Student Insurance Plans

Metlife Exclusions and DIsclaimers

Dental Disclaimers:

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. 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. Please contact HUB Benefits at 1-877-247-8817 for costs and complete details.

Vision Disclaimers:

Important: If you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans. Each plan may require you to follow its rules or use specific doctors and hospitals, and it may be impossible to comply with both plans at the same time. Before you enroll in this plan, read all of the rules very carefully and compare them with the rules of any other plan that covers you or your family.

Savings from enrolling in a MetLife Vision Plan will depend on various factors, including plan premiums, number of visits to an eye care professional by your family per year and the cost of services and materials received.  Be sure to review the Schedule of Benefits for your plan’s specific benefits and other important details.

MetLife 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. Davis Vision is part of the MetLife family of companies.

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.

Dental Exclusions:

We will not pay Dental Insurance benefits for charges incurred for:

  1. services which are not Dentally Necessary, or those which do not meet generally accepted standards of care for treating the particular dental condition;
  2. services for which You would not be required to pay in the absence of Dental Insurance;
  3. services or supplies received by You or Your Dependent before the Dental Insurance starts for that person;
  4. 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 and polishing of teeth; or
    • fluoride treatments;
  5. services which are primarily cosmetic, (For residents of Texas, see notice page section);
  6. services or appliances which restore or alter occlusion or vertical dimension;
  7. restoration of tooth structure damaged by attrition, abrasion or erosion, unless caused by disease;
  8. restorations or appliances used for the purpose of periodontal splinting;
  9. counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;
  10. personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss;
  11. decoration or inscription of any tooth, device, appliance, crown or other dental work;
  12. missed appointments;
  13. services:
    • covered under any workers’ compensation or occupational disease law;
    • covered under any employer liability law;
    • for which the Employer of the person receiving such services is required to pay; or
    • received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital;
  14. services covered under other coverage provided by the Policyholder;
  15. biopsies of hard or soft oral tissue;
  16. temporary or provisional restorations;
  17. temporary or provisional appliances;
  18. prescription drugs;
  19. services for which the submitted documentation indicates a poor prognosis;
  20. 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;
  21. dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food;
  22. caries susceptibility tests;
  23. modification of removable prosthodontic and other removable prosthetic services;
  24. fixed and removable appliances for correction of harmful habits;
  25. appliances or treatment for bruxism (grinding teeth);
  26. initial installation of a Denture or implant or implant supported prosthetic to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing teeth;
  27. precision attachments associated with fixed and removable prostheses, except when the precision attachment is related to implant prosthetics;
  28. adjustment of a Denture made within 6 months after installation by the same Dentist who installed it;
  29. duplicate prosthetic devices or appliances;
  30. replacement of a lost or stolen appliance, Cast Restoration or Denture;
  31. orthodontic services or appliances;
  32. repair or replacement of an orthodontic device;
  33. diagnosis and treatment of temporomandibular joint disorders and cone beam imaging associated with the treatment of temporomandibular joint disorders;
  34. intra and extraoral photographic images.

Vision Exclusions:

We will not pay Vision Insurance benefits for charges incurred for:

  1. Services and/or materials not specifically included in the SCHEDULE OF BENEFITS as covered Plan
  2. Any portion of a charge in excess of the Maximum Benefit Allowance or reimbursement indicated in the SCHEDULE OF BENEFITS.
  3. Plano lenses (lenses with refractive correction of less than ± .50 diopter).
  4. Two pairs of glasses instead of
  5. 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.
  6. Orthoptics or vision training and any associated supplemental
  7. Medical or surgical treatment of the
  8. Prescription or non-prescription
  9. Contact lens insurance policies and service
  10. Refitting of contact lenses after the initial (90-day) fitting
  11. Contact lens modification, polishing and
  12. Any eye examination or any corrective eyewear required as a condition of
  13. Services or supplies received by You or Your Dependent before the Vision Insurance starts for that
  14. Missed
  15. Services or materials resulting from or in the course of a Covered Person’s regular occupation for pay or profit for which the Covered Person is entitled to benefits under any Workers’ Compensation Law, Employer’s Liability Law or similar law. You must promptly claim and notify the Company of all such
  16. Local, state and/or federal taxes, except where MetLife is required by law to
  17. Services:
    • for which the employer of the person receiving such services is required to pay by law; or
    • received at a facility maintained by the Employer, labor union, mutual benefit association, or VA
  18. 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 attempting to commit a
  19. Services and materials obtained while outside the United States, except for emergency vision
  20. Services, procedures, or materials for which a charge would not have been made in the absence of 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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