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"#n'ctSu}ِauq8bbpN.Wo7b$'Tp8@ ppl?|lF-8uLaptT#[%A"$gv>vۧ ܡj8^(N ԜUOtnrr mދ`}UgLQꏮ'.IX8|[0}L o(xW3.}aLy L/μWO?|0r{n7y%J@3f@4+Y9yL/GOtyߗLy?y?^ׇu:* &~s.}jѨ:m}3V]uk IMTUMʅ1HrCsibGl?3_x}]mr3}\|>VuW'EG`3WBp{Xiw>*ֿX~iuheoz?uU&rͲy SXAӈ"whw)%KqC@'?]gY%b.]ENOH4hYW7cź8pIcP)u[Cpu'1`O5h(vgr<],!GH;/gXqȎØ^053rpDGTE>)Ok{}/ivcaUvɁ)7bω]P*NܺHN4Ü@ox~W̼J>_g?~^nNOLJ@f9c:r5k3œS=8 #$rA"o &m[99_+wb{vʏjrkUV’~J{^J E:U/2 m^Ni0 SrV郁0I&gQ⒦먜;^4;V¹v9G>U4ٚRrڌB39X2q:=VQdb-DCd:e^_[ l?ǜHMA`1S9595 bP!\s\gHϽvVB܊W-t(lehڮ.kN6cr>$;i5 =hŔ sr..u{S;|LW=+${4@b[$RTkFH9e|^V=."wt؝*Xcrs1X2IM@Ri8őpԣUW& spӶkd ٳÔbt, HyL3#0zʳ)+̫ʦ V1$1@t)1VkZ"ٴL5U\MwVh&-+$&gI.曌!-_%ST^Bg`b+lj*<.d}3IeK,g+}*FF7oOURpiXŖI d2#p)SS|핹f-[$,|]rԬBM{+[,ܱrE"j~'@L ^١bݕgٔ,n+\ŷ 6~n}w 8,-v)0dȫp2h "}Ϸ>[ѫ]9uNFUSFְE*fD4V0Wks^=ʑr4;hR|wʊO/C@_S,N6o &Ya%.!&՝n)/P~4XȉA*&auC;~*W4z8Wo_ 1݁\t%* S1a=bVs ! 9W8]srf! =I܎Ff/Зl[ kTUN8w:)٦5](uG)}@W_mWND"b7VYv ̚Gp0@>??mȿ}=-֫;h #9~aܼ;΃$`,QUzJVmiNcz56r}Fѐؗxƙ)EEK%(Ŕ1\tY÷[3n\d" PHdsgCϾĕCLjA ?)+$ AM@(ý݄S&_ppmaV0E1+}YBI3BVsʺfij.,t\8$\);w-[).Am0"ZfvM1tFHDgpr7 Mi scƀhL 5 #͔H'Iӑ*)x$a#>2.q˞o;Tx-7>dDŽv,v[+{cZN_Gj-6Xh vɊYŏs{lv UUq\IL)i#Ðy@(rMR靮Z&Ԍ+q'2_;3Np9lKpJ}ܝ^n]~Z*hw[֯Q_[lj'm|a.un]"EҿNsԪz@fp;l-RDvjpA{X;c#B L8!9@DwýL Bٗ& W'L*>1Q!~pg/w#\9vZka~lry^I{dQ2!{Wd}Gv>dϕn+zM: T0 \9ssIDKdH 2G&T? *|Eu )Jbg.>U匑?ؾٖq}b{Vp bXqpa9E4| 0À ws$Γ %XvsYPS)~80_]nq"ʁv1S-nbKT%VuU1kt5ʑ(`$H] 7C_#xݦmKi+j**B.C鵪oQ u T;mӦж\OfXp3(Up'e,)[G/y٪uXVdGe`\;ۻ"ڵ9l pjjHh.S! @1#f2 ۢ[iiHc]yC1-֋tp٧bD%UG ~Z|}~d|fu|_]o΀ߖ?S4ƫIJZc[~Gu0%ݶ>0YG:.?ޑ"_ZU=3SVl|k>>=ۆ 68o'eYH]2mвS)2Ee+eڕª$dv޾ՍY)E,owo9SئWcع*BMQnuNd;z*l Y?~ZT49׍nLR9Qtxt3g# )fwfI_@s{}mP;Zg7LJb˕dQX# ܼD`n%XL"`"MGO6bų^E6mQ˧nT[le.!Lc {I5wnٛ{s+Q\Edum5H)r1ucKhܣXW7]Ӄ7ǝ{o')aMn0c+GY4d %6k>EnҥQ`vׇpxTOʢg(?wo4;7{=s}~ntmrXžl)61e}w=)2'Rm՛sAս=B@FZK4fD2H]AO;7{ Nx){6Źd ?jXoR㬥MwWP{QFX"<޿._?K5a={zϻt?]w).RUc)!^˳bW"VɹxF8d`3};ۛdɕި{=3f`.\-Ȋ Ds)@DD4Z;v]qwnlJ% j1fFI+!ۨohĉŻrO {}{vOmY 1tkswcQ2j BՋl"97MdPIpG v]5YV[8Hn5] UY% %1Lb8VwYvpal&x୍5KμƜ*@ZEa*p)H5@8g׺S.w]9xLnhXU->:1g+K9$Y$ mYS"cƀhpEqX?Á(ćd@~Q6Ekv/?_~t9xǗppw|j\\4.o=|ݴ?U*JWn^ zoZ#zG7"}*ᎇO?7Wjs"ixgp]+*I+ 8imxwvWo˷z.C? endstream endobj 3 0 obj <> endobj 4 0 obj <> endobj 5 0 obj [1 0 R /XYZ 47.5000 654.7100 0] endobj 6 0 obj <> endobj 7 0 obj <> endobj 8 0 obj <> stream q 0 0 612 792 re W n q 1 0 0 1 47.5 759.6 cm q 1 0 0 1 437.3 0 cm q n 0 0 m 84 0 l 84 18 l 0 18 l h W n q 84 0 0 18 0 0 cm /img9345 Do Q Q Q q Q Q q Q q 1 0 0 1 47.5 12.25 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 2.78 Tm (DN-GCERT-GOLD GCERT ER Dental Benefit Summary) Tj ET BT /F3 9 Tf 1 0 0 1 375.73 23.48 Tm (200 Park Ave., New York, NY 10166) Tj ET BT /F3 9 Tf 1 0 0 1 344.57 13.13 Tm ( 2023 MetLife Services and Solutions, LLC) Tj ET BT /F3 9 Tf 1 0 0 1 403.21 2.78 Tm (L0623032885[exp0625][xNM]) Tj ET Q q Q q 1 0 0 1 47.5 43.87 cm 0 0 0 rg BT /F4 14 Tf 1 0 0 1 0 661.96 Tm (Dental) Tj ET 0 0.56471 0.8549 RG 0 J 3.45 w -0.35 654.81 m 510.85 654.81 l S 1 w BT /F3 10 Tf 1 0 0 1 0 642.03 Tm (Metropolitan Life Insurance Company) Tj ET BT /F4 14 Tf 1 0 0 1 0 614.26 Tm (Plan Design for:) Tj ET BT /F3 14 Tf 1 0 0 1 107.35 614.26 Tm ( ) Tj ET BT /F4 14 Tf 1 0 0 1 0 598.16 Tm (Date Prepared:) Tj ET BT /F3 14 Tf 1 0 0 1 99.59 598.16 Tm ( August 21, 2024) Tj ET BT /F3 8 Tf 1 0 0 1 0 576 Tm (The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs) Tj ET BT /F4 4.8 Tf 1 0 0 1 398.45 578.4 Tm (5) Tj ET BT /F3 8 Tf 1 0 0 1 401.12 576 Tm (. You get benefits for a wide) Tj ET BT /F3 8 Tf 1 0 0 1 0 566.8 Tm (range of covered services both in and out of the network. The goal is to deliver cost-effective protection for a healthier smile and a healthier you.) Tj ET 0.87843 0.87843 0.87843 RG 24.15 w 177.45 540.77 m 344.7 540.77 l S 1 w 24.15 w 345.2 540.77 m 513.2 540.77 l S 1 w BT /F4 11 Tf 1 0 0 1 5.5 542.88 Tm (Coverage Type:) Tj ET BT /F4 11 Tf 1 0 0 1 230.82 542.88 Tm (In-Network) Tj ET BT /F4 6.6 Tf 1 0 0 1 287.66 546.18 Tm (1) Tj ET BT /F3 10 Tf 1 0 0 1 227.73 531.14 Tm (% of PDP Fee) Tj ET BT /F3 6 Tf 1 0 0 1 291.09 534.14 Tm (2) Tj ET BT /F4 11 Tf 1 0 0 1 387.34 542.88 Tm (Out-of-Network) Tj ET BT /F4 6.6 Tf 1 0 0 1 467.39 546.18 Tm (1) Tj ET BT /F3 10 Tf 1 0 0 1 395.58 531.14 Tm (% of R&C Fee) Tj ET BT /F3 6 Tf 1 0 0 1 459.49 534.14 Tm (4) Tj ET BT /F4 10 Tf 1 0 0 1 5.5 519.14 Tm (Type A) Tj ET BT /F3 10 Tf 1 0 0 1 38.84 519.14 Tm ( - Preventive) Tj ET BT /F3 10 Tf 1 0 0 1 248.29 519.14 Tm (100%) Tj ET BT /F3 10 Tf 1 0 0 1 416.41 519.14 Tm (100%) Tj ET BT /F4 10 Tf 1 0 0 1 5.5 507.14 Tm (Type B) Tj ET BT /F3 10 Tf 1 0 0 1 38.84 507.14 Tm ( - Basic Restorative) Tj ET BT /F3 10 Tf 1 0 0 1 251.07 507.14 Tm (80%) Tj ET BT /F3 10 Tf 1 0 0 1 419.19 507.14 Tm (80%) Tj ET BT /F4 10 Tf 1 0 0 1 5.5 495.14 Tm (Type C) Tj ET BT /F3 10 Tf 1 0 0 1 38.84 495.14 Tm ( - Major Restorative) Tj ET BT /F3 10 Tf 1 0 0 1 251.07 495.14 Tm (60%) Tj ET BT /F3 10 Tf 1 0 0 1 419.19 495.14 Tm (60%) Tj ET BT /F4 10 Tf 1 0 0 1 5.5 483.14 Tm (Type D) Tj ET BT /F3 10 Tf 1 0 0 1 38.84 483.14 Tm ( - Orthodontia) Tj ET BT /F3 10 Tf 1 0 0 1 251.07 483.14 Tm (50%) Tj ET BT /F3 10 Tf 1 0 0 1 419.19 483.14 Tm (50%) Tj ET BT /F4 11 Tf 1 0 0 1 5.5 458.24 Tm (Deductible) Tj ET BT /F4 6.6 Tf 1 0 0 1 61.73 461.54 Tm (3) Tj ET BT /F3 10 Tf 1 0 0 1 5.5 446 Tm (Individual) Tj ET BT /F3 10 Tf 1 0 0 1 252.73 446 Tm ($) Tj ET BT /F3 10 Tf 1 0 0 1 258.29 446 Tm (50) Tj ET BT /F3 10 Tf 1 0 0 1 420.86 446 Tm ($) Tj ET BT /F3 10 Tf 1 0 0 1 426.42 446 Tm (50) Tj ET BT /F3 10 Tf 1 0 0 1 5.5 434 Tm (Family) Tj ET BT /F3 10 Tf 1 0 0 1 249.95 434 Tm ($150) Tj ET BT /F3 10 Tf 1 0 0 1 418.08 434 Tm ($150) Tj ET BT /F4 11 Tf 1 0 0 1 5.5 407.94 Tm (Annual Maximum Benefit:) Tj ET BT /F3 10 Tf 1 0 0 1 5.5 395.7 Tm (Per Individual) Tj ET BT /F3 10 Tf 1 0 0 1 247.12 395.7 Tm ($) Tj ET BT /F3 10 Tf 1 0 0 1 252.68 395.7 Tm (2000) Tj ET BT /F3 10 Tf 1 0 0 1 415.25 395.7 Tm ($) Tj ET BT /F3 10 Tf 1 0 0 1 420.81 395.7 Tm (2000) Tj ET 2 J 0.5 w [] 0 d 0 0 0 RG 0.1 552.84 m 0.1 392.1 l S 1 w [] 0 d 0.5 w [] 0 d 177.2 552.84 m 177.2 480.7 l S 1 w [] 0 d 0.5 