MMC Benefits Handbook
How the Plan Works
This Plan pays benefits for dental services received by you and your covered family members. Services can be provided by an in-network or an out-of-network provider.
If you use an in-network provider, you are responsible for the coinsurance amount on the provider's negotiated fee. The Plan pays the balance directly to a participating MetLife provider. For example, if the Plan pays an 80% benefit, your coinsurance amount would be 20% of the MetLife provider's negotiated fee.
If you use an out-of-network provider, you are responsible for the coinsurance amount on the reasonable and customary (R&C) charges for your geographic area and, depending on the service, you may have to meet a deductible. You must submit out-of-network expenses to the Claims Administrator for reimbursement. For example, if the Plan pays an 80% benefit, your coinsurance amount would be 20% of the reasonable and customary charge for your geographic area, after you meet your deductible. You are also responsible for any amount above the reasonable and customary charge.
Pretreatment estimates are recommended if the cost of the treatment will be over $300, or if you will be undergoing procedures such as crowns, bridges, implants, periodontal work, inlays or onlays.
Some services have limits or restrictions—see "What's Covered."
Certain services are not covered, see "What's Covered."
The Plan reimburses covered dental services and treatment you receive outside the US at the out-of-network reimbursement level.