How the MetLife Dental Copay Plan Works

Alternate Benefit Program

Dental expense benefits will be based on the materials and method of treatment which cost the least and which in the Plan’s view meet generally accepted dental standards.

Pre-determination of Benefits

If your dentist recommends a course of treatment that is expected to cost $300 or more, your dentist can prepare a special report describing the planned treatment. If a dental bill is expected to be $300 or more, before the dentist starts the treatment, you can find out what expenses will be paid. Your dentist should send a claim form to the administrator explaining what work will be done and what the cost will be. The administrator will review and notify you and your dentist what benefits will be paid.

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.