You select and schedule an appointment with the provider of your choice. You are not required to use a network provider. There is a difference in how a network provider versus a non-network provider bills for their services.

Network Provider
MetLife has a Preferred Dentist Program (PDP) network. Participating dentists agree to accept a discounted fee schedule as full payment for covered service. You will not be billed for any covered charges that are greater than the contracted fee schedule if you use a PDP provider.

Non-Network Provider

If you use a provider that is not part of the contracted PDP network, the plan pays benefits toward covered dental expenses on the basis of “Reasonable and Customary Charges.”
 
If you incur charges that exceed what is considered Reasonable and Customary, the plan covers the Reasonable and Customary Charge and you are responsible for paying the balance. Charges beyond Reasonable and Customary will not count toward the deductible.

Briefly, the plan covers four types of dental services:

• Type A – Preventive and diagnostic services
• Type B – Oral surgery and restorative services
• Type C – Prosthodontic services
• Type D – Orthodontic services.

The plan pays different benefits for each of these types of coverage – with one annual deductible required for Type B and Type C services only.

Annual Deductible
You and each covered dependent must satisfy a $50 individual deductible each calendar year before benefits become payable toward Type B (oral surgery and restorative) services and Type C (prosthodontic) services covered by the plan. The deductible does not apply to Type A (preventive and diagnostic) or Type D (orthodontic) services.

Maximum Benefits
The plan pays up to a maximum of $1,500 per year and $20,000 in a lifetime for each covered person for Type A, Type B, and Type C expenses combined. For Type D (orthodontic) services, there is a separate lifetime maximum of $1,500 in benefits for each covered person.