The Plan at a Glance

MMC Benefits Handbook


Plan Feature	Premier Dental Option		Standard Dental Option
	In-Network	Out-of-Network	In-Network	Out-of-Network
Annual Deductible	Individual: $25 per calendar year Family: $75 per calendar year	Individual: $25 per calendar year Family: $75 per calendar year	Individual: $50 per calendar year Family: $150 per calendar year	Individual: $50 per calendar year Family: $150 per calendar year
Plan Payment	Preventive and diagnostic—100% Basic Restorative—80% Major Restorative—50%	Preventive and diagnostic—100% of reasonable and customary charges (R&C) Basic Restorative—80% of R&C after deductible Major Restorative—50% of R&C after deductible	Preventive and diagnostic—100% Basic Restorative—80% Major Restorative—50%	Preventive and diagnostic—100% of reasonable and customary charges (R&C) Basic Restorative—80% of R&C after deductible Major Restorative—50% of R&C after deductible
Orthodontia	50%	50% of R&C	Not covered
Orthodontia lifetime maximum	$2,500 per covered individual (combined in-network and out-of-network)		N/A
Annual maximum	$2,500 per covered individual (combined in-network and out-of-network)		$1,500 per covered individual (combined in-network and out-of-network)
Lifetime maximum	None	None	None	None
Contact Information	For Dental Services: MetLife Dental Claims (Claims Administrator) P.O. Box 981282 El Paso, TX 79998-1282 Phone: +1 800 942 0854 www.metlife.com/mybenefits (Enter "Marsh McLennan" in the Account Sign in box for your company name when prompted. Then click Dental Benefits.) Marsh McLennan does not administer this Plan. MetLife's decisions are final and binding.