Commonly Asked Questions



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MetLife Preferred Dentist Program (PDP) Overview

Commonly Asked Questions

ow does the MetLife PDP work?

With a dental benefit plan featuring the MetLife PDP, you receive benefits whether or not you and/or each eligible dependent visit a participating dentist. But, when you visit a participating dentist, you have the opportunity to maximize your benefit plan with access to lower, out-of-pocket expenses. The MetLife PDP is a Preferred Provider Organization, wherein you choose a provider at the time of treatment. You do not have to pre-select a primary dentist nor do you need an ID card or referrals for specialty care.
What is a participating PDP dentist?
A general dentist or specialist who meets MetLife’s strict credentialing standards and accepts negotiated fees as payment-in-full for services rendered. There are more than 50,000 participating PDP dentists nationwide, including over 10,900 specialists. So you should have no problem finding a participating PDP dentist near your home or workplace, while you’re away on vacation, or while your covered dependents are away at college.
How do I find a Participating PDP dentist?
You can call the PDP automated Computer Voice Response line to obtain an up-to-date directory of participating dentists in your area. The system prompts you to enter your Social Security Number and a home or work ZIP code. A list of up to 205 participating dentists in the requested ZIP code is then mailed to your home the next business day. To receive your personalized directory, call 1-800-474-PDP1 (7371) Mon.-Fri. 6:00am to 11:00 pm ET or Saturday 7 am to 4:00 pm. You can also conduct online provider searches (with direction and mapping capabilities) via MetLife’s Dental Internet site at www.metlife.com/dental.
Please Note: Be sure to verify provider participation when you make your appointment.
What is a negotiated fee?
A negotiated fee refers to the PDP fee schedule which participating dentists agree to accept as payment in full. The fee is typically 10% to 30% below average fees of dentists in your area. Your plan may reimburse you for all or part of the PDP fee. When you use a participating PDP dentist, you are responsible only for the difference between MetLife’s benefit payment amount and the PDP fee.
Do I need an ID card?
No, you do not need to present an ID card to confirm that you’re eligible. You should notify your dentist that you participate in MetLife’s PDP. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system
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.
My dentist does not participate in the PDP. Is there anything I can do to encourage my dentist to participate?
The MetLife PDP Network is continually expanding, and new providers may be added if they meet MetLife’s credentialing standards. Just ask your dentist to complete a MetLife PDP nomination card or visit the dentist directory online at www.metlife.com/dental, and MetLife will send him or her information on how to apply for participation. The timing depends on how quickly MetLife receives the necessary information. Please note that there may be instances where a dentist chooses not to participate and others where MetLife does not accept the application under their stringent credentialing requirements.
Can I find out how much services will cost and obtain an estimate of what will be covered prior to treatment?
Yes, MetLife strongly recommends that you have your dentist submit a request for a pre-treatment estimate for services in excess of $200.00. This often applies to services such as: crowns, bridges, inlays, and periodontics. When your dentist suggests treatment, have him or her send an undated claim form, along with the proposed treatment plan, to MetLife. A pre-treatment estimate will be sent to you and the dentist detailing an estimate of what services MetLife will cover and at what payment level.
How do I file a claim?
Claim forms are available from your human resources department or can be downloaded and printed out from MetLife’s dental website at www.metlife.com/dental. Remember to bring one with you to your appointment. Complete the employee portion, and your dentist will assist you with the rest. You can use the same claim form whether or not your dentist is a participating dentist. MetLife will mail you a concise explanation of benefits (EOB) after each claim submission. If you have a claim inquiry or benefit questions, please call MetLife’s Dental Customer Service Department at 1-800- ASK - 4 - MET after your plan’s effective date.
If I do not enroll during my initial enrollment period can I still purchase Dental Insurance at a later date?
Yes, employees who do not elect coverage during their 31 day application period may still elect coverage later. Dental coverage would be subject to the following waiting periods.


  • 6 months on Basic Restorative (Fillings)

  • 12 months on all other Basic Services

  • 24 months on Major Services

  • 24 months on Orthodontia Services (if applicable)


M
L02022JVT(exp0203)MLIC- LD


etropolitan Life Insurance Company, NY, NY 10010




Network Comprehensive Dental

Plan Design for Axiom Resource Management, Inc.

Effective Date January 1, 2005

Benefit Highlights









How might the PDP save you money?

In-Network Out-of-Network









Type A – Preventive

 of PDP Fee*

 of R&C Fee**




Dentist’s Usual Fee

$.00

Type B – Basic

 of PDP Fee*

 of R&C Fee**




Reasonable & Customary

$.00

Type C – Major

 of PDP Fee*

 of R&C Fee**




PDP Fee

$.00

Type D – 











Deductible***

$ / $

$ / $




Out-of-Network Dental Expenses




Ind. / Family

Ind. / Family




Annual Maximum

$ per person

$ per person










 




Dentist’s Usual Fee:

$.00

* PDP Fee refers to the negotiated PDP fee schedule




Plan Payment (50% x $ R&C fee):

-$250.00

** R&C charges are based on the lesser of: (a) dentist’s usual charge, (b) usual

charge for the community, or (c) actual charge












*** Applies 




Your out-of-pocket Cost:

$250.00

MetLife Comprehensive Covered Services





In-Network Dental Expenses
Type

Services












A – Preventive


Oral Examinations







PDP Fee

$.00




Prophylaxis - Cleaning and Scaling of teeth




Plan Payment (60% x $ PDP fee):

-$210.00




Space Maintainers (dependents under age 19)













Topical Fluoride Applications







Your out-of-pocket Cost:

$140.00




Full mouth & Bitewing X-rays










Sealants (molars only, once per tooth up to the age 14






B – Basic


Fillings







In this example, you save:




Extractions







$110.00 ($250.00 - $ 140.00 )




Endodontics - Root Canal







By utilizing MetLife’s PDP network!




Periodontics













Anesthesia













Injections of Antibiotic Drugs




Note: This example assumes your deductible has been met.




Oral Surgery









Emergency palliative treatment











Repair of crowns, dentures, inlays, and onlays










Repair of Bridgework




Dental Claims Address:

C – Major

Bridgework




MetLife Dental Claims




Crowns, Onlays, and Inlays



P.O. BOX 14093





Dentures



Lexington, KY 40512- 4093


“In-Network Benefits” means benefits provided under this plan for covered dental services that are provided by a participating PDP provider.

“Out-of-Network Benefits” means benefits provided under this plan for covered dental services that are not provided by a participating PDP provider.










Please refer to your Certificate booklet for a complete list and description of covered services.

Metropolitan Life Insurance Company, NY, NY 10010




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