Student Insurance Plans

Metlife Exclusions and DIsclaimers

Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force.  You may be financially responsible for copayments, deductibles, or any other amounts in excess of those MetLife is required to pay for covered services as described in your dental certificate and/or policy.  Ask your MetLife representative for costs and complete details.

Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claims and network administration services are provided through: Davis Vision, Inc. (“Davis Vision”), a New York corporation; Superior Vision Services, Inc. (“Superior Vision”), a Delaware corporation; or Vision Service Plan (VSP), Rancho Cordova, CA. Davis Vision and Superior Vision are part of the MetLife family of companies. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.

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Dental PDP Plan Exclusions

  • Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature.

  • Services for which a covered person would not be required to pay in the absence of dental insurance.
  • Services or supplies received by a covered person before the insurance starts for that person.
  • Services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for scaling or polishing of teeth or fluoride treatment.
  • Services which are primarily cosmetic unless such service is:  required for reconstructive surgery which is incidental to or follows surgery which results from a trauma, an infection or other disease of the involved part; or required for reconstructive surgery because if a congenital disease or anomaly of a Child which has resulted in a functional defect; or (For residents of Texas) required for the treatment or correction of a congenital defect of a newborn child).
  • Services or appliances which restore or alter occlusion or vertical dimension.
  • Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease.
  • Restorations or appliances used for the purpose of periodontal splinting.
  • Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;
  • Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss
  • Initial installation of a Denture to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
  • Decoration or inscription of any tooth, device, appliance, crown or other dental work.
  • Missed appointments
  • Services covered under any workers’ compensation or occupational disease law.
  • Services covered under any university liability law.
  • Services for which the university of the person receiving such services is not required to pay.
  • Services or supplies furnished as a result of a referral prohibited by Section 1-302 of the Maryland Health Occupations Article.  A prohibited referral is one in which a Health Care Practitioner refers You to a Health Care Entity in which the Health Care Practitioner or Health Care Practitioner’s immediate family or both own a Beneficial Interest or have a Compensation Agreement.  For the purposes of this exclusion, the terms “Referral”, “Health Care Practitioner”, “Health Care Entity”, “Beneficial Interest” and Compensation Agreement have the same meaning as provided in Section 1-301 of the Maryland Health Occupations Article.
  • Services covered under other coverage provided by the Policyholder.
  • Temporary or provisional restorations.
  • Temporary or provisional appliances.
  • Prescription drugs.
  • Services for which the submitted documentation indicates a poor prognosis.
  • Services, to the extent such services, or benefits for such services, are available under a government plan.  This exclusion will apply whether or not the person receiving the services is enrolled for the government plan.  We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first.
  • The following when charged by the dentist on a separate basis – Claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
  • Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing and biting of food.
  • Caries susceptibility tests.
  • Precision attachments associated with fixed and removable prostheses.
  • Adjustment of a denture made within 6 months after installation by the same dentist who installed it.
  • Duplicate prosthetic devices or appliances.
  • Replacement of a lost or stolen appliance, cast restoration or denture.
  • Intra and extraoral photographic images.
  • Fixed and removable appliances for correction of harmful habits.
  • Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards.
  • Treatment of temporomandibular joint disorder. This exclusion does not apply to residents of Minnesota.
  • Implants supported prosthetics to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.

Vision Plan Exclusions

  • Services and/or materials not specifically included in the Summary of Benefits as covered Plan Benefits.
  • Any portion of a change in excess of the Maximum Benefits Allowance or reimbursement indicated in the Summary of Benefits.
  • Plano lenses (lenses with refractive correction of less than #50 diopter).
  • Two pairs of glasses instead of bifocals.
  • Replacement of lenses, frames, and/or contact lenses furnished under this Plan which are lost, stolen or damaged, except at the normal intervals when Plan Benefits are Otherwise available.
  • Orthoptics or vision training and any associated supplemental testing.
  • Medical or surgical treatment of the eyes
  • Prescription and non-prescriptions medications.
  • Contact lens insurance policies or service agreements.
  • Refitting of contact lenses after the initial (90-day) fitting period.
  • Contact lens modification, polishing or cleaning.
  • Local, state and/or federal taxes, except where MetLife is required by law to pay.
  • Any eye examination or any corrective eyewear where MetLife is required as a condition of employment.
  • Services and supplies received by YOU or YOUR Dependent before the Vision Insurance starts for that person.
  • Missed appointments.
  • Services or materials resulting from or in the course of a Covered Perso’s regular occupation or pay or profit for which the Covered Person is entitled to benefits under any Worker’s Compensation Law, University Liability Law or similar law. You must promptly claim and notify the Company of all such benefits.
  • Services: (a) for which the university of the person receiving such service is not required to pay: or (b) received at a facility maintained by the University, labor union, mutual benefit association, or VA hospital.
  • Services or materials received as a result of disease, defect, or injury due to war or an act of war (declared or undeclared), taking part in a riot or insurrection, or committing or attempt it to commit a felony.
  • Services and materials obtained while outside the United States, except for emergency vision care.
  • Services, procedures, or materials for which a charge would not have been made in the absence of the insurance. 

Contact Us

The enrollment process is administered by Benefit Partners Technology. Call or email our dedicated Student Support Team with questions. You can reach us toll-free Monday through Friday.

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