w [] 0 d 177.2 455.05 m 177.2 431.55 l S 1 w [] 0 d 0.5 w [] 0 d 177.2 404.75 m 177.2 392.1 l S 1 w [] 0 d 0.5 w [] 0 d 344.95 552.84 m 344.95 480.7 l S 1 w [] 0 d 0.5 w [] 0 d 344.95 455.05 m 344.95 431.55 l S 1 w [] 0 d 0.5 w [] 0 d 344.95 404.75 m 344.95 392.1 l S 1 w [] 0 d 0.5 w [] 0 d 513.45 552.84 m 513.45 392.1 l S 1 w [] 0 d 0.5 w [] 0 d 0.1 553.09 m 513.45 553.09 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 528.44 m 512.95 528.44 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 516.44 m 512.95 516.44 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 504.45 m 512.95 504.45 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 492.45 m 512.95 492.45 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 480.45 m 512.95 480.45 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 468.45 m 512.95 468.45 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 455.3 m 512.95 455.3 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 443.3 m 512.95 443.3 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 431.3 m 512.95 431.3 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 418.15 m 512.95 418.15 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 405 m 512.95 405 l S 1 w [] 0 d BT /F4 10 Tf 1 0 0 1 5.5 370.49 Tm (Orthodontia Lifetime Maximum -) Tj ET BT /F4 10 Tf 1 0 0 1 5.5 358.99 Tm (Ortho applies to Adult and Child) Tj ET BT /F3 10 Tf 1 0 0 1 288.34 370.49 Tm (Up to dependent age limit) Tj ET BT /F3 10 Tf 1 0 0 1 221.32 358.49 Tm ($1500 per Person) Tj ET BT /F3 10 Tf 1 0 0 1 389.45 358.49 Tm ($1500 per Person) Tj ET 0.5 w [] 0 d 0.1 391.54 m 0.1 356.05 l S 1 w [] 0 d 0.5 w [] 0 d 177.2 379.55 m 177.2 356.05 l S 1 w [] 0 d 0.5 w [] 0 d 344.95 367.55 m 344.95 356.05 l S 1 w [] 0 d 0.5 w [] 0 d 513.45 391.54 m 513.45 356.05 l S 1 w [] 0 d 0.5 w [] 0 d 0.1 391.79 m 513.45 391.79 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 379.8 m 512.95 379.8 l S 1 w [] 0 d 0.5 w [] 0 d 177.7 367.8 m 512.95 367.8 l S 1 w [] 0 d 0.5 w [] 0 d 0.6 355.74 m 513.45 355.74 l S 1 w [] 0 d 0.5 w [] 0 d 0.1 354.28 m 0.1 342.78 l S 1 w [] 0 d 0.5 w [] 0 d 513.45 354.28 m 513.45 342.78 l S 1 w [] 0 d BT /F3 5.4 Tf 1 0 0 1 5.5 325.28 Tm (1.) Tj ET BT /F3 9 Tf 1 0 0 1 14.5 322.58 Tm ("In-Network Benefits" refers to benefits provided under this plan for covered dental services that are provided by a) Tj ET BT /F3 9 Tf 1 0 0 1 14.5 312.23 Tm (participating dentist. "Out-of-Network Benefits" refers to benefits provided under this plan for covered dental services that) Tj ET BT /F3 9 Tf 1 0 0 1 14.5 301.88 Tm (are not provided by a participating dentist. Utilizing an out-of-network dentist for care may cost you more than using an in-) Tj ET BT /F3 9 Tf 1 0 0 1 14.5 291.53 Tm (network dentist.) Tj ET BT /F3 5.4 Tf 1 0 0 1 5.5 283.88 Tm (2.) Tj ET BT /F3 9 Tf 1 0 0 1 14.5 281.18 Tm (Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services,) Tj ET BT /F3 9 Tf 1 0 0 1 14.5 270.83 Tm (subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.) Tj ET 0.5 w [] 0 d 0.1 342.23 m 0.1 268.63 l S 1 w [] 0 d 0.5 w [] 0 d 513.45 342.23 m 513.45 268.63 l S 1 w [] 0 d 0.5 w [] 0 d 0.1 342.48 m 513.45 342.48 l S 1 w [] 0 d BT /F3 5.4 Tf 1 0 0 1 5.5 263.13 Tm (3.) Tj ET BT /F3 9 Tf 1 0 0 1 15.6 260.43 Tm (Applies to Type B and C services only.) Tj ET BT /F3 5.4 Tf 1 0 0 1 5.5 252.78 Tm (4.) Tj ET BT /F3 9 Tf 1 0 0 1 13.4 250.08 Tm (Out-of-network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable) Tj ET BT /F3 9 Tf 1 0 0 1 13.4 239.73 Tm (and Customary charge is based on the lowest of:) Tj ET BT /F6 9 Tf 1 0 0 1 14.5 228.48 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 32.5 228.48 Tm (the dentists actual charge \(the 'Actual Charge'\),) Tj ET BT /F6 9 Tf 1 0 0 1 14.5 217.23 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 32.5 217.23 Tm (the dentists usual charge for the same or similar services \(the 'Usual Charge'\) or) Tj ET BT /F6 9 Tf 1 0 0 1 14.5 205.98 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 32.5 205.98 Tm (the usual charge of most dentists in the same geographic area for the same or similar services as determined by) Tj ET BT /F3 9 Tf 1 0 0 1 32.5 195.63 Tm (MetLife \(the 'Customary Charge'\).) Tj ET BT /F3 9 Tf 1 0 0 1 171.99 195.63 Tm (For your plan, the Customary Charge is based on the 90th percentile.) Tj ET BT /F3 9 Tf 1 0 0 1 453.14 195.63 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 32.5 185.28 Tm (must be necessary in terms of generally accepted dental standards.) Tj ET BT /F3 6 Tf 1 0 0 1 5.5 177.03 Tm (5.) Tj ET BT /F3 9 Tf 1 0 0 1 15.6 174.03 Tm (Savings from enrolling in a dental benefits plan [featuring the MetLife Preferred Dentist Program] will depend on various) Tj ET BT /F3 9 Tf 1 0 0 1 15.6 163.43 Tm (factors, including the cost of the plan, how often participants visit a dentist and the cost of services rendered.) Tj ET 0.5 w [] 0 d 0.1 268.57 m 0.1 161.23 l S 1 w [] 0 d 0.5 w [] 0 d 513.45 268.57 m 513.45 161.23 l S 1 w [] 0 d 0.5 w [] 0 d 0.25 160.98 m 513.85 160.98 l S 1 w [] 0 d Q q Q Q endstream endobj 9 0 obj <> >> >> endobj 10 0 obj [9 0 R /XYZ 205.6500 556.9800 0] endobj 11 0 obj [9 0 R /XYZ 220.7700 556.9800 0] endobj 12 0 obj <> stream q 0 0 612 792 re W n q 1 0 0 1 47.5 12.25 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 2.26 Tm (DN-GCERT-GOLD GCERT ER Dental Benefit Summary) Tj ET BT /F3 9 Tf 1 0 0 1 375.73 22.96 Tm (200 Park Ave., New York, NY 10166) Tj ET BT /F3 9 Tf 1 0 0 1 344.57 12.61 Tm ( 2023 MetLife Services and Solutions, LLC) Tj ET BT /F3 9 Tf 1 0 0 1 403.21 2.26 Tm (L0623032885[exp0625][xNM]) Tj ET Q q Q q 1 0 0 1 47.5 43.35 cm 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 675.09 Tm (Selected Covered Services and Frequency Limitations*) Tj ET BT /F4 9 Tf 1 0 0 1 9 646.5 Tm (Type A - Preventive) Tj ET BT /F4 9 Tf 1 0 0 1 283.25 646.5 Tm (How Many/How Often:) Tj ET 2 J 0.945 w [] 0 d 0 0 0 RG 283.72 645.08 m 377.77 645.08 l S 1 w [] 0 d 0.5 w [] 0 d 0.25 640.9 m 512.75 640.9 