MMC Benefits Handbook
A bitewing is the dental X-ray showing the crown portions of the upper and lower teeth.
A bridge is a strong connecting link between two or more teeth, replacing a missing tooth or teeth. It usually has a gold frame and porcelain that has the shape and color of the missing teeth.
A crown—also called a cap—is a porcelain or gold tooth cover for a decayed, damaged, brittle or discolored tooth that has a strong base and roots.
Dentures are removable, artificial teeth designed to help you chew, restore your bite and improve your appearance.
Eligible Family Members
To cover an eligible family member, you will be required to certify in the Mercer Marketplace Benefits Enrollment Website that your eligible family member meets the eligibility criteria as defined below.
Spouse/Domestic Partner means:
Adding a spouse or same gender or opposite gender domestic partner to certain benefits coverage is permitted upon employment or during the Annual Enrollment period for coverage effective the following January 1st if you satisfy the plans' criteria, or immediately upon satisfying the plans' criteria if you previously did not qualify.
Spouse / Domestic Partner
- You have already received a marriage license from a US state or local authority, or registered your domestic partnership with a US state or local authority.
- Although not registered with a US state or local authority, your relationship constitutes a marriage under US state or local law (e.g., common law marriage or a marriage outside the US that is honored under US state or local law).
Domestic Partner Only
- Although not registered with a US state or local authority, your relationship constitutes an eligible domestic partnership. To establish that your relationship constitutes an eligible domestic partnership you and your domestic partner must:
- be at least 18 years old
- not be legally married, under federal law, to each other or anyone else or part of another domestic partnership during the previous 12 months
- currently be in an exclusive, committed relationship with each other that has existed for at least 12 months and is intended to be permanent
- currently reside together, and have resided together for at least the previous 12 months, and intend to do so permanently
- have agreed to share responsibility for each other's common welfare and basic financial obligations
- not be related by blood to a degree of closeness that would prohibit marriage under applicable state law.
Marsh McLennan reserves the right to require documentary proof of your domestic partnership or marriage at any time, for the purpose of determining benefits eligibility. If requested, you must provide documents verifying the registration of your domestic partnership with a state or local authority, your cohabitation and/or mutual commitment, or a marriage license that has been approved by a state or local government authority.
Child/Dependent Child means:
- your biological child
- a child for whom you or your spouse are the legally appointed guardian with full financial responsibility
- the child of a domestic partner
- your stepchild
- your legally adopted child or a child or child placed with you for adoption.
Note: Any child that meets one of these eligibility requirements and who is incapable of self support by reason of a total physical or mental disability as determined by the Claims Administrator, may be covered beyond the end of the calendar year in which the child attains age 26.
Dependent children are eligible for healthcare coverage until the end of the calendar year in which they attain age 26. This eligibility provision applies even if your child is married, has access to coverage through his or her employer, doesn't attend school full-time or live with you, and is not your tax dependent.
Note: While married children are eligible for healthcare coverage under your plan until the end of the calendar year in which they attain age 26, this provision does not apply to your child's spouse and/or child(ren), unless you or your spouse is the child's legally appointed guardian with full financial responsibility.
The Company has the right to require documentation to verify the relationship (such as a copy of the court order appointing legal guardianship). Company medical coverage does not cover foster children or other children living with you, including your grandchildren, unless you are their legal guardian with full financial responsibility—that is, you or your spouse claims them as a dependent on your annual tax return.
Endodontics refers to the care of the pulp chambers and root canals of your natural teeth; it usually involves sterilization and filling.
Fluoride is a natural substance found in minerals that works with your tooth or bone structure to make it stronger and more resistant to acid decay.
Gingivectomy refers to the surgical removal of the flaps of gum tissue that create pockets alongside teeth that have periodontal damage. This operation is designed to stop periodontal disease.
When you receive care from a dentist who has an agreement with your Plan, it is referred to as in-network care. Your costs are generally lower for in-network care than for out-of-network care.
Inlays and Onlays
An inlay is a cast porcelain, composite or gold filling that is used to help restore the side or top area of a tooth. Onlays are similar to inlays but are used to cover the entire chewing surface of a tooth.
Oral surgery is surgery of the oral mouth cavity, including teeth and gums. Dental oral surgery typically includes complex extractions and other surgical procedures.
Orthodontia is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities through the use of devices such as removable appliances or fixed braces to remove teeth or adjust underlying bone.
When you receive care from a dentist who does not have an agreement with your Plan, your services are considered out-of-network. Your costs are generally lower for in-network care than for out-of-network care.
Periodontics is the treatment of the supporting structure of the tooth—the gum and bone tissue
Reasonable and Customary Charges
A reasonable and customary (R&C) charge is the lesser of the fee most dentists in an area normally charge for the same type of dental service (as determined by MetLife) and your provider's actual charges. It is sometimes called usual, reasonable and customary (URC); or usual, customary and reasonable (UCR) charges.
A root canal is a procedure where the nerve of a heavily decayed tooth is removed from the tooth and replaced with a filling material.
A sealant is the protective plastic coating applied over grooves in your teeth to prevent decay.
A space maintainer is an appliance children use in their mouths to keep a space until a permanent tooth comes in to fill the space so their remaining teeth don't drift or crowd new teeth, up to age 19.
Splinting is connecting teeth with a fixed appliance.
Some covered services are reimbursed based on time limits. In these cases, reimbursement is determined by the exact date of the covered service. For example, the Plan reimburses dentures only after 84 months since the dentures were placed. So, if you received dentures on June 16, 2011, you will next be eligible to receive a new set of dentures on or after June 16, 2016. This is true even if new dentures are lost or stolen.
TMJ (Temporomandibular Joint) Syndrome
TMJ/TMD syndrome is a medical or dental problem related to the temporomandibular joint that links the jaw bone and skull.