Students

Dental Coverage, Fall 2013 - Spring 2014

Dental coverage is included as part of the Berkeley Student Health Insurance Plan (SHIP). All UC Berkeley students enrolled in SHIP automatically will receive benefits covering preventive and general restorative dental care.

Metlife is the dental insurance provider for SHIP students. Note that dental care is not provided at the Tang Center. SHIP members can select from a wide choice of local dentists, listed on the MetLife website.

 

Group and ID Numbers

MetLife PDP Plus Group plan number: 151638.

Member ID number: Your Metlife ID number is the nine digits after the "W" on your Aetna ID card.

Dental Benefits Summary There is a $1,000 academic year benefit maximum (August 15-August 14). If you choose an out of network dentist your coverage is reduced to a $750 academic year benefit maximum.
If the care is
provided by a…
Dentist who is an in-network MetLife PDP Plus Dentist the plan covers… Dentist who is not an in-network MetLife PDP Plus Dentist the plan covers…
Preventive and Diagnostic Services:
  • Oral exams
    (2 per year)
  • Cleanings
    (2 per year)
  • Fluoride treatment
  • X-ray Bitewing (once per year)
  • X-ray Full mouth (once every 5 years)
100%
of negotiated fees that participating dentists have agreed to accept as payment in full
80%
of reasonable and customary charges
Basic Operative and Restorative Services:
  • Fillings
  • Simple extractions
  • Oral surgery
  • Periodontics
  • Endodontics
80%
of negotiated fees after a $25 annual deductible
60%
of reasonable and customary charges after a $50 annual deductible.
Co-payments will be higher with non-Network providers than if you use an in-Network PDP Plus dentist
Major Services
  • Prosthodontics
  • Inlays/onlays
  • Crowns & cast restorations
  • Implants
70%
of negotiated fees after a $25 annual deductible
40%
of reasonable and customary charges after a $50 annual deductible.
Co-payments will be higher with non-Network providers than if you use an in-Network PDP Plus dentist
Benefits NOT covered
  • Maxillofacial prosthetics
  • Orthodontics
Frequently Asked Questions About Dental Coverage How does the dental plan work?
How do I find a dentist?
Do I need to file a claim after my visit?
Can I find out how much services will cost prior to treatment?
Can I waive the dental plan?
What if I have more questions?
  How does the dental plan work?

Dental coverage is provided through the MetLife PDP Plus plan. With this plan, you select a provider from a nationwide network of 90,000 MetLife PDP Plus Dentists, over 100 of whom are located within five miles of campus. When you make your appointment, let the dentist know you have coverage through MetLife.

You do not need to pre-select a primary dentist, carry an ID card or receive referrals for specialty care. If you visit a dentist who is not a MetLife Dentist, you will still receive benefits, but you will be charged higher out-of-pocket copayments for the services you receive.

  How do I find a dentist?

There are over 100 dentists within five miles of campus who participate in the MetLife PDP Plus plan. To find a dentist, visit the MetLife website at http://metlife.com/dental. If you need dental care when away from campus, you may choose from dentists nationwide. You have the freedom to choose any dentist at any time. You do not need to visit the same dentist every time. See the MetLife Local Dentist Directory (pdf)

  Do I need to file a claim after my visit?

Dentists will file a claim directly to MetLife. If you are responsible for any portion of the charges, you will be expected to pay that amount at the time of service. Your dentist may ask for the plan group number or your member ID number. Please call the Student Health Insurance Office at (510) 642-5700 if you do not know your ID number. If you visit a dentist who is not a MetLife dentist, you may need to pay all charges, and then file a claim for reimbursement. You may print out a claim form at http://metlife.com/dental or call (800) 942- 0854 to have one sent.

  Can I find out how much services will cost prior to treatment?

Yes. You may have your dentist request a pretreatment estimate to determine what services the plan will cover and at what payment level. We strongly recommend a pretreatment estimate if the services are expected to cost more than $200. With the pretreatment estimate, you’ll know exactly what your payment responsibilities are and can discuss treatment options.

  Can I waive the dental plan?

Dental coverage is available as part of Berkeley SHIP. If you are enrolled in SHIP, you automatically receive dental coverage. You cannot enroll in or waive dental coverage separate from SHIP.

  What if I have more questions?

MetLifeís website provides personalized information about your dental plan benefits. Visit http://metlife.com/dental to:

  • Choose a dentist and print a map to the dentistís office
  • Check the status of your claims, including tracking your deductible and year-to-date claims payments
  • Request that the Explanation of Benefits be sent you via e-mail
  • Read answers to frequently asked questions, such as how to interpret the Explanation of Benefits form.
You may also call MetLife at (800) 942-0854 to speak to a dental plan representative.

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