Plan Information

The Plan is insured by MetLife

Employees choose between two options. Both options have the same rates.

Differences between Open Network UCR Plan and the In-Network MAC Plan are reimbursement levels for Out-Of-Network providers and level of services covered.

Dental insurance premiums for Haralson County employees are among the lowest costs of any school system or other employer in this area, while providing excellent benefits.

Rates

Coverage Monthly Rates
Employee Only $35.97
Family  $105.84

Covered Dependents – Unmarried dependent children to age 26, regardless of student status.

Enhanced Benefits

Plan Year Maximum

The Plan Year Maximum is $1,250 Per Covered Participant

Adult Orthodontics

Orthodontic Coverage is available for dependent children and adults. The Lifetime Maximum is $1,000

Waiting Periods

A late entrant is an employee or dependent who does not enroll when first eligible and decides to enroll at a later date.  Late entrants can only enroll during the Annual Open Enrollment Periods and will have no waiting periods.

Plan Design

Differences between Open Network UCR Plan and the In-Network MAC Plan are reimbursement levels for Out-Of-Network providers and level of services covered.

  • Open Network UCR Plan pays out of network providers based on Usual, Customary and Reasonable fees (90% UCR). Choose this plan if your provider is Out of Network. This Plan pays Basic Services at 80%.
  • In Network MAC Plan reimburses out of network providers at the negotiated network provider fee. If your provider is out of network and you choose this plan, you will likely be balance billed.  In Network MAC Plan, includes a higher coverage level for Basic Services (100%).

MetLife Benefit Summary – Including exclusions and limitations

Benefit In Network MAC Plan * Open Network UCR Plan *
Preventive Services* 100% 100%
Basic Services* 100% 80%
 Major Services* 60% 50%
Out of Network Provider
Reimbursement
Charge Based on
Network Provider Discount*
90% Usual &  Customary*
Deductible  $50 Individual
$150 Family
$50 Individual
$150 Family
Maximum Benefit $1,250 $1,250
Orthodontic Services 50%* 50%*
Lifetime Maximum $1,000 $1,000

Contact / ID Cards

METLIFE PROVIDER SEARCH

MetLife Provider Search – use the PDP Plus Network

  • Choose the Open Network UCR/High Option if your provider isn’t part of the Network. Your out of network claims will be paid based on 90% Usual and Customary. There will be less chance of a balance bill under this option.
  • Choose the In-Network MAC/Low Plan ONLY if your provider is part of the Network. You will be balance billed the difference if you see an out of network provider on this plan.

DENTAL CARDS

  • Employees will receive customized Dental Cards mailed to their home address.
  • Employees can also create an account and print a customized dental card at any time from https://metlife.com/mybenefits

Generic ID Cards can also be utilized

Certificate of Coverage

In Network Low Option – MetLife

Open Access UCR High Option – MetLife