Dental
Houston County School District offers two dental plan options with MetLife: a Low Plan and a High Plan. The Low plan has lower premiums and a lower annual maximum and orthodontia maximum. The High plan has a higher premium, but a greater annual maximum and a higher orthodontia maximum. Dependent children can be covered up to age 26, regardless of student status.
Preventive care, or Type A services such as cleanings, exams, and x-rays are covered at 100% with no deductible. Type B services include but are not limited to fillings, sealants, space maintainers, and simple extractions. You pay a deductible first, and then the plan pays coinsurance. Major or Type C services like bridges, crowns, and surgical extractions are covered after deductible and coinsurance. Orthodontia is covered at 50% up to a separate lifetime benefit.
You choose the plan that is right for you based on the amount of coverage you need, but remember to review the dental plan Certificate of Coverage for all plan details.
| MetLife PDP Plus Coverage | Low Plan | High Plan |
|---|---|---|
|
Deductible
|
$75 individual | $225 Family | $75 individual | $225 Family |
|
Type A - Preventive Services (Deductible Waived): Cleanings, exams, fluoride, bitewing x-rays, periodontal maintenance and more
|
Plan pays 100% | Plan pays 100% |
|
Type B - Basic Services (After Deductible): Fillings, simple extractions, sealants, full mouth x-rays, general anesthesia, and more
|
Plan pays 60% | Plan pays 80% |
|
Type C - Major Services (After Deductible): Periodontal surgery, scaling / root planing, crowns, bridges, dentures, pulp therapy
|
Plan pays 50% | Plan pays 50% |
|
Type D - Orthodontia (After Deductible): Adults and children
|
Plan pays 50% | Plan pays 50% |
|
Orthodontia Lifetime Maximum
|
$750 per person | $1,500 per person |
|
Annual Maximum (per person)
|
$750 per person | $1,500 per person |
Important Notes
-
Members utilizing MetLife 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 MetLife dentists file the claim and accept payment from MetLife
- 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 with MetLife, 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.)
Ordering ID Cards
While having an ID card is not required to seek services, you can request a new ID card in three different ways.
- Call the MetLife Customer Service Center at (800) 942-0854 and speak with a representative to order a new card.
- Register on MetLife MyBenefits and view / print an ID card.
- Call the Benefits Service Center at (866) 671-0721 to request an ID card.
Virtual Dental Care
The MetLife Dental Plan offers virtual dental care for times when you're in pain or unable to visit a dentist in person. You can consult with a licensed dentist through a video call. Simply log in to your MyBenefits Account at online.metlife.com, and choose "Start Virtual Visit" to begin.
