| Enrollment |
| 1. |
What do I need to do if I want to change my enrollment option?
During the 2009 Open Season; You may enroll in a plan, change your coverage option or cancel coverage. You can go to www.BENEFEDS.com to make these enrollment changes.
|
| 2. |
If I am currently enrolled, do I need to re-enroll?
No. If you want to continue your current enrollment, do nothing. You will receive a MetLife confirmation letter in January 2009 confirming your continued enrollment.
|
| 3. |
What do I need to do if I want to add a family member to my coverage?
You can add a family member to your current plan, outside of open season, if you have a Qualifying Life Event. For specific details, please refer to the 2009 MetLife FEDVIP Brochure or visit www.BENEFEDS.com.
|
| Plan Info |
| 4. |
How does the Federal Dental plan work?
With the MetLife Federal Dental Plan, you receive a wide range of benefits whether or not you and/or each eligible dependent visit an in-network dentist (PDP Dentist), plus referrals are not necessary for specialty care. But, when you visit an in-network dentist (PDP Dentist), you have the opportunity to make the most of your benefit plan because your out-of-pocket expenses may be lower.
|
| 5. |
Is my SSN required to receive Dental services?
No. MetLife does not require your Social Security Number to submit claim payments, use the MetLife call center or access the MetLife website. When seeing your dentist, present your ID card which has your MetLife unique ID number. MetLife does not require your SSN from your dentist to prove eligibility or to submit claims. The dentist may request your SSN for their own administrative recordkeeping needs.
|
| 6. |
What is an in-network dentist (PDP Dentist) and how do I find one?
An in-network dentist is a general dentist or specialist who participates in MetLife's Preferred Dentist Program (PDP Dentist) and has agreed to accept a negotiated fee for services rendered to eligible plan members. This negotiated* fee is typically 10% to 35% below the average fee charged by dentists for the same services in a given geographical area. There are over 113,000 in-network PDP dentist locations nationwide, including over 26,000 specialists. Access a list of MetLife's in-network dentists now or call 1-888-865-6854/TDD 1-888-260-5376. These lists include name, address, specialties, languages spoken, telephone numbers, and maps/driving directions.
Continued participation of any specific provider cannot be guaranteed. Thus, you should make coverage decisions based on the plan benefits, not based on a specific provider. When you call for an appointment, please remember to verify that the selected provider is currently in the MetLife PDP Network.
*Occasionally, there may be a service for which the dentist's fee is the same or less than the MetLife negotiated fee for that service.
|
| 7. |
What if my dentist is not in MetLife's network?
We encourage you to consider using a MetLife in-network dentist (PDP Dentist) to help maximize the value of your plan. Of course, you can visit any dentist and still receive some benefits under your plan although your out-of-pocket expenses may be higher. If your current dentist does not participate in MetLife's network (PDP Dentist) and you'd like to encourage him or her to participate, tell your dentist to visit www.metdental.com, or call 1-877-MET-DDS9. Note that this website and phone number are specifically for dentists and not accessible to employees/annuitants.
|
| 8. |
Do my dependents have to visit the same dentist that I select?
No. You and your dependents each have the freedom to choose any dentist, in or out-of-network, at any time.
|
| 9. |
What services are covered by the MetLife Federal Dental Plan?
The services covered by the MetLife Federal Dental Plan are those defined under your group dental benefits plan located in the Plan section of this site. Please refer to your MetLife FEDVIP Brochure for details concerning coverage, exclusions, limitations and waiting periods. In-network discounts extend to certain non-covered services, such as cosmetic dentistry and extra cleanings, providing additional out-of-pocket savings for participants should they utilize a PDP dentist for such non-covered services.
|
| 10. |
May I choose an out-of-network dentist?
Yes. You are always free to select the dentist of your choice. However, if you choose a dentist who does not participate in MetLife's network (PDP), your out-of-pocket expenses may be higher, since you will be responsible for any difference between the dentist's fee and your plan's payment. Also, if you choose a non-participating dentist, a deductible will apply for most covered services. If you receive services from an in-network dentist (PDP Dentist), you are only responsible for the difference between the PDP negotiated fee and your plan's payment.
|
| 11. |
What is a negotiated fee*?
A negotiated fee refers to the maximum charge for a service that an in-network dentist (PDP Dentist) may charge to MetLife Federal Dental Plan participants. These fees are typically 10% to 35% below the average fee charged by a dentist for the same services in your area. Your plan may reimburse you for all or part of this fee. When you use an in-network dentist (PDP Dentist), you are responsible only for the difference between MetLife's benefits payment amount and the negotiated PDP fee for the services rendered.
*Occasionally, there may be a service for which the dentist's fee is the same or less than the MetLife negotiated fee for that service.
|
| 12. |
Can an in-network dentist (PDP Dentist) charge me his or her "usual" fee when a dental procedure is not covered under my dental plan?
