MetLife Dental Insurance

MetLife dental insurance is a leading commercial dental program. MetLife dental insurance currently has a nationwide network of 100,000 dentists. MetLife Dental insurance is preferred for their low fees that are typically 10 to 35 percent below average dental charges. MetLife has 4 dental plans: Basic Plan, Mid Plan, High Plan, and Customized Plans. To understand these plans, you need to know a little about PPO, HMO and indemnity dental insurance plans.

PPOs
Participating or Preferred Provider Plans (PPOs) are similar to indemnity plans. The patient must select their dentist from a listing of dentist’s who have signed an agreement with the insurance company to accept a pre-set fee. The dentist agrees not to charge the patient for any amount that their normal fee exceeds the pre-set fee. This means that under a PPO plan, you will have a pre-set fee of $100, the insurance will pay $80, the dentist will write off $5 by which their fee exceeds the UCR amount, and you will be responsible for $20.

TheMetLife PPOnetwork provides you with over 100,000 dentists to select from. Each dentist has agreed to accept negotiated fees as payment in full for the services they provide to you. Again, MetLife insurance fees typically range from 10 to 35 percent below the average fees charged by dentists.

If your policy requires you to go to an in-network provider, you will not be charged the difference between the dentist’s price and the UCR price. Typically, the contracted dentist and the insurance company write off the difference in charges. If your insurance allows you to pick your own dentist, you may need to check the UCR guide against the dentists charges to make sure you have enough money to cover the out-of-pocket expenses.

Typically, indemnity plans will pay 100% on preventative treatment, 50% to 80% on basic procedures, and 25% to 40% on major treatments. Preventative dental procedures are considered to be routine cleanings, x-rays, sealants, fluoride, and any preventative dental care. Basic or restorative dental procedures are described as fillings for cavities or simple extractions. Root canals are also considered basic procedures. Major dental procedures are considered to be crowns, bridges, dentures, partials, surgical extractions, and dental implants.

Indemnity plans are limited by a yearly maximum amount around $1,000 and there is sometimes a deductible the patient must pay before coverage can begin. The patient will be responsible for any fees not paid by the dental insurance company.

MetLife does offer indemnity plans for employers. These plans can be combined with MetLife’s PDP program so patients can still save on out-of-pocket expenses.

Indemnity Plans
Indemnity dental insurance plans are the traditional forms of dental insurance. The plan allows you to select a dentist of your choice without a penalty. The plan will then pay all or part of the dentist’s fee. The insurance company usually has a set UCR fee (usual, customary and reasonable). This is an established set price for every dental procedure they cover. The dentist may charge more for a certain procedure, but your insurance company will only pay what their UCR guide states.

HMOs
Dental Health Maintenance Organization plans are not dental insurance. They are plans in which you must choose a participating dentist in order to receive benefits. There are 2 differen

Capitation is when the dentist receives a small monthly payment for each patient they are assigned. The dentist is not paid for preventative care or restorative treatment they provide. However, they are paid the small monthly fee whether they treat you or not.

If your employer doesn’t offer dental insurance, you may be able to buy an individual plan. Many insurance companies can deny you coverage if you have made a large number of claims in the past. Keep in mind that the premiums for individual dental insurance can be quite expensive.

How MetLife’s PDP plan works
Unlike other insurance companies that use indemnity or HMOs, MetLife uses a PPO plan with PDPs (Preferred Dentist Program). The PDP program allows you to search MetLife’s directory of dentists and find a dentist that fits your needs. After you select a dentist you will need to tell them that you are enrolled in MetLife’s PDP program. This allows the dentist to put you in a different billing category from other patients because your out-of-pocket expenses will be considered much lower from other patients who do not have MetLife dental insurance.

You are able to select any dentist you like (as you can with an indemnity plan) that is in our out-of-network. However, you will save more money if you use an in-network dentist. You also do not need a referral to see a specialist such as an orthodontist, oral surgeon, or endodontist.

Any dentist who participates in the MetLife PDP program is required to go through a screening process to determine if they are qualified. The MetLife screening process includes emergency care arrangements, malpractice coverage, dental education history, ongoing dental training, equipment specifications, and other requirements. Each dentist who is a member of the MetLife PDP program must present valid copies of dental licenses and specialty training certificates. MetLife PDP has a strict utilization management system and claim review system. Each dentist must submit proper forms in order to receive compensation. The dentists that participate in the MetLife PDP program are also monitored on a regular basis and are required to undergo credential training every 3 years. MetLife refers to this as their Quality Initiatives Program (QIP). This program continues to monitor the changes in dental technology and keeps their network of dentists involved in changes. The MetLife Dental Advisory Council (DAC) also oversees quality initiatives, dentist and employee education, and the integration of research and professional standards into the claim payment policies.

According to MetLife, here are 5 other key aspects they provide with their QIP program:

• Rigorous up-front and periodic re-credentialing of dentists help to increase confidence in the qualifications of participating dentists
• Monitoring of dentist treatment patterns to help manage costs and improve program value
• Claim review by independent licensed dentists help provide appropriate plan reimbursements
• On-site consultations, self-assessment surveys and ongoing communications to help participating dentists promote a safe environment for patient care in accordance with safety guidelines
• Valuable discount programs and technology promotion to help dentists reduce overhead, improve overall business practices, and promote a stable network

The best option you have available is to sign-up for dental insurance through your employer. Employers are given excellent dental plans with MetLife because they have a large number of employees who sign up for coverage. This means your employer will pay a large portion of the premium, leaving you will a small amount to pay. Most companies will only make their employees pay around $25.00 or under for family dental insurance plans. Keep in mind, that the more family members you add to your dental insurance, the more you will have to pay toward the premium.

If you are a small employer looking to provide dental insurance for your employers, then you need to consider MetLife dental insurance. MetLife offers voluntary dental plans for smaller companies (10 employees or more) that allow you to use the PDP network.

MetLife also offers full service dental for retirees. This is a great program for employers, as MetLife allows for retired employees to receive dental benefits at no additional expense to the employer. The retirees pay the entire cost of the premium and MetLife will handle everything else. This is a great incentive for an employer to offer their employees, as they no longer have to worry about dental insurance after they retire.

MetLife is also one of the only dental insurance companies to offer graduating dental benefits. Participants, including dependants, are rewarded for maintaining their dental coverage. They will receive an increase in maximum benefits each year for up to three years. If you are an employer, this is a great incentive to offer your employees. Unlike other dental rollover plans, MetLife does not have special qualifications or dollar threshold limits. This allows patients to receive dental care when needed without worrying about deferring treatment to obtain additional benefits. In order to receive this benefit the employees must enroll in MetLife dental insurance and have no gaps in coverage year to year. If they do have a gap in coverage, the graduating dental benefit is still available to them at an entry level. This way, they have the opportunity to participate again in graduating dental benefits.

All in all, investing in dental insurance is a smart choice. If your employer is willing to cover most of the premium, you should sign up today. Even if you only go in for 2 cleanings a year, you are still saving yourself money on the exam, cleaning, x-rays, and other charges that could be applied. 93 percent of all patients who have used MetLife’s PDP program have said they are satisfied with the dentist and the insurance.