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 633.35 Tm (Oral Examinations) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 633.35 Tm (2 in a year) Tj ET 0.5 w [] 0 d -0.25 640.59 m -0.25 631.39 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 640.59 m 152.75 631.39 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 640.59 m 512.75 631.39 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 624.1 Tm (Full Mouth X-rays) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 624.1 Tm (1 in 3 years) Tj ET 0.5 w [] 0 d -0.25 631.34 m -0.25 622.14 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 631.34 m 152.75 622.14 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 631.34 m 512.75 622.14 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 614.84 Tm (Bitewing X-rays \(Adult/Child\)) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 614.84 Tm (2 in a year) Tj ET 0.5 w [] 0 d -0.25 622.08 m -0.25 612.88 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 622.08 m 152.75 612.88 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 622.08 m 512.75 612.88 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 605.58 Tm (Prophylaxis - Cleanings) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 605.58 Tm (2 in a year) Tj ET 0.5 w [] 0 d -0.25 612.82 m -0.25 603.62 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 612.82 m 152.75 603.62 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 612.82 m 512.75 603.62 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 596.33 Tm (Topical Fluoride Applications) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 596.33 Tm (2 in a year - Children to age 18) Tj ET 0.5 w [] 0 d -0.25 603.57 m -0.25 594.37 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 603.57 m 152.75 594.37 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 603.57 m 512.75 594.37 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 587.07 Tm (Sealants) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 587.07 Tm (1 in 60 months) Tj ET BT /F3 8 Tf 1 0 0 1 215.07 587.07 Tm (- Children to age 18) Tj ET 0.5 w [] 0 d -0.25 594.31 m -0.25 585.11 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 594.31 m 152.75 585.11 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 594.31 m 512.75 585.11 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 577.81 Tm (Space Maintainers) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 577.81 Tm (1 per lifetime per tooth area - Children up to age 12) Tj ET 0.5 w [] 0 d -0.25 585.05 m -0.25 575.85 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 585.05 m 152.75 575.85 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 585.05 m 512.75 575.85 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 5.4 553.35 Tm (Type B - Basic Restorative) Tj ET BT /F4 9 Tf 1 0 0 1 285.5 553.35 Tm (How Many/How Often:) Tj ET 0.945 w [] 0 d 285.97 551.92 m 380.02 551.92 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.4 543.41 Tm (Amalgam and Composite Fillings) Tj ET BT /F3 8 Tf 1 0 0 1 158.4 543.41 Tm (1 in 24 months.) Tj ET BT /F3 8 Tf 1 0 0 1 217.55 543.41 Tm (Anterior teeth only) Tj ET 0.5 w [] 0 d 0 550.65 m 0 541.45 l S 1 w [] 0 d 0.5 w [] 0 d 153 550.65 m 153 541.45 l S 1 w [] 0 d 0.5 w [] 0 d 513 550.65 m 513 541.45 l S 1 w [] 0 d 0.5 w [] 0 d 0.25 575.55 m 512.75 575.55 l S 1 w [] 0 d 0.5 w [] 0 d 0 550.9 m 513 550.9 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 534.15 Tm (Endodontics Root Canal) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 534.15 Tm (1 per tooth per lifetime) Tj ET 0.5 w [] 0 d -0.25 541.39 m -0.25 532.19 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 541.39 m 152.75 532.19 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 541.39 m 512.75 532.19 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 524.89 Tm (Periodontal Surgery) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 524.89 Tm (1 in 36 months per quadrant) Tj ET 0.5 w [] 0 d -0.25 532.14 m -0.25 522.94 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 532.14 m 152.75 522.94 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 532.14 m 512.75 522.94 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 515.64 Tm (Periodontal Scaling & Root Planing) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 515.64 Tm (1 in 24 months per quadrant) Tj ET 0.5 w [] 0 d -0.25 522.88 m -0.25 513.68 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 522.88 m 152.75 513.68 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 522.88 m 512.75 513.68 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 506.38 Tm (Periodontal Maintenance) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 506.38 Tm (2 in) Tj ET BT /F3 8 Tf 1 0 0 1 173.27 506.38 Tm (1 year, includes 2 cleanings) Tj ET 0.5 w [] 0 d -0.25 513.62 m -0.25 504.42 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 513.62 m 152.75 504.42 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 513.62 m 512.75 504.42 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 497.12 Tm (Oral Surgery \(Simple Extractions\)) Tj ET 0.5 w [] 0 d -0.25 504.36 m -0.25 495.17 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 504.36 m 152.75 495.17 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 504.36 m 512.75 495.17 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 487.87 Tm (Oral Surgery \(Surgical Extractions\)) Tj ET 0.5 w [] 0 d -0.25 495.11 m -0.25 485.91 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 495.11 m 152.75 485.91 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 495.11 m 512.75 485.91 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 478.61 Tm (Other Oral Surgery) Tj ET 0.5 w [] 0 d -0.25 485.85 m -0.25 476.65 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 485.85 m 152.75 476.65 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 485.85 m 512.75 476.65 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 469.35 Tm (Emergency Palliative Treatment) Tj ET 0.5 w [] 0 d -0.25 476.6 