Dental Plan Comparison Chart
| |
Penn Faculty Practice (PFP Plan)* |
MetLife Preferred Dentist Program (PDP)** |
| Preferred Provider |
Non-Preferred Provider |
| Deductible |
None |
None |
None |
Diagnostic Care
(e.g., exams, x-rays) |
100% |
100% |
100% of R&C |
Preventive Care
(e.g., cleanings) |
100%
Limited to two visits per plan year (7/1 - 6/30) |
100%
Limited to two visits per plan year (7/1 - 6/30) |
100% of R&C
Limited to two visits per plan year (7/1 - 6/30) |
Restorative Care
(e.g., fillings) |
100% |
90% |
90% of R&C |
Oral Surgery
(e.g., extractions) |
100% |
100% |
100% of R&C |
Endodontics
(e.g., root canal therapy) |
80% |
80% |
80% of R&C |
Periodontics
(e.g., gum treatment) |
80% |
80% |
80% of R&C |
Prosthodontics
(e.g., bridges, dentures) |
60% |
50% |
50% of R&C |
| Crowns and restorations |
60% |
50% |
50% of R&C |
| Implants |
50%
$1000 lifetime maximum; lifetime limit of 2 implants |
Not covered |
Not covered |
Orthodontics***
(for children under age 19) |
60%****
$2000 lifetime maximum benefit for each child |
50%
$1000 lifetime maximum benefit for each child |
50% of R&C
$1000 lifetime maximum benefit for each child |
| Annual Maximum |
$3000 per individual |
$1500 per individual |
$1500 per individual |
*Please reference the 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.
**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 5 or older.