The following explanations will help you understand how the dental plans work.
Annual Benefit Maximum. For each calendar year, each plan pays a maximum dollar amount toward your covered dental expenses. Once your dental benefits reach this dollar maximum, you are not eligible for dental benefits until the beginning of the next calendar year.
Copayment. After the plan pays a percentage of the reasonable and customary fee for dental services, the remaining cost is your copayment. For example, if the plan pays 80% of a basic or major service, the remaining 20% is your copayment. Keep in mind, the actual charges may be greater than what the insurance company defines as a reasonable and customary charge. If so, you are responsible for payment of any amounts over the reasonable and customary limits.
Deductible. You may need to pay a deductible for services performed by a non-participating dentist if you are enrolled in Plan B.
Dentist. For the purposes of these plans, a dentist must be licensed and acting within the scope of his/her profession. Any other doctor or professional providing dental services must also operate within the scope of services he/she is licensed to perform.
Participating Dentist. A dentist who is a member of the MetLife network. Keep in mind, you receive a higher level of benefits by coordinating your care through a dentist who is in the network. To obtain a directory of participating dentists, call MetLife at 1-800-942-0854.
Reasonable and Customary (R&C). The plans only pay benefits for charges that are within reasonable and customary limits. This is an amount generally charged for similar services within your geographic area. If the fee is higher than the reasonable and customary charge, you are responsible for the remaining percentage of the charge (your copayment), as well as the charges above the reasonable and customary limit.
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