Dental Plan
Maintaining Good Oral Health
When preventive care is covered, an employee is more likely to go for cleanings and checkups — this can help you avoid problems before they become too costly or complicated. Plus, going to the dentist regularly can help prevent problems that have been linked to diabetes and heart disease. That's where NCFlex's Dental Plan comes in to cover routine checkups and other dental care.
You can choose between three options on the Dental Plan: Low, Classic or High. How much you pay per pay period and at time of service differs based on the plan option you choose. Refer to the summary of benefits to review services covered under each plan.
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Monthly Cost
| Coverage Level | High Option | Classic Option | Low Option |
|---|---|---|---|
| Employee Only | $56.50 | $36.70 | $24.66 |
| Employee and Spouse | $113.34 | $73.60 | $49.70 |
| Employee and Child(ren) | $122.24 | $79.74 | $53.40 |
| Employee and Family | $200.12 | $125.86 | $85.10 |
| Coverage Level | High Option | Classic Option | Low Option |
|---|---|---|---|
| Employee Only | $55.40 | $35.90 | $24.18 |
| Employee and Spouse | $111.12 | $72.00 | $48.74 |
| Employee and Child(ren) | $119.84 | $78.00 | $52.34 |
| Employee and Family | $196.20 | $123.00 | $83.44 |
Use a Network Provider to Save
No matter which Dental Plan option you choose, you can visit any licensed dentist, in or out of the MetLife Preferred Dental Provider (PDP) Plus Network, and still receive benefits. When you go to a participating dentist, you can save even more since in-network dentists accept negotiated fees typically 30-45% less than the average charges in the same area.
What is a negotiated fee? Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefit maximums. Negotiated fees are subject to change.
Find a participating dentist: Visit MetLife Dental's website, enter your zip code and select the PDP Plus Network. You can request a provider list by calling 855-676-9441 as well.
| Dental Plan Contact Information | |
|---|---|
| Website (Find a provider, view your account) | mybenefits.metlife.com |
| Customer Service | 866-676-9441 8 a.m.–11 p.m. (EST) Monday–Friday |
| Mailing Address | MetLife Dental Claims P.O. Box 981282 El Paso, TX 79998-1282 |
Need to Know Details
Once you choose one of the three plan options (High, Classic or Low), you must keep that option for the entire play year even if you have a qualifying life event.
Employees can only change their dental plan option during the annual enrollment period. For example, you cannot switch from the Low option to the High option in the middle of the plan year or vice versa.)
The vendor for NCFlex's Dental Plan—MetLife—encourages employees to discuss their treatment plan with their provider and submit a pre-estimate before the work begins if the estimated charge for a particular dental service is expected to be $300 or more.
To submit a pre-estimate, you should have your dentist submit a request online or call 877-MET-DDS9. Your dentist will need to provide the proposed treatment plan, applicable x-rays, supporting documents and estimated charge to MetLife. This provides an opportunity to review the proposed course of treatment and estimated fees.
Below is a partial listing of the exclusions listed with the plan policy. For a complete listing refer to the plan certificate that corresponds with your plan option. If there are discrepancies, the plan certificate and/or contract shall govern.
NCFlex's Dental Plan will not pay for the following dental expenses and services:
- Services which are not dentally necessary, or those which do not meet generally accepted standards of care for treating the particular dental condition.
- Services or supplies received by the employee or their dependent before the dental insurance starts for that person.
- Services which are primarily cosmetic.
- Restoration of tooth structure damaged by attrition, abrasion or erosion, unless caused by disease.
- Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco.
- Personal supplies or devices including but not limited to: water piks, toothbrushes or dental floss.
- Missed appointments.
- Prescription drugs.
- Services for which the submitted documentation indicates a poor prognosis.
- Pulp vitality, diagnostic photographs and bacteriological studies for determination of bacteriologic agents.
- Labial veneers.
- Local chemotherapeutic agents.
- Fixed and removable appliances for correction of harmful habits.
- Appliances or treatment for bruxism (grinding teeth).
- Replacement of a lost or stolen appliance, Cast Restoration or Denture.
- Replacement of an orthodontic device.
- Diagnosis and treatment of temporomandibular joint disorders and cone beam imaging associated with treatment of temporomandibular joint disorders.
Orthodontia coverage on the High and Classic Options is for covered children only to age 19. Employees/spouses are not covered for orthodontia.
If you terminate your employment with the state or retire, you may continue your MetLife dental coverage by paying the monthly premium directly to the COBRA vendor. COBRA enrollment materials will be sent to an employee's last known address. Learn more about continuing coverage here.
NCFlex's Dental Plan is administered and underwritten by Metropolitan Life Insurance Company. For information regarding claim payment, refer to the certificate of coverage that corresponds with your plan option on the plan options page of our website.