m -0.25 467.4 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 476.6 m 152.75 467.4 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 476.6 m 512.75 467.4 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 460.1 Tm (General Anesthesia) Tj ET 0.5 w [] 0 d -0.25 467.34 m -0.25 458.14 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 467.34 m 152.75 458.14 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 467.34 m 512.75 458.14 l S 1 w [] 0 d 0.5 w [] 0 d 0.25 457.83 m 512.75 457.83 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 9 437.88 Tm (Type C - Major Restorative) Tj ET BT /F4 9 Tf 1 0 0 1 283.25 437.88 Tm (How Many/How Often:) Tj ET 0.945 w [] 0 d 283.72 436.45 m 377.77 436.45 l S 1 w [] 0 d 0.5 w [] 0 d 0.25 433.87 m 512.75 433.87 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 426.32 Tm (Crowns/Inlays/Onlays) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 426.32 Tm (1 per tooth in 84 months) Tj ET 0.5 w [] 0 d -0.25 433.57 m -0.25 424.37 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 433.57 m 152.75 424.37 l S 1 w [] 0 d 0.5 w [] 0 d 511.85 433.57 m 511.85 424.37 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 417.07 Tm (Prefabricated Crowns) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 417.07 Tm (1 in 84 months) Tj ET 0.5 w [] 0 d -0.25 424.31 m -0.25 415.11 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 424.31 m 152.75 415.11 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 424.31 m 512.75 415.11 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 407.81 Tm (Repairs) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 407.81 Tm (1 in 12 months) Tj ET 0.5 w [] 0 d -0.25 415.05 m -0.25 405.85 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 415.05 m 152.75 405.85 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 415.05 m 512.75 405.85 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 398.55 Tm (Bridges) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 398.55 Tm (1 in 84 months) Tj ET 0.5 w [] 0 d -0.25 405.8 m -0.25 396.6 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 405.8 m 152.75 396.6 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 405.8 m 512.75 396.6 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 389.3 Tm (Dentures) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 389.3 Tm (1 in 84 months) Tj ET 0.5 w [] 0 d -0.25 396.54 m -0.25 387.34 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 396.54 m 152.75 387.34 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 396.54 m 512.75 387.34 l S 1 w [] 0 d BT /F3 8 Tf 1 0 0 1 5.15 380.04 Tm (Consultations) Tj ET BT /F3 8 Tf 1 0 0 1 158.15 380.04 Tm (1 in 12 months) Tj ET 0.5 w [] 0 d -0.25 387.28 m -0.25 378.08 l S 1 w [] 0 d 0.5 w [] 0 d 152.75 387.28 m 152.75 378.08 l S 1 w [] 0 d 0.5 w [] 0 d 512.75 387.28 m 512.75 378.08 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 0 358.05 Tm (Type D Orthodontia) Tj ET BT /F6 8 Tf 1 0 0 1 4.7 346.16 Tm (x) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 346.16 Tm (Adult and Child Coverage.) Tj ET BT /F3 8 Tf 1 0 0 1 115.49 346.16 Tm (Dependent children up to age 26.) Tj ET BT /F3 8 Tf 1 0 0 1 238.24 346.16 Tm (Age limitations may vary by state.) Tj ET BT /F3 8 Tf 1 0 0 1 361.85 346.16 Tm (Please see your Plan description for) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 336.96 Tm (complete details. In the event of a conflict with this summary, the terms of the certificate will govern.) Tj ET BT /F6 8 Tf 1 0 0 1 4.7 326.96 Tm (x) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 326.96 Tm (All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia.) Tj ET BT /F6 8 Tf 1 0 0 1 4.7 316.96 Tm (x) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 316.96 Tm (Benefits for the initial placement will not exceed 20% of the Lifetime Maximum Benefit Amount for Orthodontia.) Tj ET BT /F3 8 Tf 1 0 0 1 412.51 316.96 Tm (Periodic follow-up visits) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 307.76 Tm (will be payable on a monthly basis during the scheduled course of the orthodontic treatment.) Tj ET BT /F3 8 Tf 1 0 0 1 348.51 307.76 Tm (Allowable expenses for the initial placement,) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 298.56 Tm (periodic follow-up visits and procedures performed in connection with the orthodontic treatment, are all subject to the Orthodontia) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 289.36 Tm (coinsurance level and Lifetime Maximum Benefit Amount as defined in the Plan Summary.) Tj ET BT /F6 8 Tf 1 0 0 1 4.7 279.36 Tm (x) Tj ET BT /F3 8 Tf 1 0 0 1 17.65 279.36 Tm (Orthodontic benefits end at cancellation of coverage) Tj ET 0.5 w [] 0 d 0 354.2 m 0 265.9 l S 1 w [] 0 d 0.5 w [] 0 d 513 354.2 m 513 265.9 l S 1 w [] 0 d 0.5 w [] 0 d 0.25 377.78 m 512.75 377.78 l S 1 w [] 0 d 0.5 w [] 0 d 0 354.45 m 513 354.45 l S 1 w [] 0 d 0.5 w [] 0 d 0 265.65 m 513 265.65 l S 1 w [] 0 d BT /F4 8 Tf 1 0 0 1 0 246.66 Tm (*Alternate Benefits:) Tj ET BT /F3 8 Tf 1 0 0 1 76.46 246.66 Tm (Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the) Tj ET BT /F3 8 Tf 1 0 0 1 0 237.46 Tm (least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan) Tj ET BT /F3 8 Tf 1 0 0 1 0 228.26 Tm (benefit is based, you will be responsible for any additional payment responsibility.) Tj ET BT /F3 8 Tf 1 0 0 1 292.16 228.26 Tm (To avoid any misunderstandings, we suggest you discuss) Tj ET BT /F3 8 Tf 1 0 0 1 0 219.06 Tm (treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high) Tj ET BT /F3 8 Tf 1 0 0 1 0 209.87 Tm (cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits \(EOB\) outlining the services) Tj ET BT /F3 8 Tf 1 0 0 1 0 200.67 Tm (provided, your plans reimbursement for those services, and your out-of-pocket expense. Actual payments may vary from the pretreatment) Tj ET BT /F3 8 Tf 1 0 0 1 0 191.47 Tm (estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.) Tj ET BT /F3 8 Tf 1 0 0 1 0 171.92 Tm (The service categories