Benefits at a Glance
The fully-insured plan is insured by MetLife.
Any dentist can be used.
Using an In-Network provider assures no balance billing.
Out of network providers will be paid at 90% usual, customary & reasonable.
Monthly Premiums
| Employee Only* | Employee + 1* | Family* |
| $0.00
$0.00 ** |
$51.89
$53.45 ** |
$91.74
$94.49** |
*Heard County Schools pays the Employee’s Dental Portion of $32.73.
**Beginning 7/1/2024 Heard County Schools will contribute $33.71.
(This is reflected in the above premiums).
- Children can be covered to age 26.
Summary
It pays 100% preventive; 80% for basic; and 50% for major services. The Maximum payable is $1,000 per plan year for basic and major services. Adult and child Orthodontia has a $1,000 lifetime maximum. A $50 plan year deductible is waived for preventive and orthodontic services.
Oral exams are allowed twice in 12 months
Plan Design
For further details download the Dental Benefit Summary
| Coverage Type: | In-Network1 % of Negotiated Fee2 |
Out-of-Network1 % of R&C Fee4 |
|---|---|---|
| Type A – Preventive | 100% | 100% |
| Type B – Basic Restorative | 80% | 80% |
| Type C – Major Restorative | 50% | 50% |
| Type D – Orthodontia | 50% | 50% |
| Deductible3 | ||
| Individual | $50 | $50 |
| Family | $150 | $150 |
| Annual Maximum Benefit: | ||
| Per Individual | $1000 | $1000 |
| Up to dependent age limit | ||
| Orthodontia Lifetime Maximum – Ortho applies to Adult and Child | $1000 per Person | $1000 per Person |
| Dependent Age: | Eligible for benefits until the day that he or she turns 26. | |
- “In-Network Benefits” refers to benefits provided under this plan for covered dental services that are provided by a participating dentist. “Out-of-Network Benefits” refers to benefits provided under this plan for covered dental services that are not provided by a participating dentist.
- Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.
- Applies to Type B and C services only.
- Out-of-network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary charge is based on the lowest of:
-
- the dentist’s actual charge (the ‘Actual Charge’),
- the dentist’s usual charge for the same or similar services (the ‘Usual Charge’) or
- the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the ‘Customary Charge’). For your plan, the Customary Charge is based on the 90th percentile. Services must be necessary in terms of generally accepted dental standards.
Certificate of Insurance
Contact / ID Cards
Benefit Information
MetLife Claim and Benefits information: www.metlife.com/mybenefits or call 1-800-942-0854
Network Providers
Insureds can choose ANY DENTIST. Should you visit a Network Provider, a negotiated fee schedule is used which will result in lower out of pocket costs.
To receive a list of MetLife participating dentists online: www.metlife.com/mybenefits or call 1-800-942-0854 to have a list faxed or mailed to you.
Dental Cards
Cards are not necessary to obtain services. Benefits can be verified by Social Security Number, but here is a generic dental card for Heard County Schools.
The Heard County Schools Group ID 5969697.
Employees can go to www.metlife.com/mybenefits to print a personalized card.
