MMC Benefits Handbook
Predetermination of Benefits
What is the predetermination of benefits?
This feature of the Plan helps you estimate how much the Plan may pay (subject to your deductible and plan maximum at the time the estimate is provided) before you begin treatment with any dentist (in the Preferred Dentist Program or not). It is intended to avoid any misunderstanding about coverage or reimbursement, and it is not intended to interfere with your course of treatment.
How can I find out in advance what my dental plan will pay for my dental treatment?
Ask your dentist to submit a treatment plan to MetLife Dental.
The treatment plan must include the recommended services and their costs, as well as supporting X-rays and other records. MetLife Dental will estimate how much the Plan will pay (subject to your deductible and plan maximum at the time the estimate is provided), and will notify both you and your dentist in two or three weeks of the amount, if any, the Plan will pay.
Amount for a predetermination of benefits
You should get a predetermination of benefits 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.
Can I obtain a predetermination of benefits for my covered family members?
Your covered eligible family members can also obtain a predetermination of benefits, although it will not reflect the coordination of this Plan's benefit with benefits from any other plan under which your eligible family members may be covered. You should compare the benefits of both plans and ask MetLife Dental for an explanation of the coordination of benefits provision if you have any questions.