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Dental
What Is Not Covered
It is important to understand what your plan covers and how much of
your benefits it will pay. Advance claim review helps you understand
what your copayment will be and any other cost for which you may be responsible.
The following is a list of exclusions and limitations under your dental
plan. Please refer to the actual plan documents or contact MetLife at
1-800-942-0854 for more details on limitations and exclusions:
- Services that are not considered reasonable and customary
- Services not performed by a dentist, with the exception of licensed
dental hygienists and routine x-rays
- Services performed by or for the government unless payment of the
charge is required by law
- Services that would have been covered by the government, except
for Medicaid
- Replacement or modification of dentures, bridges, crowns, or gold
restoration within five years of installation
- Dentures or bridges that replace natural teeth when the teeth were
missing before you were covered. This does not apply if the denture
or bridge also replaces a natural tooth that was removed while you
are covered and was not an abutment to a partial denture or bridge
installed in the last five years.
- Appliances, services, or supplies ordered while you were not covered
- Cosmetic services including crown facing or the facing of artificial
teeth behind the second bicuspid, except for certain eligible expenses.
Eligible expenses include cosmetic services needed as a result of accidental
injuries suffered while you are covered.
- Treatment for jaw joint problems if you are covered by the DMO® under
Plan B
- Appliances, restorations, or procedures needed to alter vertical
dimensions, restore biting, or correct attrition or abrasion
- Replacement of lost or stolen dental appliances
- Injuries or diseases covered by workers' compensation or other occupational
laws
- Charges for treatment that is deemed not medically necessary
- Any charge above the copayment percentage based on reasonable and
customary charges. Where benefits are based on a schedule, the dental
plans do not pay any amount that exceeds the scheduled benefits.
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