You select and schedule an appointment with the provider of your choice.  You are not required to use a network provider.  There is a difference in how a network provider versus a non-network provider bills for their services. 

Network Provider
MetLife has a Preferred Dentist Program (PDP) network.  Participating dentists agree to accept a discounted fee schedule as full payment for covered service.  You will not be billed for any covered charges that are greater than the contracted fee schedule if you use a PDP provider. 

The PDP network is not available to hourly employees until January 1, 2007. 

Non-Network Provider

The Plan pays benefits to non-network providers based on “Reasonable and Customary Charges”

If you use a provider that is not part of the contracted PDP network, the plan pays benefits toward covered dental expenses on the basis of “Reasonable and Customary Charges.”
 
If you incur charges that exceed what is considered Reasonable and Customary, the plan covers the Reasonable and Customary Charge and you are responsible for paying the balance.  Charges beyond Reasonable and Customary will not count toward the deductible.

Briefly, the plan covers four types of dental services:

• Type A – Preventive and diagnostic services
• Type B – Oral surgery and restorative services
• Type C – Prosthodontic services
• Type D – Orthodontic services.

The plan pays different benefits for each of these types of coverage – with one annual deductible required for Type B and Type C services only.

Annual Deductible
You and each covered dependent must satisfy a $50 individual deductible each calendar year before benefits become payable toward Type B (oral surgery and restorative) services and Type C (prosthodontic) services covered by the plan.  The deductible does not apply to Type A (preventive and diagnostic) or Type D (orthodontic) services. 

Maximum Benefits
The plan pays up to a maximum of $1,500 per year and $20,000 ($10,000 for hourly employees until January 1, 2007) in a lifetime for each covered person for Type A, Type B, and Type C expenses combined.  For Type D (orthodontic) services, there is a separate lifetime maximum of $1,500 in benefits for each covered person.

Four Types of Dental Services Type A:    Preventive and diagnostic services Type B:    Oral surgery and restorative services Type C:    Prosthodontic services Type D:    Orthodontic services

MetLife Dental Plan
Refer to the "Covered Expenses" section, provided on the following page, for details.
Services Covered	Amount of Coverage*
Calendar Year Maximum	$1,500
Lifetime Orthodontic Maximum	$1,500
Lifetime Maximum	Salaried Employees and Retirees: $20,000 Hourly Employees: $10,000 until January 1, 2007 then $20,000
Annual Deductible (applies to Type B and Type C services)	$50 per member
Services Covered	Amount of Coverage*
TYPE A – Preventive and Diagnostic Services:
Oral Examinations	Covered 100%, once every 6 months
Prophylaxis (cleanings)	Covered 100%, once every 6 months
Full mouth X-rays	Covered 100%, once every 24 months
Bite-wing X-rays	Covered 100%, one set every 6 months
Fluoride	Covered 100% under age 19
Space Maintainers	Covered 100%
TYPE B – Oral and Restorative Services:
Fillings (other than gold), general anesthesia, occlusal guards, extractions and oral surgery*, periodontics, endodontics (root canal therapy)	Covered 80% after deductible
Sealants	Not covered
TYPE C – Prosthodontic Services (no age limit for bridges, partial dentures, or full dentures)	Covered 50% after deductible
TYPE D – Orthodontic Services: braces, surgical repositioning to correct malocclusion, surgical extractions, X-rays, retention checking	Covered 50% for dependents up to age 24
*Reasonable and Customary Charges apply for non-network providers.  The PDP network fee schedule applies for PDP providers.

Type A – Preventive and Diagnostic Services
The dental plan pays 100% of covered expenses for Type A (preventive and diagnostic) services, with no deductible required.

Covered expenses for preventive and diagnostic services include Reasonable and Customary Charges for:

• oral examinations (once every six months)
• cleaning and scaling of teeth (once every six months)
• bitewing X-rays (one set every six months)
• full mouth X-rays (one set every 24 months)
• topical fluoride applications for Children under age 19 (once every six months)
• space maintainers
• emergency treatment.

Type B – Oral Surgery and Restorative Services
After the deductible has been satisfied, the plan pays 80% of covered expenses for Type B (oral surgery and restorative) services.

Covered expenses for oral surgery and restorative services include Reasonable and Customary Charges for:

• amalgam fillings (charges for precious metals such as gold and for castings are considered based on Reasonable and Customary Charges for amalgam fillings)
• treatment of gum disease (periodontics)
• endodontic treatment, including root canal services
• extractions (except in connection with orthodontic treatment)
• oral surgery
• general anesthesia when determined necessary under the plan’s dental provisions.

Type C – Prosthodontic Services
After the deductible has been satisfied, the plan pays 50% of covered expenses for Type C (prosthodontic) services.

Covered expenses for prosthodontic services include Reasonable and Customary Charges for:

• inlays, onlays, crowns, and gold fillings
• fixed bridgework installed for the first time to replace missing natural teeth, including inlays and crowns as abutments, but excluding periodontal splinting
• full or partial dentures installed for the first time to replace missing natural teeth and adjacent structures and any adjustments required during the six-month period following installation
• repair or recementing of crowns, inlays, onlays, dentures, or bridgework
• replacement or modifications of dentures or bridgework if required:

• to replace one or more teeth extracted after the existing denture or bridgework was installed
• to replace an existing appliance which is at least five years old and cannot be made serviceable
• to replace a temporary denture that cannot be made permanent and has been in place 12 months or less.

Type D – Orthodontic Services
No deductible applies to Type D covered expenses.
 
