Plan Benefits & Rates
Dental Plan
How the dental plan works:
The Dental Plan, underwritten by MetLife, pays benefits for three categories of service:
- Type A — Preventive,
- Type B — Basic Restorative and;
- Type C — Major Restorative.
Please reference the section entitled “Primary Covered Services” in the Dental Plan brochure for detail of these services.
The plan also offers you a choice; you may use a participating dentist (in-network) or you may use an out-of-network dentist. If you choose to receive services from a participating dentist, you will generally receive the greater benefit and incur the least out-of-pocket expense. If you use a participating dentist, the plan provides paid-in-full benefits for Type A services. You will have out-of-pocket costs for Type B and Type C services provided by participating dentists. If you use an out-of-network dentist, you generally will have higher out-of-pocket costs for all types of service.
Plan Benefit Details
Monthly Rates
The following monthly rates are effective through December 31, 2025:
| Enrollee | Monthly Rate |
|---|---|
| Member Only | $55.04 |
| Member + One | $122.59 |
| Member + Family | $152.70 |
Payment Methods
Select your payment method by completing the “Authorization Agreement for Dental Insurance Payments” form on the enroll page. You can select from:
- In-Service Members Only: Payroll Deductions
- Retired Members Only: Automatic monthly pension deduction (available if you are collecting a monthly pension benefit from the NYSTRS, NYSLRS, NYCTRS, or BERS, or if you are receiving income from a monthly lifetime annuity from TIAA)
- Direct Billing & ACH Options apply to both In-Service and Retired Members
Retired Members:
- Annual billing: You will be charged a $12.00 service fee per billing cycle (1 payment per year).
- Semi-annual billing: You will be charged a $9.00 service fee per billing cycle (2 payments per year).
- Quarterly billing: You will be charged a $6.00 service fee per billing cycle (4 payment per year).
Payroll deduction is available in local associations that have made the necessary payroll deduction arrangements for NYSUT Member Benefits-endorsed programs.
If you select payroll or pension deduction, there are no service fees.
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1 In Network is when you or your eligible dependent visit a participating dentist, plan benefits are based on a negotiated fee schedule. You will be responsible for the difference between the negotiated fee*** for a given service and the percentage of the fee that your plan covers for that service, subject to any deductibles.
2 Out-of-Network is when you or your eligible dependent visit a non-participating dentist, plan benefits are based on the Reasonable and Customary (R&C) charges of dentists in your area as determined by MetLife. You will be responsible for the difference between your dentist’s charge for a given service and the percentage of Reasonable and Customary fee that your plan covers, subject to any deductibles.
3 Negotiated Fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated Fees are typically 35% to 50% below community averages. Negotiated Fees are subject to change. Negotiated fees do not apply to non-covered services in states that prohibit limitations for services not covered under a plan. Participating providers in these states may charge their non-negotiated fees for non-covered service
4 R&C fee refers to the Reasonable and Customary R&C charge, which is based on the lowest of 1. the dentist’s actual charge, 2. the dentist’s usual charge for the same or similar services or 3. the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife.
Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. You may be financially responsible for copayments, deductibles, or any other amounts in excess of those MetLife is required to pay for covered services as described in your dental certificate and/or policy. Ask your MetLife representative for costs and complete details.
Group dental plans featuring the Preferred Dentist Program are provided by Metropolitan Life Insurance Company, New York, NY.
PROGRAM EXCLUSIONS*
1) Temporomandibular joint disorders (TMJ)
2) Those received before coverage begins
3) Those not performed by a dentist, except cleaning and scaling of teeth and fluoride treatments performed by a licensed dental hygienist whose work is supervised and billed by a dentist
4) Cosmetic services, surgery or supplies
5) Services or supplies that are covered by any workers’ compensation laws, occupational disease laws or employer’s liability laws, or which an employer is required by law to furnish in whole or in part
6) Those that are received through a medical department or similar facility maintained by your employer
7) Home health aids used to prevent decay, such as toothpaste and fluoride gels
8) Duplicate appliances or duplicate prosthetic devices
9) Services or supplies received by a covered person, where no charge would have been made in the absence of dental expense benefits, or which are not required to be paid
10) Materials or services that are experimental under generally accepted dental standard
11) Received as a result of dental disease, defect or injury due to an act of war, or a warlike act in time of peace, which occurs while coverage is in effect
12) Instruction for oral care such as hygiene or diet
13) Periodontal splinting
14) Benefits otherwise provided under your employer’s plan or any other plan that your employer or an affiliate contributes to or sponsors
15) Charges by the dentist for missed appointments or for completing dental forms
16) Sterilization supplies
17) Furnished by a family member
18) For Type C Expenses: 1) Replacement of a lost, missing or stolen crown, bridge or denture; 2) Initial installation of a denture or bridgework to replace one or more natural teeth lost before the Dental Expense Benefits started; 3) Replacement of an existing crown, removable denture or fixed bridgework unless it is needed because the existing crown, denture or bridgework can no longer be used and was installed at least 10 years prior(five years for crowns) to its replacement; 4) Replacement of existing immediate temporary full denture by a new permanent full denture unless: (a) the existing denture cannot be made permanent; and (b) the permanent denture is installed within 12 months after the existing denture was installed; 5) Adjustment of a denture or bridgework that is made within six months after installation by the same Dentist who installed it This plan does not cover the following services, treatments and supplies:
19) Orthodontia
20) Sealants
21) Temporary or provisional restorations
22) Temporary or provisional appliances
23) Services or supplies to the extent that benefits are otherwise provided under this plan or under any other plan that the Policyholder (or an affiliate) contributes to or sponsors
COVERED BENEFITS LIMITATIONS
The fact that a dentist recommends a dental service does not mean dental expense benefits will be paid under the Dental Plan. Dental expense benefits will be based on the most cost-effective materials and methods of treatment that meet generally accepted dental standards. MetLife’s dental consultants may review dental services to determine whether the dental service is necessary in terms of generally accepted dental standards for the purpose of determining the extent to which dental expense benefits are payable under the Dental Plan. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered and obtain a pretreatment estimate of benefits prior to receiving certain high-cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.