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Wherever our anthem is proudly sung,MetLife Federal Dental is with you.2020 Dental Plan Summary

ContentsPlan Highlights3Overview4Covered Dental Services5Benefits Options6Rates7Retired Uniformed Service Members8Enroll9Exclusions and LimitationsEnroll in the MetLife Federal DentalPlan today. Get the benefits you’relooking for: More coverage More savings More dentists More satisfactionEnroll November 11 - December 9, 2019 ESTwww.BENEFEDS.com 1-877-888-FEDS (3337)102

We’re with you in 2020 withour nationwide network ofdentists and comprehensivedental coverage.Enrollment DatesNovember 11 –December 9, 2019 ESTTo Enroll: BENEFEDSwww.BENEFEDS.com1-877-888-FEDS (3337)TTY 1-877-889-5680Find Out 4TDD 1-888-260-5376Monday–Friday, 8am–9pm ESTOPMwww.opm.gov/healthcare-insurance3

OverviewMore Coverage Child and adult orthodontia coverage on both standardand high plan options Unlimited annual maximum per person in high option No waiting periods to receive benefits No annual deductible for in-network benefitsMore Savings Big discounts up to 45% let you save even more within-network dentists1 No out-of-pocket costs for in-network cleanings, x-rays and exams2 Competitively pricedMore Dentists One of the nation’s largest networks Over 434,000 dentist locations To find out if your dentist is in the network, visitfederaldental.metlife.com and use our “Find a Dentist” toolMore Satisfaction 99% of claims are paid within 10 days3 97% of our members would tell you to choose us4 We automatically submit dental claims to FSAFEDS for youEnroll now1. Savings from enrolling in the MetLife Federal Dental Plan will depend on various factors,including the cost of the plan, how often participants visit the dentist and the cost ofservices rendered.2. Subject to frequency limitations. 3. MetLife claims data as of December 2018.4. Based on the 2018 MetLife Federal Dental Plan Participant Satisfaction Survey.4

More coverageWith the MetLife Federal Dental Plan,it’s even easier to get the coverage you need.Covered Dental ServicesHere is a summary of dentalservices covered in each category:Class B - IntermediateClass C - MajorMinor Restorative Services Resin-based anterior composites; alternate benefitof amalgam will be provided on molar teeth.Major Restorative Services Metallic onlays; four or more surfaces;one per tooth every 60 months.Prefabricated stainless steel crowns;one per tooth every 60 months.Porcelain or ceramic crown substrate;one per tooth every 60 months.Diagnostic and TreatmentPeriodic oral evaluations; one every 6 months.Endodontic Services Therapeutic pulpotomy (exclusions apply).Bitewing X-rays; one set every 6 months for children;one set every calendar year for adults.Periodontic Services Periodontal scaling and root planing; four or moreteeth per quadrant; one every 24 months.Endodontics Services Anterior, bicuspid and molar root canal(exclusions apply).Class A - BasicPreventive ServicesProphylaxis (cleanings) for adults and children;one every 6 months.Topical application of fluoride; two every 12 monthsfor children; one every 12 months for adults.Re-treatment of anterior, bicuspid andmolar root canal therapy.Prosthodontic ServicesRebase of complete maxillary dentures; one in a36-month period; 6 months after initial installation.Periodontic Services Gingivectomy or gingivoplasty; one to three teethper quadrant; one every 36 months.Oral Surgery Removal of an impacted tooth.Surgical access of an unerupted tooth.Prosthodontic Services Porcelain, ceramic and cast metal retainers forresin-bonded fixed prosthesis; one every 60 months.Class D - OrthodontiaAdult (enrollee and spouse) and dependent childrenorthodontia coverage.Covered Dental ServicesMetLife Federal Dental PlanNo waiting periods for bothStandard and High Options.Orthodontic benefits end at cancellation of coverage.The details in this document represent an overview ofyour plan benefits. This document is not a completedescription of the plan. Please note certain services listedare subject to dental review and the alternate benefit.Please visit federaldental.metlife.com for a full explanationof plan benefits including exclusions and limitations. TheMetLife 2020 Federal Dental Plan Brochure will govern ifany discrepancies exist between that Brochure and thisPlan Summary or any other document. The MetLife 2020Federal Dental Plan Brochure and 2020 Federal DentalPlan Summary are available for viewing and printing at ourwebsite, federaldental.metlife.com.Implant Services Implant services subject to the guidelines of the plan.Enroll now5

We’ve made it simple to choose the right plan to fit yourbudget with Standard and High plan options.Both plans provide savings for you and your family including: No cost for in-network cleanings, X-rays and exams1 No annual deductible for in-network services Standard Option:High Option provides you with additional protection fromunforeseen dental costs: 1,500 annual maximum per person Child orthodontia covered at 50% up to a planlifetime maximum of 2,000 Adult orthodontia covered at 50% up to a planlifetime maximum of 2,000 Unlimited annual maximum per person Adult orthodontia covered at 70% up to a plan lifetimemaximum of 3,000 Child orthodontia covered at 70% up to a plan lifetimemaximum of 5,000Benefits OptionsYou can chooseMetLife Federal Dental Plan Competitive pricing No waiting periodsStandard OptionHigh workBasic cleanings, X-rays and oral examinations100%60%100%90%Intermediate fillings and periodontal maintenance55%40%70%60%Major crowns, bridges, root canal treatment and dentures35%20%50%40%Orthodontia comprehensive orthodontic treatment, fixed appliance50%50%70%70% 0 100 0 50Annual Maximum Per Person 1,500 1,000UnlimitedUnlimitedOrthodontia Lifetime Maximum Dependent Child Per Person 2,000 2,000 5,000 5,000Orthodontia Lifetime Maximum Adult Per Person 2,000 2,000 3,000 3,000CoverageAnnual Deductible Per Person2In-Network Participating dentists charge negotiated fees that are typically 30–45% less thanaverage charges in the same community.3 Negotiated fees4 even apply to services your plan doesn’t cover, including anyyou’ve received after you reach your plan’s annual maximum.Enroll now Percentages shown are the percentage of the negotiated fee paid by the plan.You are responsible for the portion of the negotiated fee that the plan does not pay.Out-of-Network A non-participating dentist sets his or her standard fee, which is typically higher than the negotiated fee. Percentages shown are the percentage of the Usual and Customary Fee4 paid by the plan. You will beresponsible for the difference between your dentist’s charge and the covered percentage of the Usual andCustomary Fee for a given service.51. Subject to frequency limitations. 2. Annual deductible applies to Basic, Intermediate and Major Services for out of network only. 3. Based onMetLife data. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for services rendered by them,subject to any cost sharing, benefit maximums and terms of the plan. Negotiated fees are subject to change. Savings from enrolling in a dentalbenefits plan will depend on various factors, including plan design and premiums, how often participants visit the dentist and the cost of servicesrendered. 4. The Usual and Customary Fee is the lowest of (1) The dentist’s actual charge, (2) The dentist’s usual charge for the same or similarservices, or (3) The amount charged by most dentists in the same geographic area for the same or similar services as determined by MetLife. 5.Subject to any deductibles, cost sharing, benefit maximum and terms of the plan. This document is not a complete description of the plan options.The 2020 MetLife Federal Dental Plan Brochure will govern these plan options and can be viewed by visiting federaldental.metlife.com.6

Premium rating areas by stateFinding your bi-weekly rate is simple.1. Find your state and the first 3 digits of your zip code below2. Match that Rating Area to your enrollment type and plan optionEnroll nowHigh OptionStandard OptionRating AreaSelfSelf OneSelf FamilySelfSelf OneSelf Family1 10.30 20.59 30.89 19.10 38.19 57.292 11.17 22.33 33.50 21.39 42.79 64.183 12.39 24.78 37.17 23.31 46.62 69.924 13.75 27.51 41.26 25.24 50.48 75.735 15.12 30.23 45.35 28.25 56.50 84.75State State/Zip (first 3)State State/Zip (first 3)RatingState State/Zip (first 3)Rating5LAEntire State1OR970-97341MAEntire State5ORRest of State3Entire State1MD2193PA173-1744Entire State1MDRest of State4PA1835CA919-9214MEEntire State2PA189-1963CA942, 956-9584MI480-4853PARest of State1CARest of State5MIRest of State2PREntire Territory1COEntire State4MN550-555, 5634RIEntire State5CTEntire State5MNRest of State2SCEntire State1DCEntire District4MOEntire State1SDEntire State1DEEntire State3MSEntire State1TNEntire State1FL330-3343MTEntire State1TXEntire State1FLRest of State1NCEntire State1UTEntire State1GA300-303, 3052NDEntire State1VA201-205, 220-2274GA311, 3992NEEntire State1VARest of State1GARest of State1NHEntire State5VIEntire Territory1GUEntire Territory1NJ080-0843VTEntire State2HIEntire State4NJRest of State5WA980-9855IAEntire State1NMEntire State1WARest of State4IDEntire State1NVEntire State2WI5404IL600-6084NY005, 0635WIRest of State2ILRest of State1NY100-119,124-1265WV2544IN463-4644NYRest of State2WVRest of State1INRest of State1OHEntire State1WYEntire State1KSEntire State1OKEntire State1INTAll5KYEntire State1AKEntire StateALEntire StateARAZRatingRatesMetLife Federal Dental PlanFind your personalized rate and view monthly rates online by visiting us at federaldental.metlife.com/rates7

To receive FEDVIP dental coveragebeginning in 2020, you must enroll duringthe Federal Benefits Open Season,November 11 - December 9, 2019 EST.In 2019, the TRICARE Retiree Dental Program (TRDP) wasreplaced by FEDVIP dental coverage options.Here’s how the MetLife Federal Dental plan benefits you: You have a choice with the MetLife Federal Dental Standard and High Options.The benefits and differences for both can be found on page 7. Higher annual and lifetime plan maximums are available to you. One of the nation’s largest dental networks. Significant discounts for covered services by in-network dentists.Retired Uniformed Service MembersRetired UniformedService MembersMetLife Federal Dental PlanMany federal employees and retirees choose MetLife Federal Dental plans over otherFEDVIP carriers. We’re pleased to extend this same commitment of quality, service andchoice to members of the military and Retired Uniformed Service Members.If you are not enrolled and want to receive FEDVIP dental coverage beginning in 2020,you must enroll during the Federal Benefits Open Season, November 11 – December9, 2019 EST. If you are already enrolled and don’t want to make any changes to yourcoverage, you do not need to take any action.MetLife Federal Dental is proud to offer military retirees and their families dentalcoverage. MetLife currently provides dental services to nearly 80,000 military retireesand their families.Learn more at MetLife.com/FEDVIP. You can also enroll directlyat BENEFEDS.com or by calling 1-877-888-FEDS (3337).28

More dentistsYou’ll have access to one of the largest networks in thecountry. And that means more choices for you.EnrollMetLife Federal Dental PlanEnroll in the MetLife Federal Dental Plan now.MetLife provides benefits for more than 660,000 federal governmentemployees, retirees and retired uniformed service members.Onlinewww.BENEFEDS.comPhone1-877-888-FEDS (3337)TTY 1-877-889-56809