Dental Plan Comparison Chart
| |
Penn Faculty Practice
(PFP Plan)* |
MetLife Preferred Dentist Program (PDP)** |
| Preferred Provider |
Non-Preferred Provider |
| Deductible |
None |
$50 individual |
$50 individual |
Diagnostic Care
(e.g., exams, x-rays) |
$0 copay |
$0 copay |
$0 copay of R&C** |
Preventive Care
(e.g., cleanings) |
$0 copay
Limited to two visits per plan year (7/1 - 6/30) |
$0 copay
Limited to two visits per plan year (7/1 - 6/30) |
$0 copay of R&C**
Limited to two visits per plan year (7/1 - 6/30) |
Restorative Care
(e.g., fillings) |
$0 copay |
10% after deductible |
10% of R&C** after deductible |
Oral Surgery
(e.g., extractions) |
$0 copay |
$0 copay |
$0 copay of R&C** |
Endodontics
(e.g., root canal therapy) |
20% |
20% after deductible |
20% of R&C** after deductible |
Periodontics
(e.g., gum treatment) |
20% |
20% after deductible |
20% of R&C** after deductible |
Prosthodontics
(e.g., bridges, dentures) |
40% |
50% after deductible |
50% of R&C** |
| Crowns and restorations |
40% |
50% after deductible |
50% of R&C** after deductible |
| Implants |
50%
$1,000 lifetime maximum; lifetime limit of two implants |
Not covered |
Not covered |
Orthodontics***
(for children under age 19) |
40%****
$2,000 lifetime maximum benefit for each child |
50%
$1,000 lifetime maximum benefit for each child |
50% of R&C**
$1,000 lifetime maximum benefit for each child |
| Annual Maximum |
$3,000 per individual |
$2,000 per individual |
$2,000 per individual |
*Please reference the PFP plan document for limitations and exclusions. Note that if you receive dental treatment anywhere other than a Penn Faculty Practice (PFP) Plan office, no benefits will be paid unless due to an emergency that occurs outside of the Philadelphia area (outside a 50-mile radius of a PFP office). Reimbursement will be at the PFP Plan coverage level, based on PFP network fees.
**Please reference the MetLife plan summary for limitations and exclusions. Note that benefits at a MetLife PDP provider are based on the fee negotiated by MetLife with the provider. Non-preferred provider benefits are based on the Plan's reasonable and customary limits (R&C). Non-preferred dentists are not required to accept the R&C as payment in full, so you may be required to pay any charges in excess of the payment made by the Plan.
***Any amounts applied to the lifetime maximums for orthodontics apply toward the annual benefit maximums as well.
****For the Penn Faculty Practice Plan, there is a 12-month waiting period for orthodontic services for children age five or older.