How do the Plan limits work if my child has regular dental treatment and orthodontic treatment in the same year?
The two limits are separate.

Under Option 1, in a calendar year you may receive up to $600 in benefits for your child’s regular dental expenses, plus up to $600 for orthodontic expenses.

Under Option 2 and Option 3, in a calendar year you may receive up to $1,000 in benefits for your child’s regular dental expenses, plus up to $1,000 for orthodontic expenses.

Keep in mind that the orthodontic benefit limit is a lifetime limit. Any amounts applied toward the orthodontic lifetime maximum under any of the three dental options will be transferred to a new Plan option should a change in election occur.

What does "usual and customary" mean?
"Usual and customary" is a standard phrase used to determine your benefits from the Plan. The Plan covers your dental expenses up to the reasonable and customary amount if it is in line with prices for similar services from dentists in the community where the service is provided.

What is an example of an alternate service?
Dental expense benefits will be based on the materials and method of treatment that cost the least and which, based on review by a licensed MetLife dental consultant, meet generally accepted dental standards. Some examples include:

1. Fillings: Inlays, Onlays and Crowns
   If a tooth can be repaired by a less costly method than an inlay, onlay or crown, dental expense benefits will be based on the adequate method of repair that costs the least.
2. Crowns, Pontics and Abutments
   Veneer materials may be used for front teeth or bicuspids. However, dental expense benefits will be based on the adequate veneer materials that cost the least.
3. Bridgework and Dentures
   Dental expense benefits will be based on the adequate method of treating the dental arch that costs the least. In some cases removable dentures may serve as well as fixed bridgework. If dentures are replaced by fixed bridgework, the dental expense benefits will be based on the cost of a replacement denture unless adequate results can only be achieved with fixed bridgework.

If I have an accidental injury to my teeth, should I file a claim under my medical plan or the Dental Plan?
The Dental Plan does not cover expenses for accidental injury to teeth. However, these expenses may be covered by your medical coverage. If your medical coverage is with an HMO or your spouse’s plan, you will need to refer to that member handbook for covered expenses.

If I have a prescription expense as a result of my dental procedure or treatment, do I file a claim under the Dental Plan or prescription drug plan?
The Dental Plan does not cover prescription expenses as a result of a dental procedure or treatment. However, prescription expenses may be covered under your prescription drug coverage. If your medical coverage is with your spouse’s plan, you will need to refer to that member handbook for covered expenses.

If I have already received the maximum benefit of $1,000 for the current year but require more work, can the dental work be started in the same calendar year but billed in the following year when the work is completed?
In most cases, the dental expense is considered to be incurred when treatment is begun, not when it is completed. See Eligible Expenses.