If you request a plan design change, you will receive new certificates, or the necessary pages to update those certificates you have distributed and those you have in supply. We will provide instructions with any new forms.

The list bill is the most commonly selected bill type. The list bill shows each employee and the amount of premium due for each applicable coverage. Any additions, terminations, or changes made after your bill print date will be reflected on your next invoice, therefore, please pay premium as billed.

Link to sample of list bill

MetLink and Billing

Access MetLink to accomplish your billing needs. MetLink users can view the following:

• Current bills
• Current invoices
• Billing history
• Payment inquiries

You can also print current invoices, receive email billing notifications, and suppress paper bills. Log into MetLink, and click on the Billing section.

For further help navigating through the MetLink Billing section, access the Resources tab on MetLink to view your customized user guide.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

If You Have Selected The Self-Administered Billing Option

With the self-administered bill option, you are responsible for tracking and reporting additions, terminations and changes that occur between billing periods. The self-administered bill reports premium due for the total number of insured lives for each coverage, but does not include information at the employee level. You then make the appropriate adjustments in the totals for the month and mail the revised billing statement and premium to MetLife.

Link to sample of self-administered bill

How to Read Your Billing Statement

To help you better understand MetLife's billing procedures, sample bill formats are included along with an item-by-item explanation of information it contains. Please contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638) if you have questions about an item or any aspect of our billing process.

MetLife reserves the right to audit your records periodically to ensure the accuracy of premium calculations.

Please note: There is a $25.00 fee for all premium checks returned due to insufficient funds

Electronic Funds Transfer

• Authorization for Electronic Fund Transfer Form

Electronic Funds Transfer (EFT) provides a new payment option for list billed customers to remit premium electronically from your bank to ours, without the resources and costs associated with requesting and issuing a manual check each month.

You will continue to receive a List Billing statement. The last page will state “Amount To Be Drafted” instead of balance due. The premium will be drafted from your authorized bank account on each bill due date.

To implement the EFT payment option, complete the Authorization for Electronic Fund Transfer Form and attach a copy of a voided business check.

Remit the EFT form and voided check to:

MetLife
Small Market
P.O. Box 14593
Lexington, KY 40512-4593

Or Fax to:

Attn: MetLife-Small Market
Subject: EFT Authorization Form
Fax: 1-888-505-7446

To terminate your policy, please follow these steps:

• Notify MetLife in writing. Notification should be sent to MetLife at least 60 days before your specified termination date. The policy will end on the later of the date stated in the notice; or the date MetLife receives the notice.
• Pay all unpaid premiums for the time your policy was in force. If MetLife receives a notice of termination request, all outstanding premiums must be paid in full before your request can be processed.

Please submit all request for termination to:

Fax 1-888-505-7446
Small Market Administration
PO Box 14593
Lexington, KY 40512-4593

• Consumer Disclosure for Rhode Island Residents (To be distributed with Enrollment form)
• Enrollment Form (All Products)

Non-Contributory Coverage means the cost of the coverage is fully paid by the Employer.

• 100% of all eligible Employees must be enrolled.
• Eligible Employees cannot waive non-contributory coverage.

Contributory Coverage means the employee pays all or a portion of the cost of the coverage.

• Employees are not required to enroll for the coverage.

Enrollment of New Employees for Contributory Coverages

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. Employees who do not enroll within this 31-day period are considered late enrollees. Late enrollees may apply for coverage at any time, subject to certain restrictions. Please refer to the Late Enrollments section of this manual for more details. Any employee who chooses to waive coverage must complete the waiving coverage section and sign the Enrollment Form.

Enrollment of New Employees for Non-Contributory Coverages

Once new employees have met the requirements for coverage, they have 31 days to enroll in your group plan. All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits. Enrollments processed after the billing period has ended for the eligibility date will be back-billed on the first available billing after the enrollment has been received and processed.

The completed Enrollment Forms should be sent to MetLife. Keep a copy of the Enrollment Form in your files as evidence that the new employee was given the opportunity to enroll. All requested information is necessary to promptly and accurately enroll your employees.