and plan limitations shown above represent an overview of your Plan of Benefits. This document presents many services) Tj ET BT /F3 8 Tf 1 0 0 1 0 162.72 Tm (within each category, but is not a complete description of the Plan.) Tj ET BT /F3 8 Tf 1 0 0 1 239.25 162.72 Tm (Please see your Plan description/Insurance certificate for complete details.) Tj ET BT /F3 8 Tf 1 0 0 1 507.83 162.72 Tm (In) Tj ET BT /F3 8 Tf 1 0 0 1 0 153.52 Tm (the event of a conflict with this summary, the terms of your insurance certificate will govern.) Tj ET Q q Q Q endstream endobj 13 0 obj <> >> >> endobj 14 0 obj <> stream q 0 0 612 792 re W n q 1 0 0 1 50.4 12.25 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 2.78 Tm (DN-GCERT-GOLD GCERT ER Dental Benefit Summary) Tj ET BT /F3 9 Tf 1 0 0 1 375.73 23.48 Tm (200 Park Ave., New York, NY 10166) Tj ET BT /F3 9 Tf 1 0 0 1 344.57 13.13 Tm ( 2023 MetLife Services and Solutions, LLC) Tj ET BT /F3 9 Tf 1 0 0 1 403.21 2.78 Tm (L0623032885[exp0625][xNM]) Tj ET Q q Q q 1 0 0 1 50.4 43.87 cm 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 713.52 Tm (We will not pay Dental Insurance benefits for charges incurred for:) Tj ET BT /F3 9 Tf 1 0 0 1 0 690.93 Tm (1.) Tj ET BT /F3 9 Tf 1 0 0 1 18 690.93 Tm (Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the) Tj ET BT /F3 9 Tf 1 0 0 1 18 680.59 Tm (particular dental condition, or which We deem experimental in nature;) Tj ET BT /F3 9 Tf 1 0 0 1 0 670.24 Tm (2.) Tj ET BT /F3 9 Tf 1 0 0 1 18 670.24 Tm (Services for which You would not be required to pay in the absence of Dental Insurance;) Tj ET BT /F3 9 Tf 1 0 0 1 0 659.89 Tm (3.) Tj ET BT /F3 9 Tf 1 0 0 1 18 659.89 Tm (Services or supplies received by You or Your Dependent before the Dental Insurance starts for that person;) Tj ET BT /F3 9 Tf 1 0 0 1 0 649.54 Tm (4.) Tj ET BT /F3 9 Tf 1 0 0 1 18 649.54 Tm (Services which are primarily cosmetic \(For residents of Texas, see notice page section in your certificate\).) Tj ET BT /F3 9 Tf 1 0 0 1 0 639.19 Tm (5.) Tj ET BT /F3 9 Tf 1 0 0 1 18 639.19 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 639.19 Tm ( which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist) Tj ET BT /F3 9 Tf 1 0 0 1 18 628.84 Tm (which are supervised and billed by a Dentist and which are for:) Tj ET BT /F6 9 Tf 1 0 0 1 18 617.59 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 617.59 Tm (scaling and polishing of teeth; or) Tj ET BT /F6 9 Tf 1 0 0 1 18 606.34 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 606.34 Tm (fluoride treatments.) Tj ET BT /F4 9 Tf 1 0 0 1 36 595.99 Tm (For NY Sitused Groups) Tj ET 2 J 0.945 w [] 0 d 0 0 0 RG 36.47 594.56 m 134.54 594.56 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 135.01 595.99 Tm (, this exclusion does not apply.) Tj ET BT /F3 9 Tf 1 0 0 1 0 585.64 Tm (6.) Tj ET BT /F3 9 Tf 1 0 0 1 18 585.64 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 585.64 Tm ( or appliances which restore or alter occlusion or vertical dimension.) Tj ET BT /F3 9 Tf 1 0 0 1 0 575.29 Tm (7.) Tj ET BT /F3 9 Tf 1 0 0 1 18 575.29 Tm (Restoration) Tj ET BT /F3 9 Tf 1 0 0 1 64.02 575.29 Tm ( of tooth structure damaged by attrition, abrasion or erosion.) Tj ET BT /F3 9 Tf 1 0 0 1 0 564.94 Tm (8.) Tj ET BT /F3 9 Tf 1 0 0 1 18 564.94 Tm (Restorations) Tj ET BT /F3 9 Tf 1 0 0 1 68.52 564.94 Tm ( or appliances used for the purpose of periodontal splinting.) Tj ET BT /F3 9 Tf 1 0 0 1 0 554.59 Tm (9.) Tj ET BT /F3 9 Tf 1 0 0 1 18 554.59 Tm (Counseling) Tj ET BT /F3 9 Tf 1 0 0 1 63.03 554.59 Tm ( or instruction about oral hygiene, plaque control, nutrition and tobacco.) Tj ET BT /F3 9 Tf 1 0 0 1 0 544.24 Tm (10.) Tj ET BT /F3 9 Tf 1 0 0 1 18 544.24 Tm (Personal) Tj ET BT /F3 9 Tf 1 0 0 1 53.52 544.24 Tm ( supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss.) Tj ET BT /F3 9 Tf 1 0 0 1 0 533.9 Tm (11.) Tj ET BT /F3 9 Tf 1 0 0 1 18 533.9 Tm (Decoration) Tj ET BT /F3 9 Tf 1 0 0 1 61.52 533.9 Tm (, personalization or inscription of any tooth, device, appliance, crown or other dental work.) Tj ET BT /F3 9 Tf 1 0 0 1 0 523.55 Tm (12.) Tj ET BT /F3 9 Tf 1 0 0 1 18 523.55 Tm (Missed) Tj ET BT /F3 9 Tf 1 0 0 1 46.51 523.55 Tm ( appointments.) Tj ET BT /F3 9 Tf 1 0 0 1 0 513.2 Tm (13.) Tj ET BT /F3 9 Tf 1 0 0 1 18 513.2 Tm (Services) Tj ET BT /F6 9 Tf 1 0 0 1 18 501.95 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 501.95 Tm (covered under any workers compensation or occupational disease law;) Tj ET BT /F6 9 Tf 1 0 0 1 18 490.7 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 490.7 Tm (covered under any employer liability law;) Tj ET BT /F6 9 Tf 1 0 0 1 18 479.45 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 479.45 Tm (for which the employer of the person receiving such services is not required to pay; or) Tj ET BT /F6 9 Tf 1 0 0 1 18 468.2 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 468.2 Tm (received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital.) Tj ET BT /F4 9 Tf 1 0 0 1 36 457.85 Tm (For North Carolina and Virginia Sitused Groups) Tj ET 0.945 w [] 0 d 36.47 456.42 m 238.55 456.42 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 239.02 457.85 Tm (, this exclusion does not apply.) Tj ET BT /F3 9 Tf 1 0 0 1 0 447.5 Tm (14.) Tj ET BT /F3 9 Tf 1 0 0 1 18 447.5 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 447.5 Tm ( paid under any workers compensation, occupational disease or employer liability law as follows:) Tj ET BT /F6 9 Tf 1 0 0 1 18 436.25 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 436.25 Tm (for persons who are covered in North Carolina for the treatment of an Occupational Injury or Sickness which are paid) Tj ET BT /F3 9 Tf 1 0 0 1 36 425.9 Tm (under the North Carolina Workers Compensation Act only to the extent such services are the liability of the employee,) Tj ET BT /F3 9 Tf 1 0 0 1 36 415.55 Tm (employer or workers compensation insurance carrier according to a final adjudication under the North Carolina Workers) Tj ET