The SDPEBA MetLife Dental plan is coming to County employees this open enrollment! We offer two comprehensive plans each designed by SDPEBA and MetLife for San Diego employees in particular. The different plans are designed with the different needs of our members in mind!
HMO vs PPO
Before you sign up for MetLife Dental’s plan you need to understand the difference between the HMO and PPO plan.
HMO stands for Health Maintenace Organization. Which features a cheaper monthly payment and a detailed copay system. HMOs are notably less flexible than other options, but are designed that way intentionally, so that you can develop a relationship with your local dentist and so MetLife can make sure your dentist meets their high standards all while saving on regular visits.
PPO stands for Paid Provider Plan. It costs more per pay period but has access to more generous coinsurance model. This PPO also has a deductible (a minimum annual payment before you receive most benefits). PPOs are one of the most flexible types of insurance plans and are designed to save you money and give you the ability to shop around and do your own research for the dentist that is best for you. This plan also gives you the ability to seek specialty care on your own, without a referral from your dentist.
Each of these plans offer a lot in terms of coverage options and gets very specific into what you have coverage for and how much that will cost, which is great, but can be a little confusing when you’re first looking into it. If you have any questions, you can contact SDPEBA or check out our dental resources on our website.
How does it Work
The HMO plan offers copays that are all outlined on your summary of benefits, whereas the PPO plan separates different procedures into type A, B, C, or D. The HMO plan is very explicit with the costs for each procedure and has a comprehensive list in the plan’s brochure. The PPO plan on the other hand has categorized each procedure and you pay a percentage based on which category your treatment falls into.
More on the PPO Categories:
Type A – Preventative Care: 100% in-network coverage, 100% out-of-network coverage
Examples: oral exams, cleanings, full-mouth x-rays
Type B – Basic Restoration: 90% in-network coverage, 80% out-of-network coverage
Examples: sealants, root canals, fillings
Type C – Major Restoration: 60% in-network coverage, 50% out-of-network coverage
Examples: crowns, dentures, bridges
Type D – Orthodontia: 50% in-network coverage, 50% out-of-network coverage
Examples: braces, retainers, any other related charges
How do you use it?
To use the plan, simply provide your dentist with your insurance information when you arrive for treatment. We always recommend you get a pre-treatment estimate for all dental services. You can get one by simply requesting it during your dental visit.
In order to find an in-network dentist head to this site. From there you can enter your zip code and your network. With the SDPEBA MetLife Dental PPO, your network would be PDP Plus. Once you’ve entered your information, you’ll be given a list of dentists within 25 miles and whether that dentist is accepting new patients. From there you can click on the dentist’s name and receive more information about the office, its location, and the dentist’s expertise/history. From there you can call or email the dentist for an appointment.
How Much is it?
The cost of the MetLife Dental plan varies depending on which version you sign up for. We won’t have official rates until after negotiation, this should happen by mid-September. We will be posting rates in our guide and our website.
Important Note: Since this plan is administered solely by SDPEBA and MetLife, it is a post-tax plan and you cannot use your flex dollars for it. Meaning its quite different from the County’s dental plan.
How do you Enroll?
To enroll, please contact SDPEBA during open enrollment. You can email [email protected] or call 888-315-8027. If you have more questions, please check out our website http://www.sdpeba.org or head to our MetLife Dental homepage.
If you’re torn on if you should get a MetLife dental plan or which plan, consider how often you plan on going to the dentist and what kind of services you might need. If you are going to need a lot of services, which would help you save money in the long run? If you have dependents, make sure you’re factoring their rates in as well and considering whether or not the limitations will impact their access to care. Also consider deductibles, dental emergencies, orthodontics, and whether or not you’ll have access to coverage. We are happy to help walk through the options with you in more detail as well, you can contact us by emailing [email protected] or by calling 888-315-8027.