If you have 20 or more employees for at least 50% of the business days of the prior year, provide employees that are applying for Dental with the First Notice of COBRA.

Checking Enrollment Applications

For List Billed Cases: Incomplete or missing information on the Enrollment Form may delay coverage for your employees. Please check to see that all required forms are completed before submitting them to MetLife. Keep a copy of the Enrollment Form for your files.

For Self-Administered Cases: Please make sure that all required forms are completed before submitting them to MetLife. Keep a copy of each Enrollment Form for your files.

On MetLink you can maintain employee and dependent eligibility.

You will have the ability to:

• Enroll new employees
• Terminate coverage
• Reinstate coverage
• Add/Change dependent status

For Group enrollment, you can view:

• Enrollment listings
• Plan structure

Log into MetLink and click on the Enrollment Services section.

For further help navigating through the MetLink Enrollment Services section, access the Resources tab on MetLink to view your customized user guide.

If you are currently not a MetLink user, contact your MetLife Representative or broker.

Domestic Partnership

• Domestic Partnership Declaration Form

Domestic Partner means each of two people, one of whom is insured under the Policy, who represent themselves publicly as each other's domestic partner and have satisfied certain conditions set forth in the Certificate of Insurance. Review your Certificate of Insurance to verify if your plan provides Domestic Partnership benefits. A Domestic Partner can become a qualified dependent for Dental, Life and AD&D if the requirements listed in the Certificate of Insurance are met.

The insured and the declared domestic partner are required to fill out the appropriate Domestic Partnership Form. Retain the form in your files.

For more specific information concerning the Domestic Partnership option, please refer to your group Certificate of Insurance.

For more information, contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638).

Enrolling Rehired Employees

Any rehired employee should be enrolled as if he or she were a new employee regardless of whether or not this person was previously covered under your group plan. The only exception is if the employee is rehired within 6 months of the date on which coverage terminated because employment ended.

Any rehired employee returning from the armed services does not have to meet the requirements for coverage of your group plan. Please note on the Enrollment Form that the employee is returning from the armed services and the date he or she returned to full-time employment.

Effective Dates For Absent Employees And Dependents

Individual effective dates for an employee or dependent who becomes eligible for benefits after the initial effective date of the employer's plan may be delayed if the employee is not at work due to injury or sickness on the date that benefits would be effective.

At initial enrollment, eligible employees who are not at work due to injury or sickness on the day benefits would normally become effective, will have benefits delayed until they return to work. Refer to your prior carrier's Certificate of Insurance for the extension of benefits section.

Eligible dependents who are hospital confined, or confined at home under the care of a physician, on the day benefits would normally become effective will have benefits delayed until the day they are no longer confined.

• Consumer Disclosure for Rhode Island Residents (To be distributed with Enrollment Form)
• Enrollment Form (All Products)

Late Enrollment Period For Customers With Dental Plans Covering Type A, B, and C Expenses

Once employees have met the eligibility requirements, they have 31 days from the date they become eligible to enroll in your group plan. Employees who do not enroll within this 31-day period are Late Enrollees. A Late Enrollee will only be eligible for Type A services when coverage becomes effective. There is a 6-month waiting period for fillings and a 12-month waiting period for other Type B services. A late enrollee must be covered for 24 months before Type C services are payable. Orthodontic benefits, if any, will only be available after the Late Enrollee has been covered for orthodontic benefits for 24 months.

Late Enrollment Period For Customers With Dental Plans Covering Type A and B Expenses Only

Once employees have met the eligibility requirements, they have 31 days from the date they become eligible to enroll in your group plan. Employees who do not enroll within this 31-day period are Late Enrollees. A Late Enrollee will only be eligible for Type A services when coverage becomes effective. There is a 6-month waiting period for fillings and a 12-month waiting period for other Type B services.

Late Enrollments For Non-Contributory Coverage

All employees are to be covered on the date they are eligible. There are no late enrollments for non-contributory benefits.

