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2012 Plan Summary:  MetLife PDP & Delta Dental PPO

The plan design described below is offered by two dental plan administrators. In order to receive network benefits, you must utilize providers within the network of the plan administrator you choose.


MetLife Dental
Network:  PDP
Group #:  300649
www.metlife.com/dental
1-800-942-0854
Delta Dental
Network:  Delta Dental PPO
Group #:  050527
www.deltadentalmn.org
1-800-448-3815
  MetLife PDP/Delta Dental PPO Networks Delta Dental Premier Network All Networks
In-Network In-Network Out-of-Network
Individual/Family Deductible
(excludes preventive and diagnostic)
$50/$150
Annual Plan Maximum - Per Person
(excludes Ortho)
$1,500
Preventive and Diagnostic 100% 80% 80%
Basic 80% after deductible
Major 50% after deductible
Ortho  
Annual Deductible None
Coinsurance 50%
Lifetime Maximum $2,000
Eligibility All members

Last updated: 9/23/2009