PLAN INFORMATION
The Plan is insured by MetLife
Employees choose between two options. Both Options have the same rates.
Dental insurance premiums for Haralson County employees are among the lowest costs of any school system or other employer in this area, while providing excellent benefits.
ENHANCED BENEFITS
Plan Year Maximum
The Plan Year Maximum is $1,250 Per Covered Participant
Adult Orthodontics
Orthodontic Coverage is available for dependent children and adults. The Lifetime Maximum is $1,000
Waiting Periods
A late entrant is an employee or dependent who does not enroll when first eligible and decides to enroll at a later date. Late entrants can only enroll during the Annual Open Enrollment Periods and will have no waiting periods.
BENEFITS OPTIONS
Differences between Open Network UCR Plan and the In-Network MAC Plan are reimbursement levels for Out-Of-Network providers and level of services covered.
- Open Network UCR Plan pays out of network providers based on Usual, Customary and Reasonable fees (90% UCR). Choose this plan if your provider is Out of Network. This Plan pays Basic Services at 80%.
- In Network MAC Plan reimburses out of network providers at the negotiated network provider fee. If your provider is out of network and you choose this plan, you will likely be balance billed. In Network MAC Plan, includes a higher coverage level for Basic Services (100%).
MetLife Benefit Summary – Including exclusions and limitations
| Benefit | In Network MAC Plan | Open Network UCR Plan |
|---|---|---|
| Preventive Services | 100% | 100% |
| Basic Services | 100% | 80% |
| Major Services | 60% | 50% |
| Out of Network Provider Reimbursement | Charge Based on Network Provider Discount | 90% Usual & Customary |
| Deductible | $50 Individual $150 Family | $50 Individual $150 Family |
| Maximum Benefit | $1,250 | $1,250 |
| Orthodontic Services | 50% | 50% |
| Lifetime Maximum | $1,000 | $1,000 |
CERTIFICATE OF COVERAGE
In Network Low Option– MetLife
Open Access UCR High Option– MetLife
RATES
| Coverage | Monthly |
|---|---|
| Employee Only | $33.62 |
| Family | $98.92 |
Covered Dependents – Unmarried dependent children to age 26, regardless of student status.
METLIFE PROVIDER SEARCH
MetLife Provider Search – use the PDP Plus Network
Choose the Open Network UCR/High Option if your provider isn’t part of the Network. Your out of network claims will be paid based on 90% Usual and Customary. There will be less chance of a balance bill under this option.
Choose the In-Network MAC/Low Plan ONLY if your provider is part of the Network. You will be balance billed the difference if you see an out of network provider on this plan.
DENTAL CARDS
Employees will receive customized Dental Cards mailed to their home address.
Employees can also create an account and print a customized dental card at any time from https://metlife.com/mybenefits
Generic ID Cards can also be utilized
