MetLife Dental PPO at a Glance

  • The Dental PPO plan is a flexible insurance plan that offers great coverage and allows you to choose your own dentist.

  • The Dental PPO plan is a coinsurance plan that pays for a large percentage of any dental work you receive by a licensed dentist.

  • This plan is remarkably different from the HMO plan, the PPO plan costs more but has more flexible coverage and gives you more freedom when it comes to the kind of treatment you’ll get.

  • This page will focus on the PPO plan, if you’d like more details on the HMO plan, click HERE.

  • Unlike the HMO plan, there is no insurance card with the Dental PPO plan.

  • Click HERE to view the rate sheet.

  • To enroll, call SDPEBA at 888-315-8027 or click here to book a call. 

Dental insurance can be very confusing. Between procedure codes, treatment options, and weird medical jargon, it can be hard to know what’s going on until you’re hit with the bill.  

The MetLife Dental PPO plan aims to make a lot of that easier by using a more modern coinsurance model that can help reassure you that whether you’re getting a cleaning, a filling, or a crown, you’ll be covered.  

The plan breaks your coverage into four categories: Preventative (Type A), Basic Restorative (Type B), Major Restorative (Type C), and Orthodontia (Type D). Some examples of each are as follows: 

  • Preventative (Type A)
    • Oral Exams
    • Cleanings
    • Full Mouth X-Rays
  • Basic Restoration (Type B)
    • Sealants
    • Root Canals
    • Fillings
  • Major Restoration (Type C)
    • Crowns
    • Dentures
    • Bridges 

  • Orthodontia (Type D)

    • Braces

    • Retainers

    • Any other related Charges 

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Each of these categories then have a coinsurance percentage that is covered. That means that MetLife pays that percent of the bill. For example: if you have a 90% coinsurance and the bill is $100, MetLife pays $90 you pay $10.


Below are the coinsurance percentages for each of the types of coverage:

  • Preventative (Type A)
    • In-Network: 100%
    • Out-of-Network: 100% 
  • Basic Restoration (Type B)
    • In-Network: 90%
    • Out-of-Network: 80% 
  • Major Restoration (Type C)
    • In-Network: 60%
    • Out-of-Network: 50% 
  • Orthodontia (Type D)
    • In-Network: 50%
    • Out-of-Network: 50% 

Since this plan doesn’t have predetermined prices available for you like it does with the HMO plan, we highly recommend you ask for a pretreatment estimate for every procedure you get done so that way you know what you’ll be paying.


Note that MetLife’s Type B and Type C services both share a $50 deductible and have an annual maximum coverage of $2,250. 


Is the Dental PPO plan right for me?

If you need orthodontics and want more options (like Invisalign), go to the dentist regularly, or just want a more intuitive plan, you should consider this plan. This plan is also great for people who value flexibility and want to be able to go to any dentist. Ultimately this plan offers a lot of coverage but does cost more than our HMO option. We highly recommend you check out the rate sheet and make your decision from there.


How much does this plan cost?

To view up to date rates, please check the rate sheet on the sidebar for a detailed breakdown of the plan's cost.


How do I enroll?

To enroll in MetLife Dental, simply call 888-315-8027 during Open Enrollment. If you have any questions about enrolling, feel free to call that number or email support@SDPEBA.org. If you already have the PPO plan, you don’t need to reenroll, only contact us to add, change, or remove your existing plans.  Note: MEA employees will need to enroll in MetLife Dental via SAP during the City’s enrollment period.


How do I file a claim? How do I use the plan?

Once the plan begins on January 1st, you just need to make an appointment with a covered dentist! Steps from there will vary dentist to dentist but will probably involve you filling out a form or calling in.

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About Us

The San Diego Public Employee Benefit Association is a partnership of unions and associations designed to help reduce costs, improve benefits, and enhance support for San Diego’s public employees. We’re here to answer your questions and help make sure you get the most out of your benefits while also advocating for you directly to the provider to make sure you get the best experience possible.