Healthier savings for healthier smiles

Dental Insurance Healthier savings for healthier smiles Frequently asked questions about MetLife Dental for State of Oklahoma employees

2 Contents Enrollment 3 Plan Information 3 Plan Design 4 Open Season & New Hires 5 Network/Dental 5 Rates and Plan Options 6 Frequency and Allocations 8 Exclusions 11

MetLife Dental for State of Oklahoma Frequently Asked Questions 3 Enrollment Who can enroll in the plan? You and your eligible family members. For example, your spouse and dependents. When can I enroll? You can enroll during your open enrollment period. How do I enroll? You may enroll in the MetLife Dental Plan by mail: Contact your Benefits Coordinator to receive the enrollment form. Then complete the requested information and send to the address provided. Plan Information How do the MetLife Dental Plans work? With the MetLife Classic, MAC or PDP Dental Plans, you receive a wide range of benefits whether or not you and/or each eligible dependent visit an in-network dentist, plus referrals are not necessary for specialty care. But, when you visit an in-network dentist, you have the opportunity to make the most of your benefit plan because your out-of-pocket expenses may be lower. Once you enroll in the MetLife Classic, PDP or Value Dental Plan, you and your eligible dependents must remain in the plan for a period of 12 months. The rates quoted at the time of enrollment are valid until the end of the calendar year. Is my Employee ID required to receive Dental? No. MetLife does not require your Employee ID to submit claim payments, use the MetLife call center or access the MetLife website. When seeing your dentist, present your ID card which has your MetLife unique ID number. MetLife does not require your SSN from your dentist to prove eligibility or to submit claims. The dentist may request your Employee ID for their own administrative recordkeeping. Do my dependents have to visit the same dentist that I select? No. You and your dependents each have the freedom to choose any dentist, in or out-of-network, at any time. What are covered by the MetLife Dental Plans? The covered by the MetLife Dental Plans are those defined under your group dental benefits described in the FAQ Rates and Plan Options and Frequency, Allocations and Exclusions sections for details concerning coverage, exclusions, limitations and waiting periods. What is the MetLife Dental Health Manager? An online, easy to use, interactive program designed to help you understand your risk for oral disease and your current dental health status, with the goal of helping you improve your oral health. The MetLife Dental Health Manager is a proprietary program consisting of two primary components. The first is a report card that illustrates your risk and disease score utilizing an interactive oral health risk assessment and data analysis derived from dental utilization (claim) data as well as systemic disease data to help you understand and track changes in your dental risk and disease over time. The second component is the online MetLife Oral Health Library, which contains oral health educational articles and tools, designed to help you take a more active role in managing your oral health. The Library can also help you to ask informed questions about your benefits, dental care and risk for dental disease, and offers relevant information specific to your oral health needs. MetLife Dental participants can access this online tool via the MyBenefits website. Just complete the Oral Health Risk Assessment questionnaire (OHRA) to get access to education that is relevant to you and receive an action plan that may help you make more informed oral health decisions. How do I review my personal claim information? Please access/register for the MyBenefits site (metlife.com/oklahoma) from the home page. MyBenefits allows you to manage your benefits more easily. You may view your claims and personal information.

4 What is the effective date of my coverage? If you enrolled during Open Season your coverage will begin on January 1. If you are a new hire, you can enroll 60 days after you become eligible. Your enrollment will be effective the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment. If I elect to stop receiving paper Explanation of Benefits (EOB) Statements at my home, how do I view my EOB Statements? And can I still print them? Once you turn off your paper Explanation of Benefits (EOB) Statements, you will receive email alerts to notify you when a Dental claim is processed. You can view and print your Dental EOB Statements from MyBenefits. Your Dental EOB Statement history will remain online for a minimum of two years plus the current year. How long will it take to process my Dental claim? Most claims flow through our system quickly and efficiently, with 99% being processed within 10 business days. If additional information is needed for a claim, it may take longer. Who do I contact if I have any additional questions about dental coverage from MetLife? MetLife is committed to making sure you have all the information you need to make the right decision for you and your family. If you d like to know more about the MetLife Dental Plan call us at 1-855-676-9443. Customer service representatives are available Monday through Friday, 8am EST to 11pm EST. What plan options are available to me and my family? Our plans always include access to one of the largest dental network and big benefits from a trusted brand with competitive premiums. Select the dental plan that s right for you and your family, based on your needs and budget: Classic Highest benefit levels ($5,000 annual maximum) Value MAC Lowest premiums (less than $330/year) Value PDP Flexibility to see any dentist What are the rates? Please refer to the Rates section. Plan Design What are covered by the MetLife Dental Plans? The covered by the MetLife Dental Plans are those defined under your group dental benefits plan described in the FAQ Rates and Plan Options and Frequency, Allocations and Exclusions sections for details concerning coverage, exclusions, limitations and waiting periods. What is an Explanation of Benefits (EOB) Statement? An Explanation of Benefits (EOB) Statement is a summary of your processed claim or pretreatment estimate, including rendered, costs, and benefits paid. What is MetLife Claim Review (MCR) and how does it work? MetLife Claim Review is a review of certain types of dental claims that is conducted by licensed Dentist Consultants. The Dentist Consultants review the clinical information. These Dentist Consultants review this material checking for dental necessity for certain procedures such as crowns, bridges, onlays, implants, periodontal treatments, as well as other. We recommend that you get a pre-treatment estimate for the types of listed above, so that both you and your dentist are aware of what benefits will be paid for the.

