MMC Benefits Handbook
About the Network
This plan pays benefits at the in-network benefit level up to the Plan's maximum benefit when you receive care from an in-network dentist. The Plan pays an in-network dentist directly.
Note: If a claim is submitted by a participating dentist without an employee's signature or signature on file authorizing MetLife to pay the dentist, payment will be issued to the employee.
How does the network operate?
You can choose any dentist you wish. But if you use an in-network dentist, that is, a dentist in MetLife's Preferred Dentist Program, your costs are generally lower.
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. Note: If a claim is submitted by a participating dentist without an employee's signature or signature on file authorizing MetLife to pay the dentist, payment will be issued to the employee.
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, subject to the Plan's maximum benefit.
Dentists are neither agents nor employees of the Claims Administrator. The availability of any particular provider cannot be guaranteed and provider network composition is subject to change.
How can a dentist join MetLife's Preferred Dentist Program?
If your dentist is not a member of the program, he or she may call MetLife directly at +1 877 638 3379, to receive information on applying for participation.
In order to become a member of the program, the dentist must satisfy MetLife's credentialing criteria and agree to MetLife's fee schedule. Not all dentists who apply are guaranteed admittance to MetLife's network.
What happens if I am referred to an out-of-network dentist?
If you start your treatment with an in-network dentist and then are referred to an out-of-network dentist, services of the out-of-network dentist will be reimbursed at the rate for an out-of-network dentist, subject to applicable plan provisions. Be sure to secure a pre-treatment estimate, so that you are aware of the cost of the treatment beforehand.
What are the participating dentist's qualifications?
Dentists participating in the MetLife Preferred Dentist Program undergo an extensive credential-checking process by MetLife Dental that focuses on practice location, specialty, licensing, utilization, malpractice coverage and history, and emergency care arrangements. Participating dentists are re-credentialed by MetLife Dental periodically and are monitored periodically to ensure proper utilization patterns.
Where can I get a list of dentists and specialists in the network?
To view the provider directory online, visit the Claim Administrator's website (www.metlife.com/mybenefits). If you do not have internet access, a customized list of providers can be obtained without charge by contacting MetLife Dental.
Does the Plan cover dental services or treatment outside the United States?
Yes, the Plan reimburses covered dental services and treatment you receive outside the United States at the out-of-network reimbursement level.