• Change Request Form

Examples of Changes in Employee Status

Examples of changes that require notification include:

• Employee has a change in earnings or occupation that affects benefit amounts.
• Employee cancellation of a contributory coverage.
• Employee changes benefit class.
• Employee changes name.
• Employee deletes a dependent or all dependent coverages.
• Divorce or legal separation.
• Death of dependent.
• Death of employee.
• Dependent marries or reaches the limiting age as determined by individual's state requirements (see Certificate of Insurance for details).
• Employee adds a new dependent to existing dependent coverage including marriage, becoming a parent or legal guardian.

MetLife must be notified of any change in employee classification or salary to ensure maximum benefits are paid at time of claim. You may indicate the changes on a written list. The listing must include the group name and number, employee's name, effective date of the change and the employee’s Social Security number.

Death of an Employee

In the case of death of an employee, all of the deceased employee's dependent(s) coverages must be cancelled. A covered dependent may be eligible for COBRA or State Continuation. Please refer to the COBRA Continuation Coverage Section.

Complete a Change Request Form reflecting the date of death as the coverage termination date and submit to MetLife.

Notify the surviving dependents of their continuation rights if they are eligible to continue coverage under COBRA.

Employee Terminations

Examples of employee coverage terminations that require notification include:

• Employee has been terminated.
• Employee no longer meets the definition of an eligible employee under the plan.
• Employee stops making contributions.

Dependent Terminations For Customers With Dependent Coverage

Examples of dependent terminations: coverage terminates whenever the first of the following occur.

• The employee's coverage terminates.
• A dependent no longer meets the definition of an eligible dependent under the plan.
• An employee stops making contributions for the dependent coverage if the plan is contributory.

An employee's coverage may be continued even though he or she may not be actively at work under the following conditions:

• During a temporary layoff; or
• During an authorized leave of absence.

Continuing coverage in these situations is an option you should consider only when the reasonable expectation exists that the employee will return to work.

To continue coverage, the same contribution must be paid as if the employee was at work. The termination date for any employee continuing coverage under these conditions is the date employment actually terminates. Please indicate the employee's name and the date employment terminated on a Change Request Form.

For more information on the requirements and time periods for this type of coverage to continue, please refer to your Certificate of Insurance.

Layoff Or Leave Of Absence For Customers With Dependent Coverage

If the employee's coverage is being continued because of a layoff or leave of absence, the employee's dependent coverage may also be continued. To continue coverage for dependents under these conditions, the same contribution must be paid as if the employee was at work.

If the employee's coverage terminates, the employee's dependent coverage will also terminate. For more information, please refer to the Certificate of Insurance.

Temporary Layoffs Or Leaves Of Absence

For an employee who has been laid off or who has taken a leave of absence, certain coverages such as Life/AD&D and Dental may be continued as determined by the rules and practices of the employer, however, continuance cannot be longer than 2 months. In the event the leave qualifies under the Family & Medical Leave Act of 1993 (FMLA), the period cannot be longer than 12 weeks following the date the leave of absence began.

Continuation of STD/LTD coverages for such an employee, however, is determined solely by MetLife and not by the employer. Refer to your Certificate of Insurance for any applicable rules.

If the employee does not return to work, submit a Change Request Form noting the date benefits terminate. Refer to your Certificate of Insurance for further information.

Disabled Dependent Beyond Limiting Age Due to Handicap

Coverage for handicapped dependent children may be extended beyond the limiting age provided the child is physically or mentally incapable of self-sustaining employment. A Statement of Dependent Eligibility Beyond Limiting Age form must be completed by the employee, the dependent's physician and the employer.

• Statement of Dependent Eligibility for Mental or Physical Handicap

Renewal/Plan Change Procedures

What MetLife needs:

Most policies are renewed annually. Renewal underwriting and pricing typically occur before your group’s anniversary.

About four months before this date, MetLife will contact you to verify the accuracy of the insured data shown on your premium statement according to your records. We ask that you verify this information 90 days prior to your renewal date. If we have not received it, we will follow up with you.

Having a current history of covered insureds facilitates accurate pricing of your coverage.