MetLife Dental for State of Oklahoma Frequently Asked Questions 5 Open Season & New Hires Are Orthodontia benefits available? Yes, we have Adult (employee and spouse) and child/children orthodontia coverage with the Classic and MAC Plans and child/children orthodontia coverage with the PDP Plan. Do you cover crowns? Yes. Crowns are covered under the Classic and Value MAC Plans. Please review the FAQ Rates and Plan Options and Frequency, Allocations and Exclusions sections for details. Do different procedures have different age limitations? Yes. There are certain procedures with different age limitations. Please refer to the FAQ Rates and Plan Options and Frequency, Allocations and Exclusions sections for details. Are implants covered under the plan? Yes. Implant Services are a covered expense subject to plan guidelines. Please refer to the FAQ Rates and Plan Options and Frequency, Allocations and Exclusions sections for a complete listing of covered implant and precertification provisions. Prior to having implant done, we recommend you submit a pre-treatment estimate since an alternate benefit may apply. Network/Dental What is an in-network dentist and how do I find one? An in-network dentist is a general dentist or specialist who participates in MetLife s Preferred Dental Provider (PDP) Plus Network and has agreed to accept a negotiated fee for covered rendered to eligible plan members. This negotiated fee 1 is typically 30% to 45% below the average fee charged by dentists for the same in a given geographical area. There are over 360,000 in-network dentist locations nationwide, including over 82,000 specialists. To access a list of MetLife s in-network dentists use the Find a Dentist function on www.metlife.com/oklahoma, or call 1-855-676-9443. These lists include name, address, specialties, languages spoken, telephone numbers, and maps/driving directions. Continued participation of any specific provider cannot be guaranteed. Thus, you should make coverage decisions based on the plan benefits, not based on a specific provider. When you call for an appointment, please remember to verify that the selected provider is currently in the MetLife PDP Plus Network. What if my dentist is not in MetLife s network? We encourage you to consider using a MetLife in-network dentist to help maximize the value of your plan. Of course, you can visit any dentist and still receive some benefits under your plan although your out-of-pocket expenses may be higher. If your current dentist does not participate in MetLife s PDP Plus Network and you d like to encourage him or her to participate, tell your dentist to visit www.metdental.com, or call 1-877-MET-DDS9. Note that this website and phone number are specifically for dentists and not accessible to employees/annuitants. What is the difference between in and out-of-network benefits? An in-network dentist is a general dentist or specialist who participates in MetLife s PDP Plus Network and has agreed to accept a negotiated fee for rendered to eligible plan members. This negotiated fee 1 is typically 30% to 45% below the average fee charged by dentists for the same in a given geographical area. There are over 360,000 in-network dentist locations nationwide, including over 82,000 specialists. To access a list of MetLife s in-network dentists use the Find a Dentist function on www.metlife.com/oklahoma or call 1-855-676-9443. These lists include name, address, specialties, languages spoken, telephone numbers, and maps/driving directions. Continued participation of any specific provider cannot be guaranteed. Thus, you should make coverage decisions based on the plan benefits, not based on a specific provider. When you call for an appointment, please remember to verify that the selected provider is currently in MetLife s PDP Plus Network. 1. Negotiated Fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Occasionally, there may be a service for which the dentist s fee is the same or less than the MetLife negotiated fee for that service.

