Dental

School System offers two dental PPO plan options: the Standard Plan and the Premium Plan. All plan options include preventive care at 100% (no deductible). The Standard Plan has the lowest premiums and the lowest annual maximum benefit, but only includes coverage for preventive and basic restorative services.  The Premium Plan is the richest plan option with the highest annual maximum and orthodontia coverage for children up to age 19.  Dependent children can be covered up to age 26.


 

Premium Information

Important Documents

The dental PDP Plus plan provides coverage both in and out-of-network.  However, you will make the most of your dental plan benefits if you visit participating PDP Plus dentists.  We encourage you to use a participating dental provider to reduce your out-of-pocket costs and help manage the long term costs of the plan.  Participating dentist information can be found on the Resources page.

 

Below is a benefit summary of your annual deductible and co-insurance costs.

MetLife PDP Plus Coverage Standard Plan Premium Plan
Deductible
$50 individual | $150 Family $75 individual | $225 Family
Type A - Preventive Services (Deductible Waived):
Cleanings and exam
Plan pays 100% Plan pays 100%
Type B - Basic Services (After Deductible):
Fillings, simple extractions, X-rays, and more
Plan pays 80% Plan pays 80%
Type C - Major Services (After Deductible):
Oral surgery, implants, crowns, and more
Not Covered Plan pays 50%
Type D - Orthodontia; up to age 19 (After Deductible):
Not Covered Plan pays 50%
Orthodontia Lifetime Maximum
Not Covered $2,500 per person
Annual Maximum (per person)
$500 per person $1,500 per person

Important Notes


  • No age limitations for coverage, with the exception of orthodontia coverage for the Premium Plan which is up to age 19

  • Deductible (waived for preventive); differing annual maximums depending on plan

  • Members utilizing participating dentists will enjoy discounted dental fees in addition to protection from balance billing for charges above the dentist’s maximum allowable charges. Members utilizing non-participating dentists will have the same benefits but may be subject to balance billing.

Claims Process


In-Network

  • Participating dentists file the claim and accept payment from the carrier
  • Employees should not need to pay at the time of service for participating providers

 

Out-of-Network

  • For out-of-network dentists, if the dentist does not agree to file the claim as out-of-network, employee pays at the time of service and files a claim for reimbursement
  • The plan reimburses at the 90th percent of Usual and Customary (U&C) for out-of-network providers.  Charges by out-of-network providers that exceed U&C are the member’s financial responsibility. (Member pays the difference between the actual charge and the plan’s U&C reimbursement level.)