Two women in retirement walking outside for exercise

BENEFITS

Dental Insurance

PROVIDER

Group Number 139210
1-800-942-0854

Both retiree dental plan options offer MetLife’s negotiated fees for all in-network services, which can save you money on out-of-pocket costs. The negotiated fees even extend to non-covered services, which include services provided after the annual benefit maximum is exceeded.

RETIREE DENTAL SUMMARY OF BENEFITS

MetLife

Plan Features

Option 1

Option 2

Coverage Type

In-Network

Out-of-Network

In-Network

Out-of-Network

Preventive

100% of PDP Fee1

100%2

100% of PDP Fee1

100%2

Basic Restorative

70% of PDP Fee1

70%2

70% of PDP Fee1

70%2

Major Restorative

0% of PDP Fee1

0%2

70% of PDP Fee1

50%2

Deductible3:

In-Network

Out-of-Network

In-Network

Out-of-Network

Retiree Only

$75

$75

$75

$75

Retiree + 1

$150

$150

$150

$150

Retiree + 2 or more

$225

$225

$225

$225

Annual Maximum:

In-Network

Out-of-Network

In-Network

Out-of-Network

Per Person

$750

$750

$1,500

$1,500

Please Note:

  • Premiums: Individual Costs vary. To determine your individual cost, refer to the retiree packet from WoodmenLife, the enrollment packet from MetLife or call MetLife directly.

  • If you’re currently under a treatment plan, COBRA coverage may be the best option for your enrollment to complete treatment. Upon completion of treatment (or at end of 18 months), contact MetLife for your enrollment packet for Retiree Dental.

  • Benefit start date will be dependent upon when your completed enrollment is received by MetLife. If received before 15th of month, your coverage will start on the 1st of following month. If enrollment is received after the 15th of month, coverage starts the 1st of second following month.



Disclosures

  1. PDP Fee refers to the fees that participating dentists have agreed to accept as payment in full.

  2. Reasonable and customary charges are based on the research of a dentist’s usual, actual and community average charge as determined by MetLife.

  3. Applies only to Basic and Major Services

Customer Service: 1-800-225-3108
Monday – Thursday 7:00 a.m. to 5:00 p.m.
Friday 7:00 a.m. to 12:00 p.m. (Central Time)

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Omaha, Nebraska

The information on this page is a partial description of benefits, limitations, exclusions, and other provisions of the group benefits provided by Woodmen of the World Life Insurance Society (WoodmenLife). If there is a difference between the information in this summary and the plan document for each plan, the plan documents govern. Eligibility requirements apply to each of the benefits offered, criteria may include employment status and/or individual qualifications. For more detailed information, refer to the Summary Plan Description of each plan. WoodmenLife may amend these plans at any time. The description of the plan is not a guarantee of benefits and should not be construed as such.

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