Census Requirements For Self-Administered Bill Type Option

For cases using the Self-Administered bill option, MetLife does not maintain employee level data. At the time of renewal, you must provide MetLife with a detailed census of all insureds each year 90 days prior to your renewal date. In addition, provide the percentage of premium contributed by the employer for each line of coverage.

The census must include:

• name and/or Social Security Number;
• date of birth;
• gender;
• occupation (for LTD or STD);
• salary (for LTD, STD or Life);
• class information (eligibility according to the schedule of benefits);
• dependent coverage (indicate participants and whether spouse or child) for all insureds;
• number of hours worked per week (for hourly employees);
• amount of coverage (by line of coverage); and
• total number of employees eligible.

• participants;
• amount of coverage;
• amount or percentage contributed by employer; and
• total number of employees eligible.

Renewal Action Letter

MetLife sends a renewal action letter prior to your group’s anniversary. The letter states the status of your plan and any renewal changes.

When Your Group Falls Below Participation Requirements

Your group plan may terminate if the participation falls below the required participation percentage noted in your Certificate of Insurance.

Policy Changes

No changes can be made to your policy without advance approval from MetLife. To change your group policy, contact your group insurance representative or your local MetLife SBC sales office. Be sure your request includes the proposed change, effective date and an authorized signature on company letterhead.

Once MetLife approves the change, you will receive an acknowledgment letter and, if needed, replacement policy and/or certificate forms.

Examples Of Policy Changes

Examples of policy modifications include changes in:

• Affiliates
• Class
• Employer contribution percentage
• Change of policy situs state
• Waiting period
• Elimination period
• Benefit level

For groups with MetLife's Dual Option Dental plan, participating employees may elect to move their coverage between the "Low" and "High" plan options at policy anniversary. To change plan options, participating employees should complete the Dual Option Anniversary Election Form. (Employees not currently participating in the Dual Option Dental coverage should complete an enrollment form to request coverage under the plan.)

To ensure accurate claims handling, please return completed Dual Option Dental Anniversary Election forms to MetLife at the address listed on the form at least 15 days in advance of your group's policy anniversary date. (Please ensure that all fields on the form are completed, including employer name, customer number and policy anniversary date.

• COBRA Election Form

COBRA Continuation Coverage

The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) is a federal law that requires employers with 20 or more employees for at least 50% of the business days of the prior calendar year to provide continuation of group dental coverage for employees, retirees and their dependents who are no longer eligible for coverage in the employer’s insurance plan due to certain "qualifying events".

You should consult your legal counsel for specific questions or clarification about your COBRA obligations and responsibilities.

You can access MetLink to change an employee’s dental coverage to COBRA. Log into MetLink and click on the Enrollment Services section.

For further help navigating through the MetLink Enrollment Services section, access the Resources tab on MetLink to view your customized user guide.

Notifying MetLife of Covered Persons Electing COBRA

When you are notified of a qualifying event, provide a Second Notice of COBRA Form and a COBRA Election Form within 14 days of notification. Complete the employer information and give the forms to the employee or dependents.

Send the COBRA Election Form along with a Change Request Form indicating the effective date of the COBRA coverage, the qualifying event and the forecast termination date to:

MetLife
P.O. Box 14593
Lexington, KY 40512-4593

It is best to give the employee or dependents an Election Form for Continuation Coverage as soon as possible. The qualified beneficiary has 60 days from the date of that notice or from the date of the qualifying event, whichever is later, to elect COBRA continuation coverage. Then the qualified beneficiary has 45 days after electing coverage to pay the initial premium. To ensure the accuracy of your premium statement, you must notify MetLife immediately of termination of coverage.

You may find additional information regarding COBRA on the U.S. department of Labor's website at: http://www.dol.gov/dol/topic/health-plans/cobra.htm.

Call Customer Service at 1-800-ASK-MET (1-800-275-4638) if you have any questions regarding the termination of COBRA benefits.

