1 In Network is when you or your eligible dependent visit a participating dentist, plan benefits are based on a negotiated fee schedule. You will be responsible for the difference between the negotiated fee*** for a given service and the percentage of the fee that your plan covers for that service, subject to any deductibles.
2 Out-of-Network is when you or your eligible dependent visit a non-participating dentist, plan benefits are based on the Reasonable and Customary (R&C) charges of dentists in your area as determined by MetLife. You will be responsible for the difference between your dentist’s charge for a given service and the percentage of Reasonable and Customary fee that your plan covers, subject to any deductibles.
3 Negotiated Fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated Fees are typically 15% to 45% below community averages. Negotiated Fees are subject to change.
4 R&C fee refers to the Reasonable and Customary R&C charge, which is based on the lowest of 1. the dentist’s actual charge, 2. the dentist’s usual charge for the same or similar services or 3. the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife.