Deductibles Explained [MetLife Dental PPO]

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In terms of insurance, a deductible is the amount of money you must pay in health care costs before benefits like copay, coinsurance, and out-of-pocket maximum can be utilized.   

Think of a deductible as a pre-requisite to using your insurance or as something you have to reach before having access to your benefits.  

Why do I have a Deductible? 

Deductibles are usually paired with more affordable insurance plans in order to offer cheaper rates to customers who might not need that much in the way of care.  

With SDPEBA, the only Dental plan to feature a deductible is the MetLife PPO Plan

How does the MetLife Dental PPO Deductible Work?

The PPO plan splits the types of care into four categories: Type A, B, C, and D. Each of these categories has a different coinsurance amount, click here for more info about MetLife Dental's PPO coinsurance model. 

Category of Care

In-Network Coinsurance

Out-of-Network Coinsurance

Type A - Preventative

100%

100%

Type B - Basic Restorative

90%

80%

Type C - Major Restorative

60%

50%

Type D - Orthodontia

50%

50%

With the MetLife Dental PPO, your deductible only applies to type B and C care. Meaning, you do not have access to the coinsurance for Type B and C until you pay $50 for basic restorative or major restorative care. 

Once you pay $50 for care, your benefits kick in, and you will not need to pay the deductible until the following plan year. 

Details and figures used in this article reflect the 2020-2021 Benefit Year.

 

For more on your MetLife Dental Plan, click here! 

Didn’t answer your question? Click here to head to our main support page. There you can search for more answers or pose a question to our staff. 

You can also email us at support@sdpeba.org or call us at 888-315-8027! 

 

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