Dental Benefits
Benefits are paid for covered dental services based on the type of eligible expenses incurred. See Eligible Expenses for an explanation of eligible expenses. The dental benefit for each benefit period is:

• the eligible expense up to the usual and customary charge, or fee schedule, or Preferred Dentist Program schedule;
• less the applicable dental deductible;
• multiplied by the proper co-pay percentage shown in the Dental Plan Comparison Chart.

In no event may the dental benefit exceed the proper maximum shown in the Dental Plan Comparison Chart.

In order to determine the amounts of covered dental services, MetLife may request x-rays and other materials used to diagnose or evaluate a dental condition. If these items are not furnished, payment will be made only for those covered services on the basis of the information available. This may reduce the amount of benefits which would otherwise be payable.

Benefit Period
A benefit period begins January 1 and ends December 31 of each year.

Dental Deductible
The dental deductible applies to each covered person for each benefit period. It refers to the amount of eligible expense a person must incur during the benefit period for dental care before receiving reimbursement for services. Only eligible expenses may be used to compute the dental deductible. See Eligible Expenses for more information.

Maximum Benefits
Each covered person may receive benefit payments up to the dental maximum shown in the Dental Plan Comparison Chart.

Alternative Services and Supplies
When there is more than one way to provide a dental service or supply in accordance with accepted dental practice, the least costly way will be considered the eligible expense. To understand more about alternative services and supplies, view Dental Plan Questions and Answers.

Extension of Benefits
If a faculty or staff member incurs an eligible expense after coverage ends, benefits will be paid:

• For prosthodontic appliances and their modifications:
  – the dentist must take the master impression while the person is covered under the Plan;
  – the appliance must be delivered or installed within 30 days after the coverage ends; and
  – the appliance must not be related to an orthodontic service.
• For crowns, bridges, inlays, onlays, or cast restorations:
  – the teeth must be prepared while the person is covered under the Plan; and
  – installation must be within 30 days after the coverage ends.
• For root canal therapy:
  – the canal or canals must be fully prepared for filling while the person is covered under the Plan; and
  – therapy must be completed within 30 days after the coverage ends.

Predetermination Plan
The use of a Predetermination Plan is recommended to help reduce misunderstandings about benefits. The Predetermination Plan should be submitted in advance whenever non-emergency treatment is likely to exceed $150. The Predetermination Plan will be reviewed and returned to the dentist, showing an estimate of benefits that will be payable. Benefits will be paid when the services are provided and normal claims procedures are completed. In the event eligible expenses are incurred after coverage ends, benefits will be paid as described in the Extension of Benefits section above, even if a Predetermination Plan was provided based on in-force coverage.