Colonial / Metlife Dental Product Overview

Colonial / Metlife Dental Product Overview

Colonial / MetLife Dental Product Overview
Available for Quoting in OH, IN, KY

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Table of Contents

MetLife Dental

Underwriting Considerations

Colonial / MetLife Plan Designs

Information Required to Quote

New Case Submission

The PDP Plus Network

Competitive Advantages

Cross Sell Opportunities

MetLife Dental

Our Strength and Experience:

  • #1 largest commercial dental benefits provider in the U.S.
  • 55 of the top 100 Fortune 500 companies use MetLife products and services
  • Dental benefits provider for over 70% of the Federal Government and U.S. military
  • Dental benefits provider of PERS and STRS

Our Quality and Service:

  • 99.6% of PPO claims are processed accurately
  • 90% of claims were paid within five days
  • Approximately 99% of claims are processed within ten days
  • 100% of plan participants are satisfied with the quality of care they receive from their dentist
  • 98% overall group satisfaction

Underwriting Considerations

Provision / Colonial Rating Tool
(2-99 eligibles) / MetLife Standard
(2-9 eligibles) / MetLife Standard
(10-99 eligibles)
Open Enrollment / Annual / One time (no variations; 12 month waiting period for late entrants on all services) / One time (Annual can be included with 2-4% load)
Dependent Age / 26/26 / 19/23 / 19/23 (variations available with appropriate loads)
Participation Requirements / None / 1. For non-contributory plans, 100%
2. For employer sponsored contributory plans, ranges from 25% to 100%, at least 75% of all eligible dependents must enroll; and:
- at least 2 enrolled with 4 eligible lives
- at least 4 enrolled with 5 eligible lives
- at least 5 enrolled with 6 or 7 eligible lives
- at least 7 enrolled with 9 eligible lives / 1. For non-contributory plans, 100%
2. For employer sponsored contributory plans, varies from 50% to 90%
3. For voluntary plans, 35% and at least 10 covered lives
(Loads apply if minimum participation not met; MetLife will pull the offering if minimum enrollment is not met)
Minimum Enrolled / 5 lives if voluntary; 2 if employer paid / 1. For non-contributory plans, 100%
2. For employer sponsored contributory plans, ranges from 25% to 100%, at least 75% of all eligible dependents must enroll; and:
- at least 2 enrolled with 4 eligible lives
- at least 4 enrolled with 5 eligible lives
- at least 5 enrolled with 6 or 7 eligible lives
- at least 7 enrolled with 9 eligible lives / 1. For non-contributory plans, 100%
2. For employer sponsored contributory plans, varies from 50% to 90%
3. For voluntary plans, 35% and at least 10 covered lives
(Loads apply if minimum participation not met; MetLife will pull the offering if minimum enrollment is not met)
R&C Percentile Level / MAC or 90th / 80th (no variations) / MAC, 51st, 70th, 80th, 90th, 99th
Allocation of Services - Implant Services / Type C / Not Covered (no variations) / Type C
Ortho Coverage / 50% to $1,000 if elected / Not Covered (no variations) / 50% to $1,000 if currently in-force
Essential Health Benefits / Included if requested / Not Available / Included for <51 life groups if requested

Colonial / MetLife Plan Designs

High Plan with or without Orthodontia

Coverage Type / In Network
% of Negotiated Fee / Out of Network
90th Percentile
Type A - Preventative / 100% / 100%
Type B - Basic / 80% / 70%
Type C - Major / 50% / 50%
Type D - Orthodontia / 50% / 40%
Deductible: Per Individual (Type B&C) / $50 / $50
Deductible: Per Family (Type B&C) / $150 / $150
Annual Maximum Benefits: Per Individual / $1,500 / $1,500
Orthodontia Lifetime Maximum: Per Individual / $1,000 / $1,000
Ortho applies to Child Only (to age 19)
Dependent Age / 26/26
Network / Non Network Charge Example / In Network
% of Negotiated Fee / Out of Network
90th Percentile
Service: Crown in 430- zip code / Generalist: $626
Specialist: $626 / $1,165

Low Plan with or without Orthodontia

Coverage Type / In Network
% of Negotiated Fee / Out of Network
MAC Fee Schedule
Type A - Preventative / 100% / 100%
Type B - Basic / 50% / 50%
Type C - Major / 50% / 50%
Type D - Orthodontia / 50% / 50%
Deductible: Per Individual (Type B&C) / $50 / $50
Deductible: Per Family (Type B&C) / $150 / $150
Annual Maximum Benefits: Per Individual / $1,000 / $1,000
Orthodontia Lifetime Maximum: Per Individual / $1,000 / $1,000
Ortho applies to Child Only (to age 19)
Dependent Age / 26/26
Network / Non Network Charge Example / In Network
% of Negotiated Fee / Out of Network
MAC Fee Schedule
Service: Crown in 430- zip code / Generalist: $626
Specialist: $626 / Generalist: $626
Specialist: $626

