Dental
Dental plans cover diagnostic and preventive care, plus basic and major services.
Dental
Premiums
Bi-Weekly premiums
| Coverage tier | Buy-Up Employee Contribution | Buy-Up Ketjen Contribution | Base Employee Contribution | Base Ketjen Contribution |
|---|---|---|---|---|
| Employee Only | $7.14 | $9.85 | $3.59 | $9.71 |
| Employee + Spouse | $16.05 | $22.16 | $8.08 | $21.85 |
| Employee + Child(ren) | $18.55 | $25.62 | $9.34 | $25.24 |
| Employee + Family | $24.97 | $34.48 | $12.57 | $33.99 |
Employee Only
- Buy-Up Employee Contribution
- $7.14
- Buy-Up Ketjen Contribution
- $9.85
- Base Employee Contribution
- $3.59
- Base Ketjen Contribution
- $9.71
Employee + Spouse
- Buy-Up Employee Contribution
- $16.05
- Buy-Up Ketjen Contribution
- $22.16
- Base Employee Contribution
- $8.08
- Base Ketjen Contribution
- $21.85
Employee + Child(ren)
- Buy-Up Employee Contribution
- $18.55
- Buy-Up Ketjen Contribution
- $25.62
- Base Employee Contribution
- $9.34
- Base Ketjen Contribution
- $25.24
Employee + Family
- Buy-Up Employee Contribution
- $24.97
- Buy-Up Ketjen Contribution
- $34.48
- Base Employee Contribution
- $12.57
- Base Ketjen Contribution
- $33.99
Coverage Details
| Feature | BUY-UP IN-NETWORK | BUY-UP OUT-OF-NETWORK | BASE IN-NETWORK | BASE OUT-OF-NETWORK |
|---|---|---|---|---|
| Type A – Preventive | 100% | 100% | 100% | 100% |
| Type B – Basic | 80% | 80% | 80% | 80% |
| Type C – Major | 60% | 60% | 50% | 50% |
| Calendar Year Deductible applies to: Individual Family | Types B & C $50 $150 Aggregate | Types B & C $50 $150 Aggregate | Types B & C $50 $150 Aggregate | Types B & C $50 $150 Aggregate |
| Calendar Year Maximum (applies to A,B,C) | $2,250 | $2,250 | $1,250 | $1,250 |
| Orthodontia | 50% | 50% | Not Covered | Not Covered |
| Orthodontia Lifetime Maximum | $2,000 | $2,000 | Not Covered | Not Covered |
Type A – Preventive
- BUY-UP IN-NETWORK
- 100%
- BUY-UP OUT-OF-NETWORK
- 100%
- BASE IN-NETWORK
- 100%
- BASE OUT-OF-NETWORK
- 100%
Type B – Basic
- BUY-UP IN-NETWORK
- 80%
- BUY-UP OUT-OF-NETWORK
- 80%
- BASE IN-NETWORK
- 80%
- BASE OUT-OF-NETWORK
- 80%
Type C – Major
- BUY-UP IN-NETWORK
- 60%
- BUY-UP OUT-OF-NETWORK
- 60%
- BASE IN-NETWORK
- 50%
- BASE OUT-OF-NETWORK
- 50%
Calendar Year Deductible applies to: Individual Family
- BUY-UP IN-NETWORK
- Types B & C $50 $150 Aggregate
- BUY-UP OUT-OF-NETWORK
- Types B & C $50 $150 Aggregate
- BASE IN-NETWORK
- Types B & C $50 $150 Aggregate
- BASE OUT-OF-NETWORK
- Types B & C $50 $150 Aggregate
Calendar Year Maximum (applies to A,B,C)
- BUY-UP IN-NETWORK
- $2,250
- BUY-UP OUT-OF-NETWORK
- $2,250
- BASE IN-NETWORK
- $1,250
- BASE OUT-OF-NETWORK
- $1,250
Orthodontia
- BUY-UP IN-NETWORK
- 50%
- BUY-UP OUT-OF-NETWORK
- 50%
- BASE IN-NETWORK
- Not Covered
- BASE OUT-OF-NETWORK
- Not Covered
Orthodontia Lifetime Maximum
- BUY-UP IN-NETWORK
- $2,000
- BUY-UP OUT-OF-NETWORK
- $2,000
- BASE IN-NETWORK
- Not Covered
- BASE OUT-OF-NETWORK
- Not Covered
Plan Notes
- Although you can choose any dental provider, you will generally pay less when you visit an in-network dentist. If you choose an out-of-network provider, you may be billed the difference between what MetLife pays, and what your out-of-network provider charges for the services. To locate an in-network provider, please visit metlife.com.
- Out-of-Network benefits are payable for services rendered by a dentist who is not a participating provider. The 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.
- Starting in 2027, orthodontia coverage includes adults along with dependent children up to age 26.