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MetLife Dental Documents
MetLife Dental Forms
2013 - 2014 Dental Plans
EPISD is please to continue offering MetLife Dental Plans. Select from one of three Plan Options that best meets your needs.
Dental HMO Plan TX-300
- No waiting periods, claim forms, deductibles or calendar year maximums.
- It is your responsibility to manage your dental care.
- Prior to receiving services, you should review the benefits summary for covered services and co-payments. (Co–payments apply only when services are performed by your selected Metlife general dentist.
- Orthodontics and specialty care will have a 70% co-payment of dentist’s usual fee for those services.
- No Out-of-Network benefits are available under this plan.
- Benefits available only through the network of participating providers.
DHMO Provider List
DHMO Specialty Referral Process
Safeguard Customer Service 1-800-880-1800
| Monthly | Semi-monthly | |
| Employee Only | $ 8.34 | $4.17 |
| Employee & One | $13.90 | $6.95 |
| E & Children | $16.14 | $8.07 |
| E & Family | $19.48 | $9.74 |
MetLife Low Plan
MetLife Customer Service 1-800-942-0854
- Calendar year Maximum - $1,000
- Implants are a covered benefit
- Orthodontia Lifetime Maximum - $1,000 per person
- Reimburses for covered procedures based on the plan’s schedule of benefits after a $50 annual deductible per person or $150 annual deductible per family is met.
- Review the Plan Summary of Benefits prior to enrolling, to obtain a list of procedures that are covered and the reimbursement amount.
- After claim has been filed Metlife will reimburse the employee for covered procedures (based on the Schedule of Reimbursements)
- Plan allows for you to receive care from any licensed dental care provider.
- Lower your out of pocket cost by 10 to 35% by using a provider under the "Preferred Provider Program"
NEW! 2013-2014 RATES
| Monthly | Semi-Monthly | |
| Employee Only | $15.16 | $7.58 |
| Employee & One | $30.34 | $15.17 |
| E & Children | $30.94 | $15.47 |
| E & Family | $46.12 | $23.06 |
MetLife High Plan
MetLife Customer Service 1-800-942-0854
- Using a Metlife PPO contracted dentist lowers your out-of-pocket expenses.
- Treatment procedures are categorized into 4 different classes and the plan pays a specific percentage of the treatment cost for class.
- Calendar year Maximum - $1,000
- $50 annual deductible per person or $150 annual deductible per family
- Plan allows for you to receive care from any licensed dental care provider.
- Lower your out of pocket cost by 10 to 35% by using a provider under the "Preferred Provider Program"
NEW! 2013-2014 RATES
| Monthly | Semi-monthly | |
| Employee Only | $22.26 | $11.13 |
| Employee & One | $44.54 | $22.27 |
| E & Children | $45.44 | $22.72 |
| E & Family | $67.72 | $33.86 |