Third Party Administrators and COBRA

Some Employers contract with a Third Party Administrator to assist them with billing and premium collection of their COBRA participants. If a Third Party Administrator is involved, there are some important facts we need to make you aware of:

• Your COBRA participants will be listed in a separate Division or Class on your monthly billing statement from MetLife.
• The total monthly premium due will include these COBRA participants.
• The premium remitted each month for active employees and COBRA participants must be received, in total, by the due date in order to avoid risk of termination for non-payment.
• MetLife does not participate in agreements with Third Party Administrators for COBRA billing and premium collection. That relationship exists strictly between the Employer and the Third Party.

• Continuation of Dental Coverage

State Continuation Coverage

State Continuation of Dental coverage is provided by state laws that require employers to provide continuation of group dental coverage for employees, retirees and their dependents who are no longer eligible for coverage in the employer’s insurance plan due to certain "qualifying events". This only applies in the states of AR, CO, IA, IL, LA, MA, ME, MN, MO, NC, ND, NE, NH, OH, OR, TX, UT, VT, WA, WV & WY.

This section is intended to be used as a guide to help you administer State Continuation coverage with respect to dental benefits only. It is suggested that you consult your legal counsel for specific questions or clarification about your specific state laws, obligations and responsibilities.

You can access MetLink to change an employee’s dental coverage to State Continuation. Log into MetLink and click on the Enrollment Services section.

For further help navigating through the MetLink Enrollment Services section, access the Resources tab on MetLink to view your customized user guide.

Notifying Insured of Their State Continuation of Coverage Rights

If you are notified of a qualifying event, check the state specific continuation of coverage form to confirm the event is applicable for coverage.  This only applies in the states of AR, CO, IA, IL, LA, MA, ME, MN, MO, NC, ND, NE, NH, OH, OR, TX, UT, VT, WA, WV & WY.  If the qualifying event is listed, give the employee or dependent the State Continuation of Dental coverage form.

This form is sent to:

MetLife
P.O. Box 14593
Lexington, KY 40512-4593

It is best to give the employee or dependents a State Continuation of Coverage Form as soon as possible. Please check the applicable state law for any notice requirements.

Qualifying Events For State Continuation

The qualifying events vary from state to state.  Review the State Continuation of Dental coverage form for a list of qualifying events.

Length of Eligibility

Under each state law, certain qualifying events determine the length of eligibility of a participant. These events and corresponding term are listed on each form.

When State Continuation Coverage Ends

State continuation of coverage may terminate earlier if applicable state law provides.

Call Customer Service at 1-800-ASK-4-MET (1-800-275-4638) if you have any questions.

• CAL-COBRA Election Form

CAL-COBRA

CAL-COBRA is a California law that provides continuation of group health coverage when an employer has 19 or fewer employees if the employer is not subject to federal COBRA. You must notify MetLife within 30 days of your plan becoming subject to federal COBRA, i.e., when you have 20 or more employees for the required period.

The continuation of group dental insurance is required when employees, retirees and their dependents are no longer eligible for coverage in the employer's insurance plan due to certain "qualifying events."

You can access MetLink to change an employee’s dental coverage to CAL-COBRA. Log into MetLink and click on the Enrollment Services section.

Note: Once the employee's record has changed to CAL-COBRA, you will no longer be able to make any changes in MetLink. Contact Customer Service at 1-800-ASK-4-MET (1-800-275-4638) to request updates.

For further help navigating through the MetLink Enrollment Services section, access the Resources tab on MetLink to view your customized user guide.

Notifying Insured of Their CAL-COBRA Rights

When an insured or dependent notifies you of a qualifying event, e.g., divorce, or when you become aware of a qualified event, e.g., separation from employment, provide a Second Notice of COBRA Form and a CAL-COBRA Election Form within 14 days of notification. Complete the employer information and give the forms to the employee or dependents.

You must notify MetLife within 30 days of your actual knowledge of the qualifying event, e.g., by receipt of notice from the qualified beneficiary or your knowledge such as termination of employment. Send the CAL-COBRA Election Form along with an Change Request Form indicating the effective date of the COBRA coverage, the qualifying event and the forecast termination date to:

MetLife
P.O. Box 14593
Lexington, KY 40512-4593

It is best to give the employee or dependents an Election Form for Continuation Coverage as soon as possible. The qualified beneficiary has 60 days from the date of that notice or from the date of the qualifying event, whichever is later, to elect CAL-COBRA continuation coverage. Then the qualified beneficiary has another 45 days after election of CAL-COBRA to make the initial premium payment.