6 An out-of network Provider is a dental provider who does not belong to the MetLife Network. Not all dental practices join a dental network. This may be due to their unique circumstances or a philosophical difference. However, remember you are always free to select a dentist of your choice. We encourage you to consider using a MetLife in-network dentist to help maximize the value of your plan. Of course, you can visit any dentist and still receive some benefits under your plan although your out-of-pocket expenses may be higher. If your current dentist does not participate in MetLife s network and you d like to encourage him or her to participate, tell your dentist to visit www.metdental.com, or call 1-877-MET-DDS9. Note that this website and phone number are specifically for dentists and not accessible to employees/annuitants. What is a negotiated fee 2? A negotiated fee refers to the maximum charge for a covered service that an in-network dentist may charge to MetLife Dental Plan participants. These fees are typically 30% to 45% below the average fee charged by a dentist for the same in your area. Your plan may reimburse you for all or part of this fee. When you use an in-network dentist, you are responsible only for the difference between MetLife s benefits payment amount and the negotiated fee for the rendered. Why aren t there any in-network dentists in my area? Not all dental practices join a dental network. This may be due to their unique circumstances or a philosophical difference. However, remember you are always free to select a dentist of your choice. The MetLife provider network varies by area. MetLife cannot guarantee the availability of every type of specialist in all areas. If you require the of a specialist, and one is not available in your area, please contact MetLife at 1-855-676-9443. Rates and Plan Options MetLife Dental Plans for the State of Oklahoma employees include competitive monthly rates 3, access to one of the largest dental networks and big benefits administered by a trusted brand. We offer three dental plan options, the Value MAC, Value PDP or the Classic Dental Plan. Select the one that s right for you and your family, based on your needs and budget. For example: Have a family and want the most affordable plan offered to State of Oklahoma employees and educators? Select the MetLife Value MAC Plan, offering the lowest premiums (less than $330/year) Not anticipating lots of dental work, visit the dentist ~2x/year, and looking for an affordable plan? Select the MetLife Value PDP Plan, offering the flexibility to see any dentist adult orthodontia of $2,000) Anticipate seeing more specialists or a bit more dental work, but want to minimize extra charges? Select the MetLife Classic Plan, offering the highest benefit levels ($5,000 annual maximum and lifetime Competitive Monthly Rates: 3 MetLife Classic MetLife Value MAC MetLife Value PDP Employee $36.98 $27.24 $29.48 Spouse* $36.98 $27.24 $29.48 1 Child* $31.68 $23.34 $25.24 2+ Children* $78.78 $58.02 $62.80 And, each plan also includes: No cost for in-network cleanings, x-rays and exams 4 No waiting periods * An employee cannot enroll a dependent unless the employee is also enrolled. Cost savings for other in-network : Basic Care (fillings, extractions, oral surgery): 85% covered Major Care (dentures, bridge work, implants): 2. Negotiated fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Occasionally, there may be a service for which the dentist s fee is the same or less than the MetLife negotiated fee for that service. 3. Savings may vary based on numerous factors including premium cost, type and frequency of provided, the cost of rendered, and provider type (network or non-network). 4. Subject to frequency limitations.

