Your Dental Benefits Start Here
Central Texas
| HMO-POS Select | HMO-POS Preferred | HMO-POS Premium | HMO-POS Essentials | PPO Basic | PPO Platinum | |
|---|---|---|---|---|---|---|
| Monthly Premium | Included | |||||
| Yearly Benefit Maximum | ||||||
| Plans w/ Part D prescription drugs (Rx) | $3,500 | $3,000 | ||||
| Plans w/o Part D prescription drugs | $3,000 | Not available | ||||
| Deductible | $0 | |||||
| Oral Exams (every 6 months) |
$0 | |||||
| Cleanings (every 6 months) |
$0 | |||||
| Dental X-rays | $0 | |||||
| Extractions | 50% coinsurance | |||||
| Fillings (One filling per surface, per tooth every 24 months.) |
50% coinsurance | |||||
| Dentures (every 5 years) |
50% coinsurance | |||||
| Restorative Services | 50% coinsurance | |||||
2025 Dental Benefits
| HMO-POS Select | HMO-POS Preferred | HMO-POS Premium | HMO-POS Select Rx Assist | PPO Basic | PPO Platinum | |
|---|---|---|---|---|---|---|
| Monthly Premium | Included | |||||
| Yearly Benefit Maximum | ||||||
| Plans w/ Part D prescription drugs (Rx) | $3,500 | $3,000 | $3,500 | $3,000 | $3,500 | $3,000 |
| Plans w/o Part D prescription drugs | $3,000 | Not available | ||||
| Deductible | $0 | |||||
| Oral Exams (every 6 months) |
$0 | |||||
| Cleanings (every 6 months) |
$0 | |||||
| Dental X-rays | $0 | |||||
| Extractions | 50% coinsurance | |||||
| Fillings (One filling per surface, per tooth every 24 months.) |
50% coinsurance | |||||
| Dentures (every 5 years) |
50% coinsurance | |||||
| Restorative Services | 50% coinsurance | |||||
North Texas
| HMO-POS Select | HMO-POS Select Rx | HMO-POS Select Rx Assist | PPO | |
|---|---|---|---|---|
| Monthly Premium | Included | |||
| Yearly Benefit Maximum | $3,000 | $3,500 | $3,000 | $3,500 |
| Deductible | $0 | |||
| Oral Exams (every 6 months) |
$0 | |||
| Cleanings (every 6 months) |
$0 | |||
| Dental X-rays | $0 | |||
| Extractions | 50% coinsurance | |||
| Fillings (One filling per surface, per tooth every 24 months) |
50% coinsurance | 0-50% coinsurance | 50% coinsurance | 0-50% coinsurance |
| Dentures (every 5 years) |
50% coinsurance | $0 copay | 50% coinsurance | $0 copay |
| Restorative Services | 50% coinsurance | 0-50% coinsurance | 50% coinsurance | 0-50% coinsurance |
2025 Dental Benefits
| HMO-POS Select | HMO-POS Select Rx | HMO-POS Select Rx Assist | PPO | |
|---|---|---|---|---|
| Monthly Premium | Included | |||
| Yearly Benefit Maximum | $3,000 | $3,500 | $3,000 | $3,500 |
| Deductible | $0 | |||
| Oral Exams (every 6 months) |
$0 | |||
| Cleanings (every 6 months) |
$0 | |||
| Dental X-rays | $0 | |||
| Extractions | 50% coinsurance | |||
| Fillings (One filling per surface, per tooth every 24 months) |
50% coinsurance | 0-50% coinsurance | 50% coinsurance | 0-50% coinsurance |
| Dentures (every 5 years) |
50% coinsurance | $0 copay | 50% coinsurance | $0 copay |
| Restorative Services | 50% coinsurance | 0-50% coinsurance | 50% coinsurance | 0-50% coinsurance |
West Texas
| BSW SeniorCare Advantage PPO | Covenant Advantage HMO | Covenant Advantage HMO Rx | |
|---|---|---|---|
| Monthly Premium | Included | ||
| Yearly Benefit Maximum | $3,500 | $2,500 | $3,000 |
| Deductible | $0 | ||
| Oral Exams (one every 6 months) |
$0 | ||
| Cleanings (one every 6 months) |
$0 | ||
| Dental X-rays | $0 | ||
| Extractions | 50% coinsurance | ||
| Fillings (One filling per surface, per tooth every 24 months) |
0-50% coinsurance | 50% coinsurance | |
| Dentures (every 5 years) |
$0 copay | 50% coinsurance | |
| Restorative Services | 0-50% coinsurance | 50% coinsurance | |
2025 Dental Benefits
| BSW SeniorCare Advantage PPO | Covenant Advantage HMO | Covenant Advantage HMO Rx | |
|---|---|---|---|
| Monthly Premium | Included | ||
| Yearly Benefit Maximum | $3,500 | $2,500 | $3,000 |
| Deductible | $0 | ||
| Oral Exams (one every 6 months) |
$0 | ||
| Cleanings (one every 6 months) |
$0 | ||
| Dental X-rays | $0 | ||
| Extractions | 50% coinsurance | ||
| Fillings (One filling per surface, per tooth every 24 months) |
0-50% coinsurance | 50% coinsurance | |
| Dentures (every 5 years) |
$0 copay | 50% coinsurance | |
| Restorative Services | 0-50% coinsurance | 50% coinsurance | |
Information About Your Account
Log into the MetLife MyBenefits portal to verify your eligibility, find your summary of benefits, check claims status and more. Or call 855.676.9337 and speak with a MetLife customer service agent to get the answers you need.
View your Evidence of Coverage (EOC)
These booklets, accessible from your MetLife MyBenefits portal or by logging into the Member Portal, give you the details about your MetLife dental coverage from Jan. 1 through Dec. 31.
Baylor Scott & White Health Plan offers BSW SeniorCare Advantage HMO-POS plans as a Medicare Advantage (MA) organization through a contract with Medicare. Baylor Scott & White Care Plan offers Covenant Health Advantage HMO plans as an MA organization through a contract with Medicare. Baylor Scott & White Insurance Company offers BSW SeniorCare Advantage PPO plans as an MA organization through a contract with Medicare. Enrollment in one of these plans depends on the health plan's contract renewal with Medicare.
Y0058_BSWHPWEBSITE2025_C CMS 1/1/2025 | Last updated: 1/1/25