Continuation of group health coverages (dental) must be offered to every employee and dependent whose coverage is terminated due to a qualifying event under CAL-COBRA.

Qualifying Events For CAL-COBRA

A qualifying event is any of the following events if they cause an employee’s or dependent’s coverage to terminate.

For Employee:

• Termination of employment (for any reason other than gross misconduct) or reduction in hours.

For Spouse:

• Death of the employee.
• Termination of employee’s employment (for any reason other than gross misconduct) or reduction in hours.
• Divorce or legal separation from the employee.
• Employee becomes entitled to Medicare.

For Dependent Child:

• The death of a parent insured under the plan
• Termination of employee’s employment (for any reason other than gross misconduct) or reduction in hours.
• Divorce or legal separation of a parent insured under the plan.
• A parent insured under the plan becomes entitled to Medicare.
• The dependent ceases to be a dependent child under the plan.

Please note:

A child born to, or placed for adoption with, the employee during CAL-COBRA continuation coverage is entitled to continuation of coverage.

To ensure the accuracy of your premium statement, you must notify MetLife immediately of termination of coverage.

Exceptions For CAL-COBRA

The right to continue does not apply:

• to a person who does not reside in California;
• to a person who is covered by, or eligible to be covered by, Medicare;
• to a person who is covered, or who becomes covered, by another group benefit plan that does not have an exclusion or limitation for preexisting conditions that applies to the person;
• to a person who is covered, or becomes covered or could become covered by Federal COBRA (Section 4980B of the United States Internal Revenue Code);
• to a person who is covered, or becomes covered or could become covered, under a plan governed by Chapter 6A of the Public Health Service Act, 42 U.S.C. Section 300bb-1 et seq., relating to Requirements for Certain Group Health Plans for Certain State and Local Employees;
• to a person who fails to meet any one or more of the time limits set forth above for notice and election of coverage;
• to a person who fails to submit the correct premium when or before it is due;
• if at the time coverage under the plan ends the employer has 20 or more employees; or
• if the employer fails to notify MetLife of an employee termination or reduction in hours within 31 days.

Length of eligibility for CAL-COBRA

Under CAL-COBRA regulation, certain qualifying events determine the length of eligibility of a CAL-COBRA participant. These events for CAL-COBRA are:

Events Affecting Employees and Their Dependents:

• 36 months – Termination of employment or reduction in hours of the covered employee.
• When a qualified beneficiary is determined under the Social Security Act to be disabled either; (1) at the time of termination of covered employee's employment (or reduction in hours), or (2) during the final 60 days of CAL-COBRA continuation coverage, that person and any family members entitled to continuation coverage are eligible for 36 months of continuation after the date the qualified beneficiary's benefits under the contracts would otherwise have terminated because of a qualifying event.

Events Affecting Dependents Only:

• 36 months – Death of the covered employee upon whom the dependent has coverage
• 36 months – The divorce or legal separation of the covered employee from a covered spouse causing a loss of coverage for the spouse
• 36 months – Loss of dependent status for a dependent enrolled in the plan.

When CAL-COBRA Coverage Ends

CAL-COBRA coverage will terminate earlier than the applicable continuation period for any of the following reasons:

• At the end of the period in which CAL-COBRA benefits are payable
• Age 65, for former employees who were at least 60 years of age and coverage ended due to termination of employment and who worked for the employer for at least 5 years
• Cost of continued coverage is not paid within the grace period as stated in the group Certificate of Insurance (usually 31 days).
• Qualified person becomes eligible for Medicare or becomes covered under another dental/vision plan.
• Plan terminates for all employees or for an employee's class and there is no subsequent plan.

In the event of a second qualifying event occurring during the coverage period, coverage is continued for 36 months from the date of the first qualifying event.

Call Customer Service at 1-800-ASK-4-MET (1-800-275-4638) if you have any questions regarding the termination of CAL-COBRA benefits.

