Your Dental Benefits

Participating in a Dental Plan

Eligibility

Qualified Medical Child Support Order

Enrolling

Coverage Levels

ID Cards

MetLife Dental Plans

Cost of Coverage

When Coverage Begins

Changing Your Elections

Special Enrollment Event

When Coverage Ends

Coverage During a Leave

Short-Term Disability

Family Medical Leave

Leave of Absence

Long-Term Disability

Military Leave of Absence

How The MetLife PPO Dental Plan Works

How It Works

MetLife Dental PPO Plan

Necessary Care

Deductibles

Coinsurance

Reasonable and Customary Rates

Annual Maximum Benefit

Alternate Benefit Program

Pre-determination of Benefits

What is Covered

What Is Not Covered

How the MetLife Dental Copay Plan Works

How It Works

MetLife Dental Copay Plan

Copay

Deductible

Preferred Dentist Program (PDP)

MetLife Preferred Dentist Program (PDP)

Alternate Benefit Program

Pre-determination of Benefits

What is Covered

What is Not Covered

Receiving Your Benefits

Filing a Claim

MetLife Dental Plans

Coordination of Benefits

How Coordination of Benefits Works

Order of Coverage

Benefit Overpayments

Right of Recovery

If Your Claim Is Denied

Benefit Denials

Urgent Care Claims

Claim Requiring Advance Approval or Pre-Authorization

Approval of an On-going Course of Treatment

Post-Service Claim

Notification of Denial

Appealing Denied Claims

Review of Appeal

Urgent Care Claims

Claim Requiring Advance Approval or Pre-Authorization

Approval of an On-going Course of Treatment

Post-Service Claim

Notification of Appeal Denial

Administrative Information

Your ERISA Rights

Continue Group Dental Plan Coverage

Prudent Actions by Plan Fiduciaries

Enforce Your Rights

Assistance with Your Questions

Discretionary Authority

Service of Legal Process

Plan Amendment and Termination

Collective Bargaining

Privacy Information

Continuing Your Coverage Under COBRA

Very Important Notice for you and your spouse (if covered) or your Domestic Partner (if covered)

Qualified Beneficiaries

Qualifying Events

Benefits and Costs

When COBRA Coverage Ends

Disability Is a Special Case

Trade Act 2002

Additional Continuation Coverage Information

If You Have Questions

Other Plan Information

Glossary

A Final Note

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.