NCD by MetLife
NCD Complete by MetLife
- Underwritten by MetLife
- Freedom to choose any dentist, but using participating dentist will give you in-network benefits
- Coverage for you and qualified family members
- No Waiting Periods. Coverage for preventive, basic and major services offered year 1
- Increasing benefits over 3 years period for Basic and Major services
- Guaranteed acceptance
- Vanishing deductible after Year 1
| Common procedures: | |
|---|---|
| Cleaning: | 100% |
| White Filling: | 65-90% |
| Crown: | 10-60% |
| Root Canals: | 10-60% |
| Simple Extractions: | 10-60% |
| Plan Maximum: | $10,000 per Calendar Year per person $3000 per Calendar Year per person Implant Max within the Plan Max |
| Waiting Periods: | None |
| Deductible: | $100 per person for Basic and Major Services - Year 1. Vanishing Deductible after Year 1. |
| Details: |
|---|
| Fee Schedule: N/A | Dentist Search | Exams: |
| Routine oral examinations – 3 per calendar year 100% Preventive – No waiting period | Cleanings: |
| Teeth Cleanings – 3 per calendar year 100% Preventive – No waiting period | X-Rays: |
| Bitewing x-rays only – Adults – 1 time in 12 months; Child (under age 14) – one time in 12 months 100% Preventive – No waiting period | Fillings: |
| Fillings – initial placement – unlimited Replacement fillings – Replacement once every 24 months 1st year – 65% after deductible 2nd year – 80% 3rd year and after – 90% Basic – No waiting period | Extractions: |
| Extractions (simple and surgical) - unlimited 1st year – 10% after deductible 2nd year – 50% 3rd year and after – 60% Major – No waiting period | Crowns: |
| Crowns – No more than one per tooth in 10 calendar years 1st year – 10% after deductible 2nd year – 50% 3rd year and after – 60% Major – No waiting period | Root Canals: |
| Root canal treatment – one per tooth per lifetime 1st year – 10% after deductible 2nd year – 50% 3rd year and after – 60% Major – No waiting period | Dentures: |
| Dentures - one in 10 calendar years 1st year – 10% after deductible 2nd year – 50% 3rd year and after – 60% Major – No waiting period | Deep Cleanings: |
| Periodontal Scaling & Root Planing - one per quadrant in any 24 month period 1st year – 10% after deductible 2nd year – 50% 3rd year and after – 60% Major – No waiting period | Implants: |
| Implant Services ($3000 Calendar year Max within the $10,000 Plan Max) - one per tooth position in 10 calendar years 1st year – 10% after deductible 2nd year – 50% 3rd year and after – 60% Major – No waiting period | Braces/Orthodontia: |
| Not Covered Service | Teeth Whitening: |
| Not Covered Service | Additional Network Information: |
In-network refers to benefits provided under this program for covered dental services that are provided by a participating dentist. Out-of-network benefits refer to benefits provided under this program for covered dental services that are not provided by a participating dentist. If a Covered Service is performed by an In-Network Dentist, We will base the benefit on the Covered Percentage of the Negotiated Fee Schedule. If an In-Network Dentist performs a Covered Service, You will be responsible for paying:
If a Covered Service is performed by an Out-of-Network Dentist, We will base the benefit on the Covered Percentage of the Schedule Amount. Out-of-Network Dentists may charge You more than the Schedule Amount. If an Out-of-Network Dentist performs a Covered Service, You will be responsible for paying:
*The Negotiated Fee Schedule for a covered service is the amount that in-network dentists have agreed to accept as payment in full for the covered service. Percentages shown are based on the Negotiated Fee Schedule, even when a covered service is provided by an out-of-network dentist, except in AK, NV, MA and MT. In these states, out-of-network percentages shown are based on a percentile of the reasonable and customary (R&C) charge. The R&C charge is based on the lowest of: (1) the dentist’s actual charge for a covered service; (2) the dentist’s usual charge for the same or similar service; or (3) the amount charged by most dentists in the same geographic area for the same or similar service as determined by MetLife. Exclusions and LimitationsPrivacy Policy Plan Brochure |
FAQ:
Am I covered if I go to a non-participating dentist?
You can use any licensed dentist. However, if you visit an out-of-network dentist you may have higher out-of-pocket costs than if you use a dentist that is in-network. In most states, the TakeAlong Dental programs have maximum allowable charges that in-network providers have agreed to accept as payment in full for covered services*. We pay a percentage (% varies by type of procedure) of those agreed upon charges, and you are responsible for the remaining balance of those charges. In most states, out-of-network benefits are also based on a percentage of the maximum allowable charge. If you visit an out-of-network dentist, in addition to any applicable deductible, you would be responsible for the percentage of the maximum allowable charge that MetLife does not pay (the coinsurance amount) as well as for the amount of the out-of-network dentist’s fee that is in excess of the maximum allowable charge.
* Maximum allowable charges refer to the charges that in-network dentists have agreed to accept as payment in full for covered services, subject to any deductibles, copayments, coinsurance and benefit maximums. Maximum allowable charges are subject to change. In most states, out-of-network benefits are also based on a percentage of the maximum allowable charge.
How do I find a participating dentist?
You can find the names, addresses, specialties, languages spoken and telephone numbers of participating dentists in a given area by searching our online directory.
What is a participating dentist?
A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees* as payment in full for covered services. Negotiated fees typically range from 30% - 45% less than the average charges in a dentist’s community for similar services.
*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, coinsurance and benefit maximums. Negotiated fees are subject to change.
What is a pre-existing condition versus work-in-progress? Is it covered?
A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions.
Work in progress is any oral health procedure that is started and not completed prior to your enrollment in a dental program. The plan does not cover any expenses prior to the date you are covered under the Policy.
What services are covered under this Dental program?
To find out more about covered services, see Full Schedule of Benefits.
NOTE: Services started under a different carrier’s policy do not carry over to these programs – check with your dental carrier to be sure all services associated with that policy are completed before enrolling in NCD by MetLife Dental Plan.
Who can enroll in this plan?
Any individual over the age of 18 may apply for a policy for themselves and their dependents.
* Not available in PR and VI.
4201 Spring Valley Road, Suite 1500
Dallas, TX 75244
Disclaimers and Disclosures:
NCD by MetLife:Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. Like most insurance policies, insurance policies offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact [ ] for costs and complete details. Coverage may not be available in all states.
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
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