Active Employees
When you visit a general dentist or a specialist who is in the network, your out-of-pocket costs are usually lower. That is because participating dentists have agreed to accept negotiated fees that are usually 15% to 45% less than the average charges in the same community.1 Lower fees can help you cut your final costs and stretch your annual maximums.
In particular, the cost of specialty care like implants, root canals and crowns can really add up. That is why it is good to know the network is there to help you manage your out-of-pocket costs. You can view your potential savings on in-network vs. out-of-network fees by using the Dental Procedure Fee Tool2 located on metlife.com/mybenefits. Take a look at the example below, which shows you how people can save by going to an in-network specialist.
(Note: This is an example for illustration purposes only and may not reflect the actual charges in your area.)
| In-Network | Out-of-Network | |
|---|---|---|
| Specialist charge | $1,300.00 | |
| MetLife negotiated fee | $698.00 | NA |
| MetLife pays3 (based on 80 percent coinsurance amount for this type of service) |
$558.40 | $1,040.00 |
| Your out-of-pocket cost4 | $139.60 | $260.00 |
Approximate savings by visiting a participating dentist: $120.40.4 The savings is the difference between in-network and out-of-pocket cost minus out-of-network and out-of-pocket cost. |
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The chart above is a typical example of how in-network savings work. It shows that you usually save more when you stay in the network. So the next time you need dental care, find out what your plan covers and what you could save by going to a participating general dentist or specialist.
To check your coverage or find a general dentist or specialist, log on to www.metlife.com/mybenefits or call 1-888-262-4876. You can also ask your dentist to recommend a network specialist in your community.
Best of all, participating dentists and specialists have undergone a careful selection process.5 You will never need a referral. So you get convenient access to quality care and support for better savings.
1Based on internal analysis by MetLife, negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for services rendered by them, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.
2The Dental Procedure Fee Tool is provided by VerifPoint, an independent vendor. This tool does not provide the payment information used by MetLife when processing your claims. Prior to receiving services, pretreatment estimates through your dentist will provide the most accurate fee and payment information.
3This example reflects an in-network coinsurance amount of 80 percent and an out-of-network coinsurance amount of 80 percent for major services.
4The potential savings is based on the average charges shown for illustration purposes only. Actual savings for services rendered by an out-of-network dentist will vary depending on the dentist's actual charge for the service.
5Certain providers may participate with MetLife through an agreement that MetLife has with a vendor. Providers available through a vendor are subject to the vendor's credentialing process and requirements, rather than MetLife's. If you should have any questions, contact MetLife Customer Service.
Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact MetLife or your plan administrator for complete details.
