Dental Insurance
The College currently has two Dental Insurance plans provided by MetLife . The monthly premiums are listed below.
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High Plan - PDP
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Monthly Cost
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Low Plan - DHMO
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Monthly Cost
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Employee Only
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$20.51
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Employee Only
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$10.36
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Employee + Spouse/Partner
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$43.10
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Employee + Spouse/Partner
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$18.14
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Employee + Child(ren)
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$43.51
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Employee + Child(ren)
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$21.76
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Employee + Family
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$72.16
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Employee + Family
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$30.56
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LOW PLAN
SafeGuard DHMO
With this plan there are no claim forms, no yearly deductible and no yearly maximums.
You must select a SafeGuard contracted dentist when you enroll by utilizing the online directory at www.safeguard.net
Our dental plan is SGX245-FL. Each enrolled family member may select a different contracted dentist.
You may call Customer Service at 1.800.880.1800
A LIST OF FREQUENTLY COVERED SERVICES AND COSTS
| Preventative Services | Co-Pay | Basic Services | Co-Pay | Major Services | Co-Pay |
| Office visit | $5 | Bitewing X-ray | $0 | Dentures | $325 |
| Oral exam | $0 | Amalgam fillings | $0 | Crowns | $245 |
| Cleanings | $0 | Extraction - Single tooth | $5 | Bridges | $245 |
| Sealants | $0 | Endodonics | $210 | Replacement Limits - Every 5 years | |
| Fluoride Treatments (2 x yr) |
$0 | Periodonics | $110 | Orthodontics Services | $1,850 |
HIGH PLAN
MetLife Dental PDP
This plan allows you to select the dentist of your choice. If you select a dentist who does not participate in the MetLife PDP, your out-of-pocket expenses may be more.
You may search for a participating MetLife PDP dentist at www.metlife.com/dental
MetLife Dental Customer Service Department may be reached at 1.800.275.4638
| Coverage Type | In - Network | Out - of - Network |
| Type A - Preventative | 100% of PDP Fee | 100% of R&C Fee |
| Type B - Basic Restorative | 80% of PDP Fee | 80% of R&C Fee |
| Type C - Major Restorative | 50% of PDP Fee | 50% of R&C Fee |
| Deductible | In-Network | Out-Of Network |
| Individual | $50 | $50 |
| Family | $100 | $100 |
| Annual Maximum Benefits | In-Network | Out - of - Network |
| Per Person | $1000 | $1000 |
In-Network Benefits means benefits under this plan for covered dental services that are provided by a MetLife PDP Dentist.
Out-of-Network Benefits means benefits under this plan for covered dental service that are not provided by a MetLife PDP Dentist.
PDP Fee refers to the fees that MetLIfe dentists have agreed to accept as payment in full.
Out-of-Network benefits are payable for service rendered by a dentist who is not a participating provider. The Reasonable and customary charge is based on the lowest of:
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The dentist's actual charge
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The dentist's usual charge for the same or similar services
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The usual sharge of most dentists in the same geographic area for the same or similar services as determined by MetLife. For your plan, the Customary Charge is based on the 90th Percentile. Services must be necessary in terms of generally accepted dental standards.
| Type A - Preventative | How Many / How Often |
| Prophylaxis - Cleanings | 1 cleaning in 6 months |
| Oral exams | 1 oral exam in 6 months |
| Topical fluoride applications | 1 fluoride treatment in 12 months for dependent children up to 19th birthday |
| Bitewing X-rays | Adult - 1 time in 12 months / Child - 2 times in 12 months up to 19th birthday |
| Periodontal Maintenance | 4 periodontal treatments in 1 year / includes 2 cleanings |
| Emergency palliative treatment | |
| Type B - Basic Restorative | How Many / How Often |
| Full mouth X-rays | 1 full mouth x-ray in 60 months |
| Endodontics - Root canal | Root canal treatment limited to 1 per 24 months |
| Oral surgery -simple & surgical | |
| Periodontal surgery | 1 per quandrant in any 36 month period |
| Periodontal scaling & root planing | 1 per quandrant in any 24 month |
| Amalgam & composit fillings | |
| Type C - Major Restorative | How Many / How Often |
| Bridges | 1 in 10 years |
| Dentures | 1 in 10 years |
| Crowns / Inlays / Onlays | 1 replacement per 60 months |
| Prefabricated Stainless steel and Resin crowns | 1 replacement per 60 months |