Cost of CAL-COBRA Coverage

Any person who elects to continue coverage under the plan must pay the full cost of the dental coverage plus any additional amount permitted by law. The employer includes that premium in the regular payments to MetLife. All payments for continued coverage must be made by the first day of the month; however, qualified beneficiaries are entitled to the same grace period that the employer is entitled to from MetLife.

Information about the Uniformed Services Employment and Reemployment Rights Act (USERRA)

USERRA is a federal law. If an employee takes leave from employment for “service in the uniformed services,” as that term is defined in USERRA, and as a consequence their dental insurance coverage under their employer’s group dental insurance policy ends, they may elect to continue dental insurance for themselves and their covered dependents, for a limited period of time.

Review the certificate of coverage for additional details.

• Dental ID Card (Generic)

A convenient way to provide the insured with the generic Dental ID is to print or email this card and give it to the insured before he/she goes to the dentist.  Contact customer service for customized Dental ID cards. You can also order generic ID cards by accessing MetLink; go to the Dental Claims section.

• Dental Claim Form

MetLink and Claim Inquiry

Employee Dental claims can be reviewed (if the group is HIPAA certified) by the employee’s social security or identification number. You will be able to view claim summary, the date of service and benefit amount.

Log into MetLink and click on the Claims section.

For further help navigating through the MetLink Claims section, access the Resources tab on MetLink to view your customized user guide.

Steps For Filing a Dental Claim

An employee should be given a Dental Claim Form whenever he or she expects to incur dental expenses. This claim form includes instructions for the employee and the dentist.

The employee should complete the Employee section (Part 1) and give the form to the attending dentist at the beginning of any dental treatment.

Refer to the group Certificate of Insurance for details on when the attending dentist should send a Treatment Plan to MetLife for a Pretreatment Estimate of Benefits review.

The attending dentist should complete and sign the Dentist section (Part 2) after the dental work is completed.

The patient or employee, if patient is a minor, must sign the form where indicated.

All data, including Pretreatment Estimate of Benefits review, assignment forms and itemized bills are then sent to MetLife.

For New Mexico Residents only:

New Mexico Notice of Confidential Abuse Practices
This form permits victims of domestic violence to participate in a location confidentiality program as provided under the New Mexico Domestic Abuse Insurance Protection Act.

• New Mexico Domestic Abuse

Getting Claim Assistance

MetLife is available to answer questions regarding group claim procedures. The employee may contact the MetLife Claims Office at the following address and telephone number:

MetLife Dental Claims Unit
P.O. Box 981282
El Paso, TX 79998-1282
Telephone 1-800-275-4638

International Dental Travel Assistance Program¹

Thanks to an agreement with AXA Assistance, all MetLife Preferred Dentist Program ("PDP") participants will be able to get referrals to local dentists when traveling outside the continental United States through the International Dental Travel Assistance program. While participants have always had coverage under their out-of-network benefits for dental service received internationally, this new program makes it more convenient and provides access to credentialed providers.

Ease and convenience for participants

This new program provides all MetLife PDP participants with:

• 24/7 availability to multilingual assistance coordinators
• Toll-free calling within the U.S. or collect calling outside the U.S.
• Access to providers in more than 200 countries
• Providers selected based upon strict credentialing criteria

Reimbursement for services using an international dentist will be considered under the participant’s out-of-network benefits². To receive reimbursement, participants simply need to save all receipts and submit a dental claim.

When traveling internationally call collect
+1 (312) 356-5970
any time for a dental referral

If the employee is in the U.S. and planning an international trip call (888) 558-2704.

Like most group dental policies, MetLife policies contain certain exclusions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact MetLife for costs and complete details.

¹International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife, and the services they provide are separate and apart from the benefits provided by MetLife. Referrals are not available in all locations. ²Participants should refer to their dental benefits plan summary for more information about out-of-network dental coverage.

With VisionSavings Eyecare Program, qualified employee and dependents receive discounts on eyecare services and eyewear products at thousands of participating providers nationwide. These discounts apply to eye examinations, eyeglasses and contact lenses. The program can be used as often as needed.

