Dental
Effingham County Schools offers three dental PPO plan options: the Base Plan, the Core Plan, and the Buy-Up Plan. All plan options include preventive care at 100% (no deductible). The Base Plan has the lowest premiums and the lowest annual maximum benefit, but only includes coverage for preventive and basic restorative services. The Core Plan has slightly higher premiums and a higher annual maximum, but does not include orthodontia coverage. The Buy-up 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.
The MetLife 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 MetLife PDP Plus dentists. We encourage you to use a MetLife 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 | Base Plan | Core Plan | Buy-Up Plan |
|---|---|---|---|
|
Deductible
|
$50 individual | $150 Family | $75 individual | $225 Family | $75 individual | $225 Family |
|
Type A - Preventive Services (Deductible Waived): Cleanings and exam
|
Plan pays 100% | 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% | Plan pays 80% |
|
Type C - Major Services (After Deductible): Oral surgery, implants, crowns, and more
|
Not Covered | Plan pays 50% | Plan pays 50% |
|
Type D - Orthodontia; up to age 19 (After Deductible):
|
Not Covered | Not Covered | Plan pays 50% |
|
Orthodontia Lifetime Maximum
|
Not Covered | Not Covered | $2,500 per person |
|
Annual Maximum (per person)
|
$500 per person | $1,250 per person | $1,500 per person |
Important Notes
-
No age limitations for coverage, with the exception of orthodontia coverage for the Buy-up Plan which is up to age 19
-
Deductible (waived for preventive); differing annual maximums depending on plan
-
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.)
Dental Plan Information
