MetLife Dental Plans – Keywords – Morgan Stanley Benefits

MetLife Preferred Provider (PDP) Network

MetLife’s nationwide network features more than 317,000 dentists, and all PDP dentists must meet MetLife’s standards for licensing, education, practice history and emergency coverage.

When you receive services from a PDP dentist, you do not need to meet an annual deductible; your out-of-pocket expenses are reduced to pre-negotiated rates and your annual benefit maximum is greater than if you use a non-PDP dentist.

MetLife Option A	MetLife Option B
Note
The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums, which employees pay.
Individual Annual Deductible
In-Network: No annual deductible Out-of-Network: $50	In-Network: No annual deductible Out-of-Network: $100
Family Annual Deductible
In-Network: No annual deductible Out-of-Network: $150	In-Network: No annual deductible Out-of-Network: $300
Diagnostic and Preventive Care
In-Network: 100% Out-of-Network: 80% of R&C; deductible waived	In-Network: 100% Out-of-Network: 50% of R&C; deductible waived
Restorative Services
In-Network: 80% of discounted fee Out-of-Network: 75% of R&C, after annual deductible	In-Network: 80% of discounted fee Out-of-Network: 40% of R&C, after annual deductible
Prosthodontics
In-Network: 50% of discounted fee Out-of-Network: 50% of R&C, after annual deductible	In-Network: 50% of discounted fee Out-of-Network: 25% of R&C, after annual deductible
Orthodontics
In-Network: 50% of discounted fee, up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults) Out-of-Network: 50% of R&C, up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults)	In-Network: 50% of discounted fee, up to a $2,000 lifetime benefit maximum per child (children to age 19) Out-of-Network: Not covered
Annual Benefit Maximum per Person
In-Network: $3,000 Out-of-Network: $2,000	In-Network: $2,000 Out-of-Network: $1,000

MetLife Option A

MetLife Option B

Note

The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums, which employees pay.

Individual Annual Deductible

In-Network:
No annual deductible

Out-of-Network:
$50

In-Network:
No annual deductible

Out-of-Network:
$100

Family Annual Deductible

In-Network:
No annual deductible

Out-of-Network:
$150

In-Network:
No annual deductible

Out-of-Network:
$300

Diagnostic and Preventive Care

In-Network:
100%

Out-of-Network:
80% of R&C; deductible waived

In-Network:
100%

Out-of-Network:
50% of R&C; deductible waived

Restorative Services

In-Network:
80% of discounted fee

Out-of-Network:
75% of R&C, after annual deductible

In-Network:
80% of discounted fee

Out-of-Network:
40% of R&C, after annual deductible

Prosthodontics

In-Network:
50% of discounted fee

Out-of-Network:
50% of R&C, after annual deductible

In-Network:
50% of discounted fee

Out-of-Network:
25% of R&C, after annual deductible

Orthodontics

In-Network:
50% of discounted fee, up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults)

Out-of-Network:
50% of R&C, up to a $3,000 lifetime benefit maximum per person (children to age 26 and adults)

In-Network:
50% of discounted fee, up to a $2,000 lifetime benefit maximum per child (children to age 19)

Out-of-Network:
Not covered

Annual Benefit Maximum per Person

In-Network:
$3,000

Out-of-Network:
$2,000

In-Network:
$2,000

Out-of-Network:
$1,000

Note: Out-of-network reimbursements and maximums are based on reasonable and customary (R&C) charges as determined by each Dental Plan administrator. Please refer to the Health Benefits and Insurance Summary Plan Description for details.

Orthodontics Lifetime Maximum Benefit

The orthodontics lifetime benefit maximum is combined across plan options.

A Note About Annual Benefit Maximums

In no event can any one person receive more than the annual benefit maximum during a calendar year (excluding orthodontics), even if provided by an in-network or Premier Network dentist.

Dental Contributions

You and the Firm share the cost of your Dental Plan coverage. Your contributions are deducted from your pay on a before-tax basis.

Note: Your location and salary band are used to calculate only your medical contribution rates.
The costs shown below are per paycheck contributions. For the monthly cost, double the amounts shown.

	Yourself Only	Yourself + Spouse/Domestic Partner	Yourself + Children	Yourself + Family
MetLife Option A	$13.92	$27.83	$27.83	$41.75
Delta Dental Option A	$13.92	$27.83	$27.83	$41.75
MetLife Option B	$7.88	$15.75	$15.75	$23.92
Delta Dental Option B	$7.88	$15.75	$15.75	$23.92

If you are covering a domestic partner or the children of a domestic partner, the IRS determines the tax status of a dependent and may impose a tax on the value of coverage. Consult your tax advisor for more information.