How the MetLife PPO Dental Plan Works

How It Works

Annual Maximum Benefit

The Annual Maximum Benefit is the most each covered person can receive from the plan each year. Once you reach the maximum benefit for the year, no more benefits will be paid.

For Example*
Mary has employee coverage in the MetLife Dental PPO Plan. Her deductible is $60. Her annual maximum benefit is $1,500. After Mary pays her deductible, the plan pays a percentage of her dental bills. In this case, it pays 50% because bridges and crowns are major care. Once the plan has paid $1,500 in benefits, Mary must pay for any added dental care she receives.	Dentist’s charges:
		Bridge Crown Total Charges	$2,500 + $900 $3,400
	First Mary pays a deductible:
		Total Charges Deductible Remaining Charges	$3,400 - $60 $3,340
	Then the plan pays a percentage of her charges:
		Remaining Charges Plan Covers Plan Pays	$3,340 50%, up to $1,500 $1,500
	Mary Owes		$1,840

*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.