Home / Benefits / Health & Welfare / Dental Plans / MetLife Dental Copay Plan

1. Blue Cross Blue Shield Dental Coverage Michigan

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• The Blue Cross ® and Blue Shield words and symbols and FEP BlueDental® are all trademarks owned by Blue Cross Blue Shield Association. FEP BlueDental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
• Blue Cross & Blue Shield of Nebraska offers a variety of health, dental & travel insurance plans for groups, individuals and families at an affordable rate.
• Blue Cross and Blue Shield of Texas (BCBSTX) is providing access to the Dental Wellness Center website as a courtesy, as part of its BlueCare Dental Connection program. The content on the Dental Wellness Center website is provided by go2dental.com. BCBSTX and go2dental.com are separate companies.
• The Blue Cross ® and Blue Shield words and symbols and FEP BlueDental® are all trademarks owned by Blue Cross Blue Shield Association. FEP BlueDental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

MetLife Dental Copay Plan

. Your dental plan options remain with Delta Dental. PCP $15 Copay $15 Copay 10% Coinsurance. The Blue Cross and Blue Shield Association is an association.

The MetLife Dental Copay Plan is a dental plan in which you make a copay based on a fee schedule, called the Procedure Charge Schedule. The Procedure Charge Schedule is based on the ZIP code where your dentist’s office is located. Each time you need care, you can visit any licensed dentist you choose. However, if you visit a preferred network provider, you save money since providers in the network charge lower negotiated rates. If you visit an out-of-network provider you must meet an annual deductible, you pay a higher copay and your annual maximum benefit is reduced. You can can compare Metlife Dental Copay Plan benefits to the other dental plan to determine if it will meet your dental needs.

Your cost for the plan depends on the coverage you select. Enrolling in the plan is limited to certain times or events during your employment.

Select benefit design features are provided below, including the copay percentage you may be asked to pay at the time dental services are rendered. MetLife may be contacted at 800.942.0854.

In-network	Out-of-network
Choice of Dentist	Limited to MetLife Network	Any licensed provider
Deductible	None	Per individual: $75* Per family: Up to $225*
Annual Maximum The most coverage that the Plan will provide you in one year.	Per individual: $5,000	Per individual: $1,000
Preventive Care One visit in a six month period.	You pay 10%; Plan pays 90%**	You pay 30%; Plan pays 70%***
Basic Care	You pay 30%; Plan pays 70%**	You pay 60%; Plan pays 40%***
Major Care	You pay 50%; Plan pays 50%**	You pay 70%; Plan pays 30%***
Orthodontia (Adult and Child)	You pay 50%; Plan pays 50%** Lifetime maximum per individual: $1,500	You pay 60%; Plan pays 40%*** Lifetime maximum per individual: $500

* Waived for orthodontia

** Payment for percentage of negotiated fees as determined by MetLife, subject to cost sharing, deductible and benefit maximums.

***Payment for percentage of reasonable and customary charges as determined by MetLife. You are also responsible for 100% of any charges in excess of the reasonable and customary charge.

Maintenance Notification:
Blue Access for Members and quoting tools will be unavailable from 3am - 6am on Saturday, October 20.
We apologize for any inconvenience.

Maintenance Notification:
Blue Access for Members and quoting tools will be unavailable from 2am - 5am Saturday, October 20.
We apologize for any inconvenience.

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