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I am hopeful you’re tracking all thatI’m here to talk to you about yourdental plan it is dental PPO so itworks much like you would expect on a on an HMO for medical I’m sorry on a PPOfor medical so let’s go through some ofthe changes that are taking place for2019 one of the enhancements that you’r gonna find is a missing tooth provision so before there was no provision onthere so that if you had a missing toothand .
you needed correction of that toothwhether it was for a bridge or an implant or ortho work whatever needed tobe done to fix that missing tooth there was no coverage so now you do havecoverage on that plan on this plan andso you will be able to have that missingtooth replaced how it needs to be fixedalso harmful habits bruxism is nowcovered and that’s excessive grinding ofthe teeth or jaw clenching so that wasadded to the plan for 2019 your orthomax was increased to 1500.
that is themaximum amount that could be paid fororthodontic treatment so if you hadworth of work in the past the way thatortho works is there is a maximum it’s alifetime maximum so if it was a thousandbefore and now it’s 1500 you now have anadditional 500 for anyone who’s had workbefore and if you have new work that youmight need going into 2019 you’llreceive that additional 500 okay alsoyour full mouth panoramic x-rays aregoing from one every three years to oneevery five years you also you get yourbite Wings automatically you get twosets of bite.
Wings on the plan everycalendar year so this is referring tothe full mouth x-ray which is going from the three years to the five yearsokay so eligibility you must roll on theplan during open enrollment just likeall of your other benefits and thebenefits will become effectivebeginning in January 2019 once youenroll in the plan that’s the plan thatyou’re in for the year and you can’tmake any other changes andas a qualifying event that would justifythat change a couple of the tools thatwe have if you need to get informationis this oral Fitness library comm itgives you a wealth of information
Ireally encourage you to just take a lookbefore you actually need it just to seewhat’s out there in case something comesup but you can go into those oralFitness library and there’s there’squestion and answers there’s glossaryzuv terms here’s a sample explanationof benefits that helps you to understandwhat’sbeing paid and what your amountis that you have to owe to the dentistonce you have services done there’sdifferent treatment options on there hasa lot of great information and articlesto help you through whatever dentalservice it is that you need to get moreinformation and to help you.
when you goto the dentists to know what kind ofquestions you need to ask to make surethat you’re getting the best carepossible in addition you can register onmet lives my benefits portal you’ll alsohave an access to that oral healthlibrary but this is more tailored to yoin the plan that you have and so it cansee your claim so if you need to viewyour claims you can go on there you canprint out an ID card although you don’tneed one when you’re going to thedentist it will allow you to print oneif you feel more comfortable having thatand you can look search for a providerand when you search for a provider whatyou’re going to be looking for is thePDP plus Network.
it will ask you whatnetwork you’re in and you want to makesure that you choose that lunch so itshows you the appropriate list ofparticipating dentists for that planit’s the PDP pluslet’s go some of the key features onthis dental PPO plan.
it is a very largenetwork you won’t have trouble findingany any providers in the network it islarge enough however your benefit is aPPO which means you have in network andout of network benefits so you do wantto pay attention to the difference thatyou would be paying out-of-pocket bygoing to one of our participatingdentists and in the second bullet pointthere you see that we have negotiatednegotiated fees out of typically fifteento forty five percent less than thecharges that you’re going to find if youwere to go to an out of network dentist so it’s important that if you are movinginto this plan and you’re currently havea dentist that you’ve been using thatyou’re going to want to check thenetwork to make sure that they are in inour network the participating dentistsare what we call their contracted withus so if you call your dentist and areasking if they’ll take MetLife that wordtake .
MetLife is basically saying willyou take money from MetLife and theiranswer is gonna be yes we’ll take itfrom anyone you take if you want to giveit to us from however you want to makesure that they are a participatingdentists you can use that term or acontracted dentists in order to find outbut the best place to find out if theyare is if you can go to MetLife comm orto search on our my benefits portal ifyou’re having any sort of service thatis over three hundred dollars is aboutthe mark that dentists will probablytell .
you that they’d like to do this ontheir own is you’re gonna want to get apretreatment estimate just like youwould do if you were going and havingyour car fixed and that’s going to tellyou what your out-of-pocket costs aregoing to be okay we have a customerservice number you can call go on phonefax online we have a lot of informationthat’s on the back table back therethere’sza packet that has everythingthat we’re talking about today and youcan get those phone numbers in there aswellokay here we see a highlight of yourplan and I want to step through whatthose benefits are and how they work soyou’re clearly understanding how the PPOfunctions s with a PPO as you heard onthe medical.
you have a coinsurance a coinsurance versus a copay which is aflat dollar amount so with a coinsuranceyou’re paying a percentage share a dMetLife pays a percentage share and soyou see those listed in three differentcolumns here the first column shows youyour types of services type a B and Cthe second column shows your in-networkbenefits and the third column shows yourout of network benefits I’m going tofirst step through the first column wecategorize the types of services andyou’ll see the different percentages associated with them so type a servicesare your preventive type services thoseare your cleanings type B are your basicservices fillings extractions and type Care more of the major services denturescrowns bridges if you look to the rightyou’ll see under preventive care ahundred percent coverage whether it’s inor out of network okay if you look atthat top column on in network it saysit’s it’s hundred percent but of anegotiated fee whereas out of network isof a reasonable and customary fee.