BT /F3 9 Tf 1 0 0 1 36 405.2 Tm (Compensation Act or an order of the North Carolina Industrial Commission approving a settlement agreement under the) Tj ET BT /F3 9 Tf 1 0 0 1 36 394.85 Tm (North Carolina Workers compensation Act;) Tj ET BT /F6 9 Tf 1 0 0 1 18 383.6 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 383.6 Tm (or for persons who are not covered in North Carolina, services paid or payable under any workers compensation or) Tj ET BT /F3 9 Tf 1 0 0 1 36 373.25 Tm (occupational disease law.) Tj ET BT /F4 9 Tf 1 0 0 1 36 362.9 Tm (This exclusion only applies) Tj ET BT /F4 9 Tf 1 0 0 1 155.53 362.9 Tm (for North Carolina Sitused Groups) Tj ET 0.945 w [] 0 d 156 361.48 m 301.57 361.48 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 302.04 362.9 Tm (.) Tj ET BT /F3 9 Tf 1 0 0 1 0 352.56 Tm (15.) Tj ET BT /F3 9 Tf 1 0 0 1 18 352.56 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 352.56 Tm (:) Tj ET BT /F6 9 Tf 1 0 0 1 18 341.31 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 341.31 Tm (for which the employer of the person receiving such services is required to pay; or) Tj ET BT /F6 9 Tf 1 0 0 1 18 330.06 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 330.06 Tm (received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital.) Tj ET BT /F4 9 Tf 1 0 0 1 36 319.71 Tm (This exclusion only applies) Tj ET BT /F4 9 Tf 1 0 0 1 155.53 319.71 Tm (for North Carolina Sitused Groups) Tj ET 0.945 w [] 0 d 156 318.28 m 301.57 318.28 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 302.04 319.71 Tm (.) Tj ET BT /F3 9 Tf 1 0 0 1 0 309.36 Tm (16.) Tj ET BT /F3 9 Tf 1 0 0 1 18 309.36 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 309.36 Tm ( covered under any workers' compensation, occupational disease or employer liability law for which the employee/or) Tj ET BT /F3 9 Tf 1 0 0 1 18 299.01 Tm (Dependent received benefits under that law.) Tj ET BT /F4 9 Tf 1 0 0 1 18 288.66 Tm (This exclusion only applies) Tj ET BT /F4 9 Tf 1 0 0 1 137.53 288.66 Tm (for Virginia Sitused Groups) Tj ET 0.945 w [] 0 d 138 287.23 m 254.07 287.23 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 254.54 288.66 Tm (.) Tj ET BT /F3 9 Tf 1 0 0 1 0 278.31 Tm (17.) Tj ET BT /F3 9 Tf 1 0 0 1 18 278.31 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 278.31 Tm (:) Tj ET BT /F6 9 Tf 1 0 0 1 18 267.06 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 267.06 Tm (for which the employer of the person receiving such services is not required to pay; or) Tj ET BT /F6 9 Tf 1 0 0 1 18 255.81 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 255.81 Tm (received at a facility maintained by the policyholder, labor union, mutual benefit association, or VA hospital.) Tj ET BT /F4 9 Tf 1 0 0 1 18 245.46 Tm (This exclusion only applies) Tj ET BT /F4 9 Tf 1 0 0 1 137.53 245.46 Tm (for Virginia Sitused Groups) Tj ET 0.945 w [] 0 d 138 244.03 m 254.07 244.03 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 254.54 245.46 Tm (.) Tj ET BT /F3 9 Tf 1 0 0 1 0 235.11 Tm (18.) Tj ET BT /F3 9 Tf 1 0 0 1 18 235.11 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 235.11 Tm ( covered under other coverage provided by the Employer.) Tj ET BT /F3 9 Tf 1 0 0 1 0 224.76 Tm (19.) Tj ET BT /F3 9 Tf 1 0 0 1 18 224.76 Tm (Temporary) Tj ET BT /F3 9 Tf 1 0 0 1 61.51 224.76 Tm ( or provisional restorations.) Tj ET BT /F3 9 Tf 1 0 0 1 0 214.41 Tm (20.) Tj ET BT /F3 9 Tf 1 0 0 1 18 214.41 Tm (Temporary) Tj ET BT /F3 9 Tf 1 0 0 1 61.51 214.41 Tm ( or provisional appliances.) Tj ET BT /F3 9 Tf 1 0 0 1 0 204.06 Tm (21.) Tj ET BT /F3 9 Tf 1 0 0 1 18 204.06 Tm (Prescription) Tj ET BT /F3 9 Tf 1 0 0 1 65.52 204.06 Tm ( drugs.) Tj ET BT /F3 9 Tf 1 0 0 1 0 193.71 Tm (22.) Tj ET BT /F3 9 Tf 1 0 0 1 18 193.71 Tm (Services) Tj ET BT /F3 9 Tf 1 0 0 1 52.51 193.71 Tm ( for which the submitted documentation indicates a poor prognosis.) Tj ET BT /F3 9 Tf 1 0 0 1 0 183.37 Tm (23.) Tj ET BT /F3 9 Tf 1 0 0 1 18 183.37 Tm (The) Tj ET BT /F3 9 Tf 1 0 0 1 33.51 183.37 Tm ( following when charged by the Dentist on a separate basis:) Tj ET BT /F6 9 Tf 1 0 0 1 18 172.12 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 172.12 Tm (claim form completion;) Tj ET BT /F6 9 Tf 1 0 0 1 18 160.87 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 160.87 Tm (infection control such as gloves, masks, and sterilization of supplies; or) Tj ET BT /F6 9 Tf 1 0 0 1 18 149.62 Tm (x) Tj ET BT /F3 9 Tf 1 0 0 1 36 149.62 Tm (local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.) Tj ET BT /F3 9 Tf 1 0 0 1 0 139.27 Tm (24.) Tj ET BT /F3 9 Tf 1 0 0 1 18 139.27 Tm (Dental) Tj ET BT /F3 9 Tf 1 0 0 1 44.02 139.27 Tm ( services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to) Tj ET BT /F3 9 Tf 1 0 0 1 18 128.92 Tm (chewing or biting of food.) Tj ET BT /F4 9 Tf 1 0 0 1 18 118.57 Tm (For NY Sitused Groups) Tj ET 0.945 w [] 0 d 18.47 117.14 m 116.54 117.14 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 117.01 118.57 Tm (, this exclusion does not apply.) Tj ET BT /F3 9 Tf 1 0 0 1 0 108.22 Tm (25.) Tj ET BT /F3 9 Tf 1 0 0 1 18 108.22 Tm (Caries) Tj ET BT /F3 9 Tf 1 0 0 1 44.01 108.22 Tm ( susceptibility tests.) Tj ET BT /F3 9 Tf 1 0 0 1 0 97.87 Tm (26.) Tj ET BT /F3 9 Tf 1 0 0 1 18 97.87 Tm (Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such) Tj ET BT /F3 9 Tf 1 0 0 1 18 87.52 Tm (person was insured for Dental Insurance, except for congenitally missing natural teeth.) Tj ET BT /F3 9 Tf 1 0 0 1 0 77.17 Tm (27.) Tj ET BT /F3 9 Tf 1 0 0 1 18 77.17 Tm (Other) Tj ET BT /F3 9 Tf 1 0 0 1 40.51 77.17 Tm ( fixed Denture prosthetic services not described elsewhere in this certificate.) Tj ET BT /F3 9 Tf 1 0 0 1 0 65.92 Tm (28) Tj ET BT /F3 9 Tf 1 0 0 1 18 65.92 Tm (Precision attachments) Tj ET BT /F3 10 Tf 1 0 0 1 106.54 65.92 Tm (.) Tj ET BT /F3 9 Tf 1 0 0 1 0 55.32 Tm (29.) Tj ET BT /F3 9 Tf 1 0 0 1 18 55.32 Tm (Initial installation or replacement of a full or removable Denture to replace one or more natural teeth which