VisionSavings Eyecare Program

• An easy and cost-effective way to maintain proper vision care
• Instant savings at point of service
• No enrollment forms to fill out
• Choice through a national network of retail providers
• Online access to the program
• No claim forms to submit
• Unlimited use for you and your family
• Mail Order Contact Lens Replacement Program
• Laser Vision Correction Program

Direct your employees to MyBenefits to find out more about the Vision Savings Eyecare Program.

Find a Participating Provider

To find a participating provider or order ID cards call 800-ASK-4-MET (1-800-275-4638) prompt 2, then 5 or access the website
http://www.eyemedvisioncare.com/MetLife

The employees can call direct at 1-800-ASK-4-MET (1-800-275-4638) prompt 1, then 4, to order ID cards or find a participating provider.

The employee needs to identify him/herself as a VisionSavings Eyecare Program member when making an appointment.  At the time of service, present the ID card to verify participation.  The provider will apply applicable discounts at the time of service.

Participating Optical Retailers

Use the VisionSavings Eyecare Program at these participating optical retailers*:

• Pearle Vision
• Sears Optical
• Target Optical
• JCPenney Optical Center
• LensCrafters

* Some locations do not participate. Call in advance.

ERISA is an important federal law that governs most benefit plans established and maintained by employers. It imposes among other things certain participant reporting requirements on an employer. As a service to employers, MetLife can include an "ERISA Information" statement with the Certificates of Insurance issued to a group. This statement, combined with a Certificate of Insurance, is intended to assist you in meeting ERISA’s requirement to provide a summary plan description (SPD) to participants describing the insurance benefits provided by MetLife under the ERISA plan. If you want the ERISA Information for your plan sent to you, please send a written request to us. Your request must include your MetLife group number, the name, address, and phone number of the plan administrator of your plan, the employer identification number (which may be your Federal Tax Identification Number), and the beginning and end date of your Plan's fiscal year.

NOTE: It is the employer's legal responsibility to comply with any subsequent updates or filings that the law requires. ERISA confers substantial law enforcement responsibilities on the Department of Labor. Non-compliance with the law may result in certain civil or criminal penalties to an employer. We have included some general information about ERISA, however, we urge employers to obtain advice from their own legal and tax advisors concerning any obligations they may have under this law.

What Is ERISA?

ERISA is a federal law that governs most employer established welfare benefit plans (government and church plans are excluded as well as some employee pay all plans). It is the employer's responsibility to provide certain information to plan participants and the Department of Labor and comply with other requirements.

What types of employer groups are governed by ERISA?

This law generally applies to any employee welfare benefit plan that is established or maintained by:

• Any employer engaged in commerce or in any industry affecting commerce, or
• Any employee organization(s) representing employees engaged in commerce that provides certain benefits to their employees, participants, dependents, or beneficiaries.

Welfare benefit plans may include plans that provide the following types of benefits:

• medical, dental, disability income, or life benefits
• unemployment, vacation or severance benefits
• other types of employer sponsored benefits.

Is there a minimum number of employees below which ERISA does not apply?

No. ERISA governs all welfare benefit plans that have one or more employees, unless they are church or government groups.

What does ERISA require employers to do?

Generally, ERISA requires all employers (or plan administrators that an employer may contract with) to provide participants and beneficiaries with a summary plan description SPD describing in understandable terms their rights, benefits and responsibilities under the plan. Employers are also required to furnish participants with a summary of any material changes to the plan or changes to the information contained in the summary plan descriptions. These documents must be furnished to the Department of Labor on request.

Employers with 100 or more participants must file a Form 5500 annually. Employers with fewer than 100 participants must file Form 5500-C at least every third year and Form 5500-R in the two intervening years.

Where can I obtain additional information about ERISA?

You should contact your legal and tax counsel to advise you about your obligations as an employer under this law. You may also contact The Department of Labor or visit their web site at www.dol.gov for more information.

ERISA Plan Number

Welfare Benefit Plans must start with 501.

• Guaranty Association Notices