MetLife Dental for State of Oklahoma Frequently Asked Questions 7 Plan Options Overview MetLife Classic MetLife Value MAC MetLife Value PDP In-Network Out of Network 5 In-Network Out of Network 5 In-Network Out of Network 5 Reimbursement Negotiated Fee Schedule R&C 70th Percentile Negotiated Fee Schedule Negotiated Fee Schedule MAC Negotiated Fee Schedule R&C 70th Percentile Diagnostic Type A cleanings and oral examinations 100% covered Routine Exams and Cleanings Fluoride (up to age 16) 100% covered Routine Exams and Cleanings Fluoride (up to age 16) 100% covered Routine Exams and Cleanings Fluoride (up to age 16) 100% covered Routine Exams and Cleanings Fluoride (up to age 16) 100% covered Routine Exams and Cleanings Fluoride (up to age 16) 100% covered Routine Exams and Cleanings Fluoride (up to age 16) Basic Type B Extractions, Oral Surgery 85% covered Root Canal 1 per tooth per lifetime 85% covered Root Canal 1 per tooth per lifetime 85% covered Root Canal 1 per tooth per lifetime 70% covered Root Canal 1 per tooth per lifetime 85% covered Root Canal 1 per tooth per lifetime 70% covered Root Canal 1 per tooth per lifetime Major Type C 50% covered 50% covered crowns, bridges, root canal treatment and dentures Dentures 1 in 5 years Fixed Bridges/ Inlays/Onlays I in 5 years Dentures 1 in 5 years Fixed Bridges/ Inlays/Onlays I in 5 years Dentures 1 in 10 years Fixed Bridges/ Inlays/Onlays I in 10 years Dentures 1 in 10 years Fixed Bridges/ Inlays/Onlays I in 10 years Dentures 1 in 10 years Fixed Bridges/ Inlays/Onlays I in 10 years Dentures 1 in 10 years Fixed Bridges/ Inlays/Onlays I in 10 years Implants 1 per tooth in 5 years Implants 1 per tooth in 5 years Implants 1 per tooth in 10 years Implants 1 per tooth in 10 years Implants 1 per tooth in 10 years Implants 1 per tooth in 10 years Orthodontia Type D comprehensive orthodontic treatment, fixed appliance Offered for Adults (employee/ spouse) and child/children Offered for Adults (employee/ spouse) and child/children Offered for Adults (employee/ spouse) and children 50% covered Offered for Adults (employee/ spouse) and children Offered for child/children 50% covered Offered for child/children Annual Deductible Per Person $25/person, $75/ family Applies to $25/person, $75/ family Applies to $25/person, $75/ family Applies to $25/person, $75/ family Applies to $25/person, $75/ family Applies to $25/person, $75/ family Applies to Annual Maximum Per Person $5,000, applies to Preventive, $5,000, applies to Preventive, $2,500, applies to Preventive, $2,500, applies to Preventive, $2,500, applies to Preventive, $2,500, applies to Preventive, Basic and Major Orthodontia Lifetime Maximum $2,000 lifetime maximum, applies to Adult and Child $2,000 lifetime maximum, applies to Adult and Child $2,000 lifetime maximum, applies to Adult and Child $2,000 lifetime maximum, applies to Adult and Child $2,000 lifetime maximum, applies to Child $2,000 lifetime maximum, applies to Child Implant Lifetime Maximum $1,000 lifetime maximum $1,000 lifetime maximum $1,000 lifetime maximum $1,000 lifetime maximum $1,000 lifetime maximum $1,000 lifetime maximum 5. Out of Network benefits are payable for rendered by a dentist who is not a participating provider. The 70th percentile Reasonable and Customary charge is based on the lowest of (1) the dentist s actual charge (the Actual Charge ), (2) the dentist s usual charge for the same or similar (the Usual Charge ) or (3) the charge of most dentists in the same geographic area for the same or similar as determined by MetLife (the Customary Charge ). Services must be necessary in terms of generally accepted dental standards.

8 Frequency and Allocations MetLife Classic, Value MAC and Value PDP Plans available to all Active Full Time Employees (30 Hours) Type A: Benefits are payable immediately from the start date of an individual s benefits MetLife Classic MetLife Value MAC MetLife Value PDP Examinations 2 times in 12 months 2 times in 12 months 2 times in 12 months Examinations Problem Focused Combined with Examinations Limit Combined with Examinations Limit Combined with Examinations Limit Prophylaxis: Cleanings 2 times in 12 months 2 times in 12 months 2 times in 12 months Sealants 1 per molar in 60 months for a child under age 16 1 per molar in 60 months for a child under age 16 1 per molar in 60 months for a child under age 16 Space Maintainers 1 per lifetime for a child under age 14 1 per lifetime for a child under age 14 1 per lifetime for a child under age 14 Fluoride 2 times in 1 calendar year for a dependent child under age 16 2 times in 1 calendar year for a dependent child under age 16 2 times in 1 calendar year for a dependent child under age 16 Full Mouth X-Rays Once in 3 calendar years Once in 3 calendar years Once in 3 calendar years Bitewing X-Rays For a child under 19: 1 time in 12 months For a child under 19: 1 time in 12 months For a child under 19: 1 time in 12 months Labs & Other Tests No limit No limit No limit Periapical X-Rays No limit No limit No limit Other X-Rays No limit No limit No limit

MetLife Dental for State of Oklahoma Frequently Asked Questions 9 Type B: Benefits are payable immediately from the start date of an individual s benefits MetLife Classic MetLife Value MAC MetLife Value PDP Amalgam Fillings 1 replacement per surface in 24 Months 1 replacement per surface in 24 Months 1 replacement per surface in 24 Months Root Canal 1 per tooth per lifetime 1 per tooth per lifetime 1 per tooth per lifetime Periodontal Maintenance 2 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 2) 2 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 2) 2 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 2) Periodontal Surgery 1 per quadrant in any 36 month period Scaling & Root Planing 1 per quadrant in any 24 month period 1 per quadrant in any 36 month period 1 per quadrant in any 24 month period 1 per quadrant in any 36 month period 1 per quadrant in any 24 month period Emergency Palliative Treatment Resin Composite Fillings (excludes coverage for composite fillings on molars) No limit No limit No limit No limit No limit No limit Pulp Capping No limit No limit No limit Pulp Therapy No limit No limit No limit Periodontal Surgery Soft & Connective Tissue Grafts Periodontics Non-Surgical Oral Surgery: Simple Extractions Oral Surgery: Surgical Extractions No limit No limit No limit No limit No limit No limit No limit No limit No limit No limit No limit No limit Other Oral Surgery No limit No limit No limit General Services No limit No limit No limit

