How the MetLife PPO Dental Plan Works

How It Works

Coinsurance

Coinsurance is the portion of covered dental bills that you pay for necessary care after you meet your deductible. For example, if the plan pays 80%, your coinsurance is 20%.

For Example*
Mark has employee coverage in the MetLife Dental PPO Plan. In March, he gets two fillings. His dentist charges $60. Because Mark has not yet met his $60 deductible, he pays the full bill from his dentist. In November, Mark needs a crown. His dentist charges him $700. Since Mark has already met his deductible, the plan pays 50%. As shown at right, Mark would pay $350.	First you must meet your deductible:
		Charge for fillings Deductible Amount of remaining deductible	$60 - $60 $0
	Then the plan pays a percentage of your bill:
		Charge for crown Plan covers Plan pays Charge for crown Mark’s coinsurance Mark pays	$700 x 50% $350 $700 x 50% $350

*This example is for illustrative purposes only and may not reflect true claim charges.

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.