All covered Children through age 23 are eligible to receive benefits for orthodontic services.  At age 24, all coverage under the plan ends, even if a course of orthodontic treatment is ongoing.

The plan payment for covered expenses (initial and monthly) is based on a schedule of allowances for non-network providers.  This schedule is available from the Benefit Plans Office.  A PDP network provider is paid based on the PDP fee schedule. 

Covered expenses for orthodontic services include charges for:

• braces
• surgical repositioning of the jaw, facial bones and/or teeth to correct malocclusion
• surgical extractions
• X-rays
• retention checking.

The MetLife Dental plan does not cover certain expenses, including but not limited to charges for:

• services provided before plan coverage becomes effective
• services other than those specifically covered by the plan
• services and supplies that are not provided by a legally licensed dentist or physician (or a licensed hygienist for the scaling or cleaning of teeth and topical application of fluoride under the dentist’s supervision)
• services or supplies that are cosmetic in nature, including charges for personalization or characterization of dentures
• replacement of a lost, missing, or stolen prosthetic device
• services covered by any workers’ compensation laws or employer’s liability laws, or services which an employer is required by law to furnish in whole or in part
• services rendered through a medical department, clinic, or similar facility provided or maintained by the patient’s employer
• services or supplies for which a covered person would not legally have to pay if there were no coverage
• services or supplies which do not meet accepted standards of dental practices, including charges for services or supplies which are unnecessary or experimental in nature
• services or supplies received as a result of dental disease, defect or injury due to an act of war, whether declared or not
• dental services or supplies that are payable by any government
• any duplicate prosthetic devices or sealants (material, other than fluorides, painted on the grooves of the teeth in an attempt to prevent future decay), oral hygiene, and dietary instruction
• plaque control programs
• implantology (an insert set firmly or deeply into or onto the part of the bone that surrounds and supports the teeth)
• periodontal splinting
• myofunctional therapy.

Expenses incurred for any of the services or supplies listed above may not be used to satisfy your deductible.

If your coverage ends because your employment terminates, you retire, or you lose eligibility, benefits for covered expenses incurred before your termination remain payable under the plan.

If you are undergoing a course of treatment when your coverage ends, benefits are payable for most covered charges related to that treatment and incurred up to 30 days after your termination.

Exceptions to this 30-day extension include treatment involving:

• prosthetic devices – impressions and tooth preparation must be completed before coverage ends and the device must be installed or delivered within two calendar months following the end of coverage

• crowns – tooth preparation must be completed before the coverage ends and the crowns installed within two calendar months following the end of coverage

• root canal therapy – the tooth must be opened before coverage ends and treatment completed within two calendar months following the end of coverage

• orthodontia – not extended, under any circumstance.

When you or your covered Eligible Dependents require dental care and treatment, you should discuss in advance with your dentist what needs to be done and how much it will cost.  If treatment is expected to cost $100 or more, you should ask your dentist to file for predetermination of benefits.  This helps you avoid surprises by letting you know how much is payable for the proposed treatment before it begins.

Here is how it works:

• Your dentist submits the proposed course of treatment to MetLife by itemizing services and charges on a regular claim form.
• MetLife then determines the amount the plan will pay and informs you and your dentist by sending each of you a “Notice of Benefits Allowable” statement.
• You are free to pursue any treatment; however, the plan may only pay for the treatment that is indicated on the "Notice of Benefits Allowable."

Whether or not you request predetermination of benefits, MetLife will pay the claim based on whatever information it has about your treatment.

If, according to generally accepted professional standards of dental practice, there is more than one suitable procedure for the treatment of a dental condition, the plan will pay benefits for the least expensive procedure that can be used for the effective treatment of that condition.  MetLife determines the benefit reimbursement amount when alternative courses of treatment are available.

If you and your dentist elect to use a more expensive procedure or material than the one determined to be appropriate by MetLife, you will be required to pay the difference between the dentist’s bill and the costs covered by the plan.

The plan does not cover treatment received before your insurance becomes effective.  However, if a course of treatment is started before the effective date and completed after the effective date, part of

the cost may be covered.  MetLife will determine whether a portion of the dentist’s fee can be allocated to treatment received after the effective date and covered under the plan.

You should file a claim whenever you and your covered Eligible Dependents incur covered dental expenses.  Claim forms are available from the Benefit Plans Office.  Claims must be filed no later than 90 days after the plan year in which the services were rendered.

Completed forms should be mailed to MetLife at the address listed on the claim form.

MetLife will send an explanation of payment with the benefit check.  If you have authorized MetLife pay your dentist directly, the dentist will receive an explanation of payment with the check, and you will receive a copy of the explanation.

The dental plan has a Coordination of Benefits (COB) provision that is designed to prevent duplication of payments when a person can collect benefits from more than one employer group dental plan.         

Under this provision, when coverage is provided both by the Company and another employer group plan, you can receive up to 100% of your covered expenses from both plans, but no more than that.

If you have an accidental injury, seek recommended care through your medical plan’s primary care physician to receive in-network benefits.  Treatment of injuries to your natural teeth by a dentist, physician or surgeon is covered under your medical coverage as long as services are provided within 12 months of the accident.

File your medical claim with your medical plan.  Claim must be filed no later than 90 days after the plan year in which services were rendered.

Dental benefits payable under a Company medical plan will reduce your benefits otherwise payable under the dental plan.  After you receive notice of payment from the medical plan, you should submit the notice of payment to MetLife.