Dental HMO & Contributions
Nant associates located in California, Texas, New York and New Jersey are eligible to participate in the MetLife Dental HMO Plan highlighted in the following charts for yourself and, if you wish, your eligible dependents. The DHMO plan provides coverage for a wide range of services while you enjoy substantial cost savings. When you enroll in the DHMO Plan, you must choose a Primary Dental Provider (PDP) from the Dental DHMO network to manage your care.
The chart below illustrates how the DHMO plan works and how each type of service is covered by the dental plan. Refer to the dental benefit summary for more details.
| Dental DHMO | |
|---|---|
| METLIFE HMO | You Pay |
| Office Visit | $5 copay |
| Annual Maximum | Unlimited |
| D1110 - Adult Prophylaxis (Cleaning) 2 per calendar year | No charge |
| D2750 - Crown, Porcelain fused to high noble metal (Molar) | $185 |
| D3330 - Root Canal, Molar (excluding final restoration) | $200 |
| D8080 / D8090 Orthodontia | $1,695 adult / $1,695 child |
| D9243 - General Anesthesia, 15 minutes | $60 |
| Contribution | Dental HMO Bi-Weekly Cost |
|---|---|
| You Pay | |
| Employee Only | $1.62 |
| Employee+Spouse | $3.09 |
| Employee+Child(ren) | $3.25 |
| Family | $4.63 |
To optimize your dental benefits with MetLife, be sure to visit their online provider finder to look up participating providers within your DHMO network. Go to www.metlife.com/dental. Go to the center of the screen and click on “Find a Participating Dentist”. Under the “Select your network” dropdown select “Dental HMO/Managed Care.” Under “Select a Plan” select “MET185” as your plan. Input your zip code and select your search radius. Press “Search” to begin your search.
Dental PPO
All Nant associates are eligible for the dental PPO plan. The two charts below illustrate how the DPPO plan works and how each type of service is covered by the dental plan. Refer to the dental benefit summaries from MetLife for more details.
To optimize your dental benefits with MetLife, be sure to visit their online provider finder to look up participating providers within your DPPO network. Go to www.metlife.com/dental. Go to the center of the screen and click on “Find a Participating Dentist”. Under the “Select your network”, select “PDP Plus.” Input your zip code and select your search radius. Press “Search” and you will be directed to another screen where the providers will be listed. Modify the search criteria to refine your search
Dental PPO Low - $2,000 Annual Maximum Option & Contributions
| METLIFE DENTAL | Dental PPO - $2,000 Annual Maximum Option | |
|---|---|---|
| In-Network | Non-Network | |
| Deductible (In-and Non-Network Combined) | $25/Individual; $75/Family (Type B & C) |
|
| Annual Maximum Benefit: Per Individual | $2,000 | |
| Type A - Diagnostic & Preventive Services | 0%; No deductible | 0%; No deductible |
| Type B- Basic Services | 20%; after deductible | 20%; after deductible |
| Type C- Major Services | 50%; after deductible | 50%; after deductible |
| Orthodontia Lifetime Maximum: Per Individual | $2,000 | |
| Orthodontia Lifetime Maximum: Per Individual (Adults and Children to age 26) | 50% | 50% |
| Contribution | Dental PPO Low - $2,000 Annual Maximum Option Bi-Weekly Cost |
|---|---|
| You Pay | |
| Employee Only | $5.04 |
| Employee+Spouse | $10.30 |
| Employee+Child(ren) | $12.20 |
| Family | $18.77 |
Dental PPO High - $5,000 Annual Maximum Option & Contributions
| METLIFE DENTAL | Dental PPO - $5,000 Annual Maximum Option | |
|---|---|---|
| In-Network | Non-Network | |
| Deductible (In-and Non-Network Combined) | $25/Individual; $75/Family (Type B & C) |
|
| Annual Maximum Benefit: Per Individual | $5,000 | |
| Type A - Diagnostic & Preventive Services | 0%; No deductible | 0%; No deductible |
| Type B- Basic Services | 20%; after deductible | 20%; after deductible |
| Type C- Major Services | 50%; after deductible | 50%; after deductible |
| Orthodontia Lifetime Maximum: Per Individual | $2,000 | |
| Orthodontia Lifetime Maximum: Per Individual (Adults and Children to age 26) | 50% | 50% |
| * $25 per person up to a max of $75. If there are more than 3 family members in the family, it would max out at $75 once met | ||
| Contribution | Dental PPO High - $5,000 Annual Maximum Option Bi-Weekly Cost |
|---|---|
| You Pay | |
| Employee Only | $5.21 |
| Employee+Spouse | $10.60 |
| Employee+Child(ren) | $12.39 |
| Family | $19.11 |