so letme just give you a quick overview ofwhat that is so a negotiated fee is afee that we’ve negotiated with thatdentist that they will accept as payment in full they cannot charge over that amount thatwe’ve agreed upon with them so you’repaying a percentage of a very definedamount and based on the type of servicethat it is that’s what the amount isgoing to be on that if it’s a fillingit’s this if it’s a crown is this soyou’re paying a percentage of that feewhen you go out of network it’s apercentage based on a reasonable andcustomary so we look at what thatspecific service is we look at the zipcode that geographical area and whatmost dentists are going to charge forthat particular service so it’s it’s afee that’s going to end up being like wesaid before fifteen to forty fivepercent higher than what you’d get asnegotiated fee and then on top of thatthey are allowed to do what’s calledbalance.\
billing and they can charge thereamamount of you to get to what they wouldhave charged above up and above thatreasonable and customary amount not alldentists will do that additional balancebilling but some will so it’s importantto know that difference because when yousee on preventive care it’s a hundredpercent so there’s no out-of-pocketcosts for you unless that dentist ischarging doing that balance billing whenyou go out of network okay but where itthat means wepay eighty percent you pay twentypercent when wou’re in network out ofnetwork it changes and now it’s aseventy thirty we pay seventy you pay thirty so that additional percentagethere now instead of you paying twentypercent you’re paying thirty percent butyou’re paying a higher percentage on ahigher amount because it’s no longer thenegotiated fee.
if you’re in network it’snow that higher percentage on thereasonable and customary rate pluspossibly balanced billing okay so youcan see even though it’s just tenpercent a lot of people look at this andyou say it’s only a ten percentdifference but you just have to knowwhat your percentage of is and so it’simportant to have that distinction so Ilike to spend a little bit of time onthat okay because it’s a PPO plan thereis a deductible on it and so you seeyour deductible there is for type A andB services only and that’s the amountthat you have to pay before the planstarts paying it’s cochere so it’s afifteen dollar for individual and 45 forfamily if you’re in network and then itincreases out of network to twenty-fivefor individual as seventy five forfamily and what that means when we splitthat out between individual and familyis that individual component justapplies to you so even though you’recovering your family you may be coveringsomeone more than just you on the planyou still only need to meet yourindividual deductible for yourself andthen the plan will start kicking in it’scoinsurance.
so if you’re in network it’sfifteen dollars so if you go and have afilling done and it cost a hundreddollars the first fifteen dollars isgoing to be out of your pocketthe remaining eighty five dollars ofthat filling is now going to be subject to the coinsurance you pay twentypercent and the plan will pay eightypercentokay there is an annual benefits maximumon the plan and this works a little bitdifferently than the maximum you’ll findon a medical plan on a medical plan youhave an out-of-pocket maximum that’s themost you will pay out-of-pocket once youhit that max then it’s covered a hundredpercent for you when it comes to dental it’s a planned maximum the plan beingMetLife which means once MetLife hitsthat maximum MetLife stops paying on theplan so as we’re paying our co share andyou’re paying your co share once metlife’s expenses hit $2,000 then MetLifestops paying on the plan and theremainder would be out of your pocketokay it is a per person maximum so eachperson in your family that’s coveredgets $2,000 and that’s for the calendaryear and it resets again the next yearwhen you enroll orthodontia has its ownseparate maximum and this maximum is theone that we said was enhanced this yearto be $1,500 and that’s again per personit’s both adult and child ortho on theplan so adults do have access to thisbenefit so once we hit $15 $1500 thenthe plan won’t pay any more and rememberthat on ortho it is a lifetime max asopposed to a calendar year max so youget that on time but like I said if youwere on the plan before and it was onlya thousand max now you have thisadditional 500 if you need more workdone in this next new year in 2019you’ll get that additional 500 benefitto complete your 1500 lifetime.
the my benefits portal we talked aboutit you can go on online there you cansee who’s covered on your plan what yourplan benefits are print ID cards look atclaims information look up providerslike I said it’s tailored to you ifyou’ve never been on it before this planis new to you you need to go on andregister it just takes a couple minutesto go ahead and fill out your personalinformation regarding your name and allof that and they’ll get you registeredinto the plan and then you can access things that are particularly right toyou we also have a mobile app so everything that we’re doing when you’re on the go it’s an easy access especiallyif you’re somebody who’s traveling oftenyou’re gonna want to be able to accessaccess providers that are in the networkand view them so it’s great to have theapp on your phone okay you need toenroll by the end of November I’m goahead on your benefits portal and that’swhere you’re going to enroll and if youhave any questions at any time you cango ahead and call us it’s an easiermember 1-800 get met eight and thenumbers are there Monday through Friday5:00 a.m. to 5:00 p.m.and I’ll be available afterward forquestions thank you