| NCD - METLIFE Complete | SPIRIT Flex Plus 2500 | SPIRIT Senior Preferred PPO 3500 | SPIRIT PINNACLE PPO 5000 | |
| Area | Zip Codes 483 _ _ | Zip Codes 483 _ _ | Zip Codes 483 _ _ | Zip Codes 483 _ _ |
| Premium | $94 | $64.16 | $47.20 | $47.95 |
| Added with Vision | Extra $22 per month | Extra $7 per month | Extra $7 per month | Extra $7 per month |
| Deductible | $100 Lifetime | $100 Lifetime | $100 Lifetime | $100 Lifetime |
| Waiting Period Preventative/Basic/Major | None | None | None | None |
| Max Benefit (Adult) | $10,000 | Cumulates to $1500/2500/2500 Years 1,2,3 and on | Cumulates to $1500/3500/3500 Years 1,2,3 and on | Cumulates to $1200/2500/5000 Years 1,2,3 and on |
| Coverages on Diagnostic and Preventative | Exam,
3 Cleanings, Bitewing Xrays |
Exams, 3 Cleanings | Exams, 3 Cleanings | Exams, 3 Cleanings |
| Coverage types on Basic or Minor | Panoramic Xray, Fillings, Simple Extractions, Periodontal Maintence(deep cleaning) | Bitewing Xrays, Basic Fillings | Bitewing Xrays only | Bitewing
Xrays, Basic Fillings |
| Coverage types on Major | Crowns, Oral Surgery, Surgical Extractions, Endodontics, Periodontics, Dentures and repairs, Bridge, Anesthesia, and Implants | Panoramic, Simple Extractions, Oral Surgery, Endodontic, Periodontic, Bridges, Dentures, Crowns, Inlays and Onlays | Panoramic, Simple Fillings and Extractions, Oral Surgery, Endodontic, Periodontic, Bridges, Dentures, Crowns, Inlays and Onlays, Inplants | Panoramic, Simple Extractions, Oral Surgery, Endodontic, Periodontic, Bridges, Dentures, Crowns, Inlays and Onlays, Inplants |
| Tier 1 (Preventative) in/out of network % |
100% | 100% | In Network: 100% Out of Network: 90% |
In Network: 100% Out of Network: 90% |
| Tier 2 (Minor/Basic) in/out of network % |
Plan pays 65% Year 1, 80% Year 2, and 90% Year 3 of eligible charges | Plan pays 50% Year 1, 70% Year 2 and 80% Year 3 of eligible charges. | In Network: 65%, 100% and 100% Out of Network: 55%, 90% and 90% Years 1-3+ | In Network: 50%, 60% and 80%, Out of Network: 40%, 50% and 50% Years 1 - 3 + |
| Tier 3 (Major) in/out of network % |
Plan pays 10% Year 1, 50% Year 2, and 60% Year 3 | Plan pays 20% Year 1, 40% Year 2 and 50% Year 3 of eligible charges. | In Network: 20%, 50% and 50% Out of Network: 10%, 40%, and 40% Years 1-3+ | In Network: 25%, 30% and 60%, Out of Network: 15%, 20% and 20% Years 1 - 3 + |
| Tier 4 (Ortho) | None | None | None | Under 19 Only |
| Tier 4 (Implants) | Same as Major with a limit of $3,000 in the Calendar Year | None | In Network: 10%, 20% and 20% Years 1-3+, Out of Network 10% All Years | In Network: 10%, 10% and 20% Years 1 - 3+ Out of Network 10% All Years |
| Implant Benefit Details | Same as Major with a limit of $3,000 in the Calendar Year | N/A | In Network: 10%, 20% and 20% Years 1-3+, Out of Network 10% All Years | In Network: 10%, 10% and 20% Years 1 - 3+ Out of Network 10% All Years |
| Orthodontic Coverage | None | None | None | Under Age 19 |
| Hearing Available | None | None | Up to $75 for eligible hearing exams. 50% of hearing aid cost up to max benefit per ear of $200 Day 1 and $400 after Year 1. | None |
| Vision Available | Optional Buy Up | Optional Buy Up - See brochure for details provided in link below. | Optional Buy Up - See brochure for details provided in link below. | Optional Buy Up - See brochure for details provided in link below. |
| Enrollment Process | MetLife Enrollment Link | Spirit Enrollment Link | ||
| Important to Note | Network Dentists have a negotiated fee schedule so you should save more money going to an in network dentist. | Non Network Dentist will be based on Usual and Customary Charges. Recommend In Network. | Non Network Dentist, you pay the difference between what the plan pays (Maximum Allowable Benefit) and the Dentist's Actual Charge. | Non Network Dentist, you pay the difference between what the plan pays (Maximum Allowable Benefit) and the Dentist's Actual Charge. |
| Additional Links |
MetLife Providers Link MetLife Summary of Benefits Link |
Spirit Dental Plan Details, Limitations and Rates | ||
| Exclusions | MetLife Limitations & Product Overview and Details | See Brochure in Link above | Spirit Dental Plan Details, Limitations and Rates | See Brochure in Link above |