2019 Dental Plans
There are no changes or rate increases for any of the dental plans in 2019.
The Standard and Premium maximum allowable charge (MAC) plans offer pre-determined fees for dental services with specific in-network providers to help you get quality care at better prices. Out-of-network providers may be used but may charge much higher rates for the services than the fees that MetLife has negotiated with in-network providers1. If you choose to see an out-of-network provider, you will be required to pay the difference between the actual charge and the approved in-network fee for that service in addition to any applicable co-insurance. It’s important to make sure your dental provider is in-network to avoid unnecessary out-of-pocket costs.
The Premium Access Plus Plan still offers access to all dental providers in the MetLife network and has the same coinsurance levels, deductibles and plan maximums as the Premium MAC plan. However, the Premium Access Plus Plan pays out-of-network claims based on reasonable and customary charges. Under this plan, your out-of-pocket expenses are lower for out-of-network providers.
With the Standard and Premium MAC plans, it’s important to make sure your dental provider is in-network to keep your out-of-pocket costs low. To see if your dental care providers are in-network, visit metlife.com, select "Dental insurance" and then under "Find a Dentist", select the "PDP Plus" network or call MetLife Dental at 855-488-0520.
1 Negotiated Fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.
Below is an overview of each plan’s benefits:
- The deductibles apply to basic and major restorative dental care.
- The PDP Fee refers to the fees that In-network dentists (Participating Dental Providers) have agreed to accept as payment in full, minus deductibles and co-insurance.
- For the Premium and Standard MAC plans, out-of-Network applies the same co-insurance to the PDP fee (Maximum Allowable Charge). You are responsible for the difference between actual charge and PDP fee.
- For the Premium Access Plus Plan, out-of-Network applies the same co-insurance to the Reasonable and Customary Charges (R&C).
It is recommended that you request a pre-treatment estimate for services in excess of $300. Have your dentist submit a request at www.metdental.com or call 1-877-MET-DDS9. In most cases the estimate can be verified while you are still in the office.
What is the difference between the Premium MAC and the Premium Access Plus Plans?
For service details, see Benefit Summaries below.
Find a Dentist
To find an In-Network provider - visit: www.mybenefits.metlife.com
1. Choose Mohawk ESV., Inc. as the group name:
2. Create a login if you have not previously done so in order to view claims history and plan details or search for a provider on the landing page:
View Your Claims, Coverage and More
Login to Metlife.com to
- View your coverage
- Access your claims
- Access procedure fee tool
Go to www.mybenefits.metlife.com and login with your username and password or create an account.
Summary Plan Descriptions
Contact the Benefits Service Center or MetLife
For questions about your benefits including claims, eligibility, or to order an ID card contact us at
Benefits Service Center | 1-866-481-4922
MetLife | 1-855-488-0520 | www.metlife.com