10 Type C: Benefits are payable immediately from the start date of an individual s benefits MetLife Classic MetLife Value MAC MetLife Value PDP Consultations 1 in 12 months 1 in 12 months 1 in 12 months Prefabricated Crowns 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years Crown Buildups / Post Core 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years Repairs 1 in 12 months 1 in 12 months 1 in 12 months Recementations 1 in 12 months 1 in 12 months 1 in 12 months Dentures 1 in 5 calendar years 1 in 10 calendar years 1 in 5 calendar years Dentures Rebases / Relines 1 in 36 months 1 in 36 months 1 in 36 months Denture Adjustments 1 in 12 months 1 in 12 months 1 in 12 months Fixed Bridges 1 in 5 calendar years 1 in 10 calendar years 1 in 5 calendar years Inlays / Onlays /Crowns 1 replacement per tooth in 5 calendar years 1 replacement per tooth in 10 calendar years 1 replacement per tooth in 5 calendar years Implant Services 1 per tooth position in 5 calendar years 1 per tooth position in 10 calendar years 1 per tooth position in 5 calendar years Implant Repairs 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years Implant Supported Prosthetic 1 per tooth in 5 calendar years 1 per tooth in 10 calendar years 1 per tooth in 5 calendar years Tissue Conditioning 1 in 36 months 1 in 36 months 1 in 36 months Occlusal Adjustments 1 in 12 months 1 in 12 months 1 in 12 months General Anesthesia No limit No limit No limit Pulpotomy No limit No limit No limit Apexification & Recalcification No limit No limit No limit Orthodontics Benefits are payable immediately from the start date of an individual s benefits Orthodontic Diagnostics No limit No limit No limit Orthodontic Treatment No limit No limit No limit

MetLife Dental for State of Oklahoma Frequently Asked Questions 11 Exclusions: The below exclusions apply to the MetLife Classic, Value MAC and Value PDP Dental Plans Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature. Services for which a covered person would not be required to pay in the absence of dental insurance. Services or supplies received by a covered person before the insurance starts for that person. Services which are neither performed nor prescribed by a dentist except for those of a licensed dental hygienist which are supervised and billed by a dentist and which are for scaling or polishing of teeth or fluoride treatment. Services which are primarily cosmetic. (For residents of Texas: Services which are primarily cosmetic unless required for the treatment or correction of a congenital defect of a newborn child). Services or appliances which restore or alter occlusion or vertical dimension. Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease. Restorations or appliances used for the purpose of periodontal splinting. Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco. Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss. Initial installation of a Denture to replace one or more teeth which were missing before such person was insured for dental insurance, except for congenitally missing natural teeth. Decoration or inscription of any tooth, device, appliance, crown or other dental work. Missed appointments. Services covered under any workers compensation or occupational disease law. Services covered under any employer liability law. Services for which the employer of the person receiving such is not required to pay. Services received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital. Services covered under other coverage provided by the Policyholder. Temporary or provisional restorations. Temporary or provisional appliances. Prescription drugs. Services for which the submitted documentation indicates a poor prognosis. Services, to the extent such, or benefits for such, are available under a government plan.this exclusion will apply whether or not the person receiving the is enrolled for the government plan. We will not exclude payment of benefits for such if the government plan requires that dental insurance under the group policy be paid first. The following when charged by the dentist on a separate basi: claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or algesia such as nitrous oxide. Dental arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing and biting of food. Caries susceptibility tests. Precision attachments associated with fixed and removable prostheses. Adjustment of a denture made within 6 months after installation by the same dentist who installed it. Duplicate prosthetic devices or appliances. Replacement of a lost or stolen appliance, cast restoration or denture. Intra and extraoral photographic images. Fixed and removable appliances for correction of harmful habits. Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards. Treatment of temporomandibular joint disorder. This exclusion does not apply to residents of Minnesota.

MetLife Dental for State of Oklahoma employees Choose the dental plan that s right for you and your family, based on your needs and budget: Classic Highest benefit levels ($5,000 annual maximum) Value MAC Lowest premiums (less than $330/year) Value PDP Flexibility to see any dentist Find out more: Call 1-855-676-9443 or visit www.metlife.com/oklahoma Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 L0917498736[exp1118][All States][DC,GU,MP,PR,VI] 2017 METLIFE, INC.