MetLife Auto & Home selected Concentra Integrated Services to administer this plan for injuries covered by new policies effective 8/1/05, or policies which were renewed after 9/15/05.

These documents will provide all necessary informational materials:
Decision point review and pre-certification plan

Initial Information letter to insured/eligible injured person/medical provider

Effective 10/15/06, all new injury claims will be administered by Consolidated Services Group (CSG) and will be governed by the following decision point review and pre-certification plan.
These documents will provide all necessary informational materials:
Decision point review and pre-certification plan

Initial Information letter to insured/eligible injured person/medical provider

How Co-Payments and Deductibles are Applied to Your PIP Policy
Insurers, such as MetLife Auto & Home, may apply co-payments and deductibles to your Personal Injury Protection (PIP) policies in any order, provided that the order in which the application is processed is the same for all customers.

For MetLife, Auto & Home, the order to apply the deductible and co-payment for all customers in New Jersey when there is a PIP claim is as follows:

Deductible
The deductible amount is taken from the first bill received after the Claim Department has reviewed the bill. If the bill amount is less than the full deductible, the remaining amount will be taken from the next bill received, etc.

Co-Payment
After the deductible has been met, a 20% co-payment is applied to all bills, once the bill has been reviewed by the Claim Department until the co-payment limit has been met.

A customer's co-payment limit is based on what deductible was selected for the policy:

$250 deductible -    $950.00 co-payment = $1,200 out-of-pocket
$500 deductible -    $900.00 co-payment = $1,400 out -of-pocket
$1,000 deductible - $800.00 co-payment = $1,800 out-of-pocket
$2,000 deductible - $600.00 co-payment = $2,600 out-of-pocket
$2,500 deductible - $500.00 co-payment = $3,000 out-of-pocket

In addition, effective October 27, 2004, the Attending Provider Treatment Plan form * shall be used by all providers to submit Decision Point Review and Pre-certification requests.