Information Required to Quote;

Please send requests to quote to

Groups with 2 to 99 eligibles:

  1. Name and Address of Group
  2. # of eligible employees
  3. Zip code of group
  4. SIC code
  5. Expected Participation – over/under 50%

Groups with 100+ eligibles:

  1. Name and address of group
  2. Inforce/renewal rates
  3. Employer/employee contribution and participation
  4. Plan design, full certificates
  5. SIC code
  6. Census Information:
  7. Home zip codes
  8. Dependent status (employee only (EE), employee + spouse (ES), employee + child (EC), family (F)
  9. Experience (2-years is preferred)

Sold Case Materials (

New Case Submission Checklist:

  1. MetLife Master Application (1 page. Signed by Employer and Agent)
  2. MetLife New Group Submission Application (3 pages. Signed by Employer)
  3. Census Template (Dependents listed on Tab 2)
  4. Copy of Sold Case Proposal (signed by agent)
  5. NO BINDER CHECK IS NEEDED. Employer will be billed when case is implemented.

NOTE: MetLife does not issue ID Cards. Once new group is setup in MetLife’s system, all an employee/dependent needs to do is let the dentist know they are covered under MetLife.

The PDP Plus Network

Two most important network elements: Size/Access and Discounts

  • Size/Access helps to quantify distribution and ability of patients to schedule appointments
  • Discounts are the reduced/negotiated fees that help drive plan savings for the employer and lower participant out-of-pocket expenses

The Ruark Consulting Company

  • Who are they?
  • An industry leading actuarial, network and data analysis consulting company
  • What do they do?
  • Annual study of Dental networks for 13 of the nation’s largest carriers and networks

The Ruark Data – Local Results for Size/Access

UNIQUE DENTISTS 2013
Zip / Area / MetLife PDP Plus / Aetna II / CIGNA Core / Delta Dental PPO / DenteMax / Guardian / United Concordia Advantage Plus / United Concordia Alliance
430 / Newark/Columbus area / 448 / 429 / 308 / 251 / 367 / 340 / 251 / 287
431 / Lancaster / 212 / 185 / 114 / 127 / 160 / 139 / 114 / 144
432 / Columbus / 483 / 417 / 389 / 372 / 442 / 447 / 263 / 326

The Ruark Data – Local Results for Discounts

IN NETWORK DISCOUNTS 2013
Zip / Area / State / Lowest Discount / Highest Discount / Market Weighted Average / MetLife / MetLife Quartile
430 / Newark/Columbus area / OH / 25% / 36% / 30% / 36% / First
431 / Lancaster / OH / 24% / 39% / 33% / 39% / First
432 / Columbus / OH / 27% / 38% / 32% / 36% / First

Competitive Advantages

  • Our PDP Plus Network
  • Size/Access – over 256,000 Dental Access Points nationally
  • Our Discounts – negotiated in-network fees 15 – 45% less than average charges in the same community
  • When visiting participating dentists, negotiated fees extend to non-covered services and services provided after plan maximums are exceeded
  • Our Contract
  • Open List Contract (as opposed to closed list contract) – if a service is not listed as “Excluded”, then it is covered if dentally necessary
  • Coverage for Implants, Implant Services, and Implant Repairsis standard
  • Coverage for White (Resin Composite) Fillings on all teeth is standard
  • High Annual Maximums – up to $5,000 maximums available (50+)
  • Our Service
  • Over 95% of claim payments are assigned to the provider
  • Dedicated Account Managers for day to day service needs
  • MetLink – employer online self-service portal
  • MyBenefits – employee online self-service portal

Cross Sell Opportunities

MetLife Vision

  • Network: a combination of the VSP Choice Network and MetLife’s own Vision Network
  • Wide range of flexible plan designs
  • Fixed copays for popular lens options, like Progressive lenses, and Anti-reflective and Scratch-resistant coatings – as well as contact lens fitting and evaluation
  • Information required to quote:
  • Zip code of group
  • SIC code
  • Participation – over/under 50%
  • Number of eligibles
  • Vision Guidelines:
  • Available to groups with 5+ lives
  • Minimum of 10% participation with at least 5 enrolled
  • Employees age 65 and over must be less than 20% of the group
  • Rates are guaranteed for 24 months

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