MetLife Preferred Dentist Provider (PDP) Plan

The MetLife Preferred Dentist Provider (PDP) plan is a dental insurance option designed to give members affordable access to a wide network of dentists across the United States. It combines preventative care coverage with a flexible, feeforservice structure that can help manage outofpocket costs while encouraging regular dental visits.

How the PDP Plan Works

Unlike traditional dental HMO plans, the PDP plan does not require members to obtain referrals or get prior authorization for most services. Instead, it operates on a preferred provider model:

• Innetwork dentists agree to a prenegotiated rate with MetLife. When you see an innetwork dentist, you typically pay a reduced copayment or a percentage of the allowed fee.
• Outofnetwork dentists can still be used, but you will be charged the dentists full fee and then reimbursed at the plans allowed amount, which may result in a larger balance due.
• Annual maximum Most PDP plans set a maximum benefit amount per year (e.g., $1,500 or $2,000), after which you are responsible for all additional costs.

Key Benefits

Covered Services

Category	Typical Coverage	Member Cost
Preventive	Routine exams, cleanings, Xrays, fluoride	0% 100% covered (usually 100%)
Basic	Fillings, simple extractions, periodontal scaling	20%30% coinsurance
Major	Crowns, bridges, dentures, root canals	40%50% coinsurance
Orthodontics (optional addon)	Braces, aligners for eligible members	Usually 25%50% after deductible

Typical Costs

Costs vary based on the specific PDP plan chosen and whether the provider is innetwork. Below is a general example for a common PDP 1500 plan:

• Annual Premium: $20$35 per month (individual) or $45$70 per month (family).
• Deductible: $50 per person per year.
• Preventive visits: $0 copay.
• Basic services: 20% coinsurance after deductible.
• Major services: 40% coinsurance after deductible.
• Annual Maximum Benefit: $1,500 per person.

Finding a PDP Dentist

MetLife provides several convenient ways to locate an innetwork dentist:

1. Online Provider Search Visit the MetLife website, enter your zip code, and filter by specialty or distance.
2. Mobile App The MetLife Dental app lets you search, book appointments, and view your benefits on the go.
3. Phone Support Call the member services line (available 24/7) and request a list of nearby PDP dentists.

How to Use Your Benefits

1. Verify that the dentist participates in the PDP network.
2. Schedule an appointment and inform the office that you have MetLife PDP coverage.
3. The dentist will submit the claim electronically to MetLife.
4. MetLife processes the claim and sends an Explanation of Benefits (EOB) to you and the dentist.
5. You pay any required copay or coinsurance at the time of service.

Claims and Billing

Most innetwork dentists handle claims submission for you. If you see an outofnetwork provider, you will need to:

• Obtain an itemized receipt.
• Complete a claim form (available online).
• Submit the form and receipt through the MetLife portal or by mail.

Reimbursement is typically processed within 1014 business days after receipt of a complete claim.

Plan Limitations & Considerations

• Annual Maximum Once you reach the limit, you will pay 100% of additional costs.
• Waiting Periods Some plans impose a 6month waiting period for basic services and 12 months for major services.
• Orthodontic Coverage Usually requires a separate rider and has its own lifetime maximum.
• OutofNetwork Costs Expect higher outofpocket expenses if you choose a dentist outside the PDP network.

Comparing PDP to Other Dental Options

When evaluating dental insurance, consider three common models:

Model	Network Flexibility	Cost Predictability	Typical Use Cases
PDP (Preferred Provider)	Large network; outofnetwork allowed	Moderate fixed copays for many services	Members who want choice but still want lower fees
Dental HMO	Strictly innetwork only	High low or no copays, lower premiums	Families focused on preventive care
Dental Indemnity (FeeforService)	No network restrictions	Low higher outofpocket, reimbursement after service	Members who prefer any dentist and are comfortable with larger bills

FAQs

1. Can I switch dentists during the plan year?

Yes. You may change innetwork dentists at any time without affecting your coverage.

2. What happens if I exceed the annual maximum?

After the maximum is reached, you are responsible for 100% of further dental expenses until the next plan year.

3. Does the PDP plan cover implants?

Implants are generally classified as major services and are covered at the plans major service coinsurance rate, subject to the annual maximum.

4. How are orthodontic benefits applied?

Orthodontic coverage is usually an optional rider with its own lifetime maximum and may require a separate deductible.

5. Is there a separate deductible for each individual in a family plan?

Most PDP plans have an individual deductible for each covered person, plus a family deductible that may be higher.

Explore MetLife PDP Plans