were missing) Tj ET BT /F3 9 Tf 1 0 0 1 18 44.97 Tm (before such person was insured for Dental Insurance, except for congenitally missing natural teeth.) Tj ET BT /F3 9 Tf 1 0 0 1 0 34.63 Tm (30.) Tj ET BT /F3 9 Tf 1 0 0 1 18 34.63 Tm (Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person) Tj ET BT /F3 9 Tf 1 0 0 1 18 24.28 Tm (was insured for Dental Insurance, except for congenitally missing natural teeth.) Tj ET BT /F3 9 Tf 1 0 0 1 0 13.93 Tm (31.) Tj ET BT /F3 9 Tf 1 0 0 1 18 13.93 Tm (Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it.) Tj ET BT /F3 9 Tf 1 0 0 1 0 3.58 Tm (32.) Tj ET BT /F3 9 Tf 1 0 0 1 18 3.58 Tm (Fixed and removable appliances for correction of harmful habits.) Tj ET BT /F3 5.4 Tf 1 0 0 1 274.13 6.28 Tm (1) Tj ET Q q Q Q endstream endobj 15 0 obj <> >> >> endobj 16 0 obj <> endobj 17 0 obj <> stream q 0 0 612 792 re W n q 1 0 0 1 50.4 12.25 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 2.78 Tm (DN-GCERT-GOLD GCERT ER Dental Benefit Summary) Tj ET BT /F3 9 Tf 1 0 0 1 375.73 23.48 Tm (200 Park Ave., New York, NY 10166) Tj ET BT /F3 9 Tf 1 0 0 1 344.57 13.13 Tm ( 2023 MetLife Services and Solutions, LLC) Tj ET BT /F3 9 Tf 1 0 0 1 403.21 2.78 Tm (L0623032885[exp0625][xNM]) Tj ET Q q Q q 1 0 0 1 50.4 43.87 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 716.23 Tm (33.) Tj ET BT /F3 9 Tf 1 0 0 1 18 716.23 Tm (Appliances or treatment for bruxism \(grinding teeth\), including but not limited to occlusal guards and night guards.) Tj ET BT /F3 5.4 Tf 1 0 0 1 469.24 718.93 Tm (1) Tj ET BT /F3 9 Tf 1 0 0 1 0 705.73 Tm (34.) Tj ET BT /F3 9 Tf 1 0 0 1 18 705.73 Tm (Diagnosis and treatment of temporomandibular joint \() Tj ET BT /F16 9 Tf 1 0 0 1 230.11 705.73 Tm (TMJ) Tj ET BT /F3 9 Tf 1 0 0 1 244.46 705.73 Tm (\) disorders. This exclusion does not apply to residents of Minnesota.) Tj ET BT /F3 5.4 Tf 1 0 0 1 515.6 708.43 Tm (1) Tj ET BT /F3 9 Tf 1 0 0 1 0 695.38 Tm (35.) Tj ET BT /F3 9 Tf 1 0 0 1 18 695.38 Tm (Repair or replacement of an orthodontic device.) Tj ET BT /F3 5.4 Tf 1 0 0 1 207.61 698.08 Tm (1) Tj ET BT /F3 9 Tf 1 0 0 1 0 685.04 Tm (36.) Tj ET BT /F3 9 Tf 1 0 0 1 18 685.04 Tm (Duplicate prosthetic devices or appliances.) Tj ET BT /F3 9 Tf 1 0 0 1 0 674.69 Tm (37.) Tj ET BT /F3 9 Tf 1 0 0 1 18 674.69 Tm (Replacement of a lost or stolen appliance, Cast Restoration, or Denture.) Tj ET BT /F3 9 Tf 1 0 0 1 0 664.34 Tm (38.) Tj ET BT /F3 9 Tf 1 0 0 1 18 664.34 Tm (Intra and extraoral photographic images.) Tj ET BT /F3 9 Tf 1 0 0 1 0 653.99 Tm (39.) Tj ET BT /F3 9 Tf 1 0 0 1 18 653.99 Tm (Services or supplies furnished as a result of a referral prohibited by Section 1-302 of the Maryland Health Occupations Article.) Tj ET BT /F3 9 Tf 1 0 0 1 18 643.64 Tm (A prohibited referral is one in which a Health Care Practitioner refers You to a Health Care Entity in which the Health Care) Tj ET BT /F3 9 Tf 1 0 0 1 18 633.29 Tm (Practitioner or Health Care Practitioners immediate family or both own a Beneficial Interest or have a Compensation) Tj ET BT /F3 9 Tf 1 0 0 1 18 622.94 Tm (Agreement.) Tj ET BT /F3 9 Tf 1 0 0 1 69.53 622.94 Tm (For the purposes of this exclusion, the terms Referral, Health Care Practitioner , Health Care Entity,) Tj ET BT /F3 9 Tf 1 0 0 1 18 612.59 Tm (Beneficial Interest and Compensation Agreement have the same meaning as provided in Section 1-301 of the Maryland) Tj ET BT /F3 9 Tf 1 0 0 1 18 602.24 Tm (Health Occupations Article.) Tj ET BT /F4 9 Tf 1 0 0 1 18 591.89 Tm (This exclusion only applies) Tj ET BT /F4 9 Tf 1 0 0 1 137.53 591.89 Tm (f) Tj ET 2 J 0.945 w [] 0 d 0 0 0 RG 138 590.47 m 140.05 590.47 l S 1 w [] 0 d BT /F4 9 Tf 1 0 0 1 140.53 591.89 Tm (or Maryland Sitused Groups) Tj ET 0.945 w [] 0 d 141 590.47 m 260.57 590.47 l S 1 w [] 0 d BT /F3 6 Tf 1 0 0 1 2.78 573.29 Tm (1) Tj ET BT /F3 9 Tf 1 0 0 1 6.12 570.29 Tm (Some of these exclusions may not apply.) Tj ET BT /F3 9 Tf 1 0 0 1 174.7 570.29 Tm (Please see your Certificate of Insurance.) Tj ET Q q Q Q endstream endobj 18 0 obj <> >> >> endobj 19 0 obj <> stream q 0 0 612 792 re W n q 1 0 0 1 50.4 12.25 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 2.26 Tm (DN-GCERT-GOLD GCERT ER Dental Benefit Summary) Tj ET BT /F3 9 Tf 1 0 0 1 375.73 22.96 Tm (200 Park Ave., New York, NY 10166) Tj ET BT /F3 9 Tf 1 0 0 1 344.57 12.61 Tm ( 2023 MetLife Services and Solutions, LLC) Tj ET BT /F3 9 Tf 1 0 0 1 403.21 2.26 Tm (L0623032885[exp0625][xNM]) Tj ET Q q Q q 1 0 0 1 50.4 43.35 cm 0.90196 0.90196 0.90196 RG 0 J 13.8 w -5.4 705.75 m 526.7 705.75 l S 1 w 0 0 0 rg BT /F4 12 Tf 1 0 0 1 0 701.78 Tm (Common Questions Important Answers) Tj ET BT /F4 10 Tf 1 0 0 1 0 678.29 Tm (Who is a participating dentist?) Tj ET BT /F3 9 Tf 1 0 0 1 0 666.55 Tm (A participating, or network, dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in) Tj ET BT /F3 9 Tf 1 0 0 1 0 655.17 Tm (full for covered services provided to plan members, subject to any deductibles, copayments, cost sharing and benefit) Tj ET BT /F3 9 Tf 1 0 0 1 0 643.78 Tm (maximums. Negotiated fees typically range from 30-45% below the average fees charged in a dentists community for the) Tj ET BT /F3 9 Tf 1 0 0 1 0 632.4 Tm (same or substantially similar services.*) Tj ET BT /F3 9 Tf 1 0 0 1 0 609.63 Tm (In addition to the standard MetLife network, your employer may provide you with access to a select network of dental) Tj ET BT /F3 9 Tf 1 0 0 1 0 598.25 Tm (providers that may be unique to your employers dental program. When visiting these providers, you may receive a better) Tj ET BT /F3 9 Tf 1 0 0 1 0 586.86 Tm (benefit, have lower out-of-pocket costs and/or have access to care at facilities at your worksite. Please sign into MyBenefits for) Tj ET BT /F3 9 Tf 1 0 0 1 0 575.48 Tm (more details.) Tj ET BT /F3 6 Tf 1 0 0 1 0 555.43 Tm (* Based on internal analysis by MetLife. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments,) Tj ET BT /F3 6 Tf 1 0 0 1 0 547.84 Tm (deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of) Tj ET BT /F3 6 Tf 1 0 0 1 0 540.25 Tm (the plan, how often members visit a dentist and the cost of services rendered. Negotiated fees are subject to change.) Tj ET BT /F4 10 Tf 1 0 0 1 0 517.56 Tm (How do I find a participating dentist?) Tj ET BT /F3 9 Tf 1 0 0 1 0 506.97 Tm (There are thousands of general dentists and specialists to choose from nationwide) Tj ET BT /F3 9 Tf 1 0 0 1 333.19 506.97 Tm (--so you are sure to find one that meets your) Tj ET BT /F3 9 Tf 1 0 0 1 0 496.62 Tm (needs.) Tj ET BT /F3 9 Tf 1 0 0 1 32.02 496.62 Tm (You can receive a list of these participating dentists online at www.metlife.com/dental or call 1-800-275-4638 to have a list) Tj ET BT /F3 9 Tf 1 0 0 1 0 486.27 Tm (faxed or mailed to you.) Tj ET BT /F4 10 Tf 1 0 0 1 0 464.69 Tm (What services are covered by my plan?) Tj ET BT /F3 9 Tf 1 0 0 1 0 454.1 Tm (Please see your Certificate of Insurance for a list of covered services.) Tj ET BT /F4 10 Tf 1 0 0 1 0 433.64 Tm (May I choose a non-participating dentist?) Tj ET BT /F3 9 Tf 1 0 0 1 0 423.05 Tm (Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating \(out-of-network\) dentist,) Tj ET BT /F3 9 Tf 1 0 0 1 0 412.7 Tm (your out-of-pocket costs may be greater than your out-of-pocket costs when visiting an in-network dentist.) Tj ET BT /F4 10 Tf 1 0 0 1 0 389.95 Tm (Can my dentist apply for participation in the network?) Tj ET BT /F3 9 Tf 1 0 0 1 0 378.2 Tm (Yes. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your) Tj ET BT /F3 9 Tf 1 0 0 1 0 366.82 Tm (dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use) Tj ET BT /F3 9 Tf 1 0 0 1 0 355.43 Tm (by dental professionals only.) Tj ET BT /F3 6 Tf 1 0 0 1 0 336.42 Tm (* Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Tj ET BT /F4 10 Tf 1 0 0 1 0 313.73 Tm (How are claims processed?) Tj ET BT /F3 9 Tf 1 0 0 1 0 303.14 Tm (Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even) Tj ET BT /F3 9 Tf 1 0 0 1 0 292.79 Tm (receive email alerts when a claim has been processed. If you need a claim form, visit) Tj ET BT /F3 9 Tf 1 0 0 1 340.15 292.79 Tm (www.metlife.com/dental) Tj ET BT /F3 9 Tf 1 0 0 1 435.19 292.79 Tm ( or request one by) Tj ET BT /F3 9 Tf 1 0 0 1 0 282.44 Tm (calling 1-800-275-4638.) Tj ET BT /F4 10 Tf 1 0 0 1 0 259.71 Tm (Can I get an estimate of what my out-of-pocket expenses will be before receiving a service?) Tj ET BT /F3 9 Tf 1 0 0 1 0 249.12 Tm (Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and) Tj ET BT /F3 9 Tf 1 0 0 1 0 238.77 Tm (requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request) Tj ET BT /F3 9 Tf 1 0 0 1 0 228.42 Tm (a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com) Tj ET BT /F3 9 Tf 1 0 0 1 0 218.07 Tm (or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office.) Tj ET BT /F3 9 Tf 1 0 0 1 0 207.72 Tm (Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.) Tj ET BT /F4 10 Tf 1 0 0 1 0 186.12 Tm (Can MetLife help me find a dentist outside of the U.S. if I am traveling?) Tj ET BT /F3 9 Tf 1 0 0 1 0 174.37 Tm (Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970) Tj ET BT /F3 9 Tf 1 0 0 1 0 164.02 Tm (\(collect\) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your) Tj ET BT /F3 9 Tf 1 0 0 1 0 153.68 Tm (out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim.) Tj ET BT /F4 6 Tf 1 0 0 1 0 138.45 Tm (*) Tj ET BT /F3 6 Tf 1 0 0 1 2.34 138.45 Tm (International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. \(AXA Assistance\). AXA Assistance provides dental referral services only.) Tj ET BT /F3 6 Tf 1 0 0 1 451.53 138.45 Tm (AXA Assistance is not) Tj ET BT /F3 6 Tf 1 0 0 1 0 131.55 Tm (affiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife. Referral services are not available in all locations.) Tj ET BT /F3 6 Tf 1 0 0 1 0 124.65 Tm (** Refer to your Certificate of Insurance for your out-of-network dental coverage.) Tj ET BT /F4 10 Tf 1 0 0 1 0 102.66 Tm (How does MetLife coordinate benefits with other insurance plans?) Tj ET BT /F3 9 Tf 1 0 0 1 0 90.91 Tm (Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by) Tj ET BT /F3 9 Tf 1 0 0 1 0 79.53 Tm (more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental) Tj ET BT /F3 9 Tf 1 0 0 1 0 68.15 Tm (benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. If the) Tj ET BT /F3 9 Tf 1 0 0 1 0 56.76 Tm (MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after) Tj ET BT /F3 9 Tf 1 0 0 1 0 45.38 Tm (benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the) Tj ET BT /F3 9 Tf 1 0 0 1 0 33.99 Tm (benefits paid under the primary plan.) Tj ET BT /F4 10 Tf 1 0 0 1 0 10.23 Tm (Do I need an ID card?) Tj ET Q q Q Q endstream endobj 20 0 obj <> >> >> endobj 21 0 obj <> stream q 0 0 612 792 re W n q 1 0 0 1 50.4 12.25 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 2.26 Tm (DN-GCERT-GOLD GCERT ER Dental Benefit Summary) Tj ET BT /F3 9 Tf 1 0 0 1 375.73 22.96 Tm (200 Park Ave., New York, NY 10166) Tj ET BT /F3 9 Tf 1 0 0 1 344.57 12.61 Tm ( 2023 MetLife Services and Solutions, LLC) Tj ET BT /F3 9 Tf 1 0 0 1 403.21 2.26 Tm (L0623032885[exp0625][xNM]) Tj ET Q q Q q 1 0 0 1 50.4 43.35 cm 0 0 0 rg BT /F3 9 Tf 1 0 0 1 0 704.5 Tm (No, You do not need to present an ID card to confirm that you are eligible.) Tj ET BT /F3 9 Tf 1 0 0 1 299.18 704.5 Tm (You should notify your dentist that you are enrolled) Tj ET BT /F3 9 Tf 1 0 0 1 0 693.11 Tm (in a MetLife Dental Plan.) Tj ET BT /F3 9 Tf 1 0 0 1 103.06 693.11 Tm (Your dentist can easily verify information about your coverage through a toll-free automated) Tj ET BT /F3 9 Tf 1 0 0 1 0 681.73 Tm (Computer Voice Response system.) Tj ET BT /F4 10 Tf 1 0 0 1 0 658.06 Tm (Do my dependents have to visit the same dentist that I select?) Tj ET BT /F3 9 Tf 1 0 0 1 0 647.46 Tm (No. You and your dependents each have the freedom to choose any dentist.) Tj ET Q q Q Q endstream endobj 22 0 obj <> /XObject <> >> >> endobj 23 0 obj <> stream JFIF``ZExifMM*JQQQC    $.' 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