No limit No limit No limit

Periapical X-Rays No limit No limit No limit

Other X-Rays No limit No limit No limit


Type B:


Amalgam Fillings 1 replacement per surface in 24 Months

1 replacement per surface in 24 Months

1 replacement per surface in 24 Months

Root Canal 1 per tooth per lifetime 1 per tooth per lifetime 1 per tooth per lifetime

Periodontal Maintenance 2 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 2)

2 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 2)

2 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 2)

Periodontal Surgery 1 per quadrant in any 36 month period

1 per quadrant in any 36 month period


Scaling & Root Planing 1 per quadrant in any 24 month period



Emergency Palliative Treatment

No limit No limit No limit

Resin Composite Fillings (excludes coverage for composite fillings on molars)


Pulp Capping No limit No limit No limit

Pulp Therapy No limit No limit No limit

Periodontal Surgery — Soft & Connective Tissue Grafts


Periodontics — Non-Surgical


Oral Surgery: Simple Extractions


Oral Surgery: Surgical Extractions


Other Oral Surgery No limit No limit No limit

General Services No limit No limit No limit

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Type C:


Consultations 1 in 12 months 1 in 12 months 1 in 12 months

Prefabricated Crowns 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years

Crown Buildups / Post Core 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years

Repairs 1 in 12 months 1 in 12 months 1 in 12 months

Recementations 1 in 12 months 1 in 12 months 1 in 12 months

Dentures 1 in 5 calendar years 1 in 10 calendar years 1 in 5 calendar years

Dentures — Rebases / Relines 1 in 36 months 1 in 36 months 1 in 36 months

Denture Adjustments 1 in 12 months 1 in 12 months 1 in 12 months

Fixed Bridges 1 in 5 calendar years 1 in 10 calendar years 1 in 5 calendar years

Inlays / Onlays /Crowns 1 replacement per tooth in 5 calendar years

1 replacement per tooth in 10 calendar years

1 replacement per tooth in 5 calendar years

Implant Services 1 per tooth position in 5 calendar years

1 per tooth position in 10 calendar years

1 per tooth position in 5 calendar years

Implant Repairs 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years

Implant Supported Prosthetic 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years

Tissue Conditioning 1 in 36 months 1 in 36 months 1 in 36 months

Occlusal Adjustments 1 in 12 months 1 in 12 months 1 in 12 months

General Anesthesia No limit No limit No limit

Pulpotomy No limit No limit No limit

Apexification & Recalcification No limit No limit No limit

Orthodontics — Benefits are payable immediately from the start date of an individual’s benefits

Orthodontic Diagnostics No limit No limit No limit

Orthodontic Treatment No limit No limit No limit


Exclusions:The below exclusions apply to the MetLife Classic, Value MAC and Value PDP Dental Plans

• 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 basi: claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or algesia 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.

MetLife Dental for State of Oklahoma employees

Choose the dental plan that’s right for you and your family, based on your needs and budget:

ClassicHighest benefit levels ($5,000 annual maximum)

Value MACLowest premiums (less than $330/year)

Value PDPFlexibility to see any dentist

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166L0917498736[exp1118][All States][DC,GU,MP,PR,VI] © 2017 METLIFE, INC.

Find out more:

Call 1-855-676-9443 or visit www.metlife.com/oklahoma

healthier savings for healthier smiles - metlife...help you take a more active role in managing your...

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