An in-network dentist (PDP Dentist) should not bill you for amounts that are in excess of the PDP fees that your dentist has agreed to accept as payment for services. This rule applies even if services are not covered under your specific dental plan. You should always verify that your dentist is a MetLife in-network dentist (PDP Dentist) at the time of your appointment. To search for an in-network dentist (PDP Dentist) near your job or home (including a map and driving directions), use the Find a Dentist function on this site or call a MetLife Customer Service Specialist - 1-888-865-6854/TDD 1-888-260-5376.
|
| 13. |
Why aren't there any in-network dentists (PDP Dentist) in my area?
Not all dental practices join a dental network. This may be due to their unique circumstances or a philosophical difference. However, remember you are always free to select a dentist of your choice. And if you are located in an underserved area, you are eligible to receive in-network benefits from whatever dentist you feel most comfortable with. Please contact MetLife at 1-888-865-6854/TDD 1-888-260-5376 to see if your area is an underserved area.
The MetLife provider network varies by area. MetLife cannot guarantee the availability of every type of specialist in all areas. If you require the services of a specialist, and one is not available in your area, please contact MetLife at 1-888-865-6854/TDD 1-888-260-5376.
|
| 14. |
Are my benefits changing in 2009?
Yes, but there are no significant plan changes in 2009.
Effective 1/1/09 MetLife will offer:
- Implants and related services - Implant services, incurred in 2009, are now considered a covered expense subject to plan guidelines. Please refer to your 2009 FEDVIP brochure for a complete list of implant covered services.
- Third Party Appeal Review - The charge amount for which you may be eligible for a third party review has been reduced from $1,000 to $300.
|
| Plan Design |
| 15. |
What services are covered by the MetLife Federal Dental Plan?
The services covered by the MetLife Federal Dental Plan are those defined under your group dental benefits plan located in the Plan section of this site. Please refer to your MetLife FEDVIP Brochure for details concerning coverage, exclusions, limitations and waiting periods. In-network discounts extend to certain non-covered services, such as cosmetic dentistry and extra cleanings, providing additional out-of-pocket savings for participants should they utilize a PDP dentist for such non-covered services.
|
| 16. |
How do I understand my Explanation of Benefits (EOB) Statement?
An Explanation of Benefits (EOB) Statement is a summary of your processed claim or pretreatment estimate, including services rendered, costs, and benefits paid.
|
| 17. |
Does MetLife coordinate benefits with other dental insurance plans?
Yes, in certain circumstances.
- If you are enrolled in an FEHB plan that provides dental benefits, the FEHB plan is primary and the FEDVIP Plan is secondary.
- If you are covered by a non-FEHB group plan that offers dental benefits and the FEDVIP Plan, the determination of primary payor is based on standard COB rules. Please see the MetLife FEDVIP Brochure for further information.
For specific details, please refer to the 2009 MetLife FEDVIP Brochure and/or contact MetLife at 1-888-865-6854/ TDD 1-888-260-5376.
|
| 18. |
What if I have limited dental benefits available through my Federal Employee Health Benefit (FEHB) Plan? How does this affect my MetLife dental claims?
Federal Law requires that benefits for all dental procedures under the MetLife Federal Dental Plan must be coordinated with your Federal Employees Health Benefits (FEHB) Plan, if the FEHB Plan provides dental benefits. The FEHB Plan will be the first/primary payor of any benefit payments. The MetLife Federal Dental Plan is secondary to the FEHB Plan. You or your dentist should first submit your claim to your FEHB carrier. Once the FEHB carrier has made a benefit determination, you or your dentist should return this EOB (Explanation of Benefits) along with a copy of the FEHB Plan's EOB to the address listed below.
Submit Completed Claims To:
MetLife Dental
P.O. Box 981282
El Paso, TX 79998-1282
For quicker, more accurate claim processing be sure to:
- Advise your dentist if you are covered by/enrolled in an FEHB plan.
- Provide your dentist your FEHB Plan Name and Plan Code (in most instances this information can be found on your FEHB ID Card).
- Inform your dentist if your FEHB plan has dental benefits coverage and provide them a copy of your FEHB Plan Brochure.
|
| 19. |
How will Orthodontic benefits be calculated?
Benefits for orthodontic treatment will be payable at 50% up to a lifetime maximum which varies, depending on the Plan option under which you have coverage. Orthodontic benefits are subject to a 24-month waiting period* which begins on the effective date of coverage.
*The person receiving orthodontic services must be covered under the same plan option for the entire waiting period. Dependent children are covered until the end of the month of their 19th birthday.
|
| 20. |
What is MetLife Claim Review (MCR) and how does it work?
MetLife Claim Review is conducted by licensed Dentist Consultants who review the clinical documentation submitted by your treating dentist. These Dentist Consultants review this material checking for dental necessity for certain procedures such as crowns, bridges, onlays, implants, periodontal treatments, as well as other services. The Dentist Consultants may also recommend that an alternate benefit be applied to a service in accordance with the terms of the plan. It is very important that these types of dental services are pre-estimated so that you and your dentist are aware of benefits before services are provided.
|
| 21. |
What is an Alternate Benefit and how does it work?
If MetLife determines that a less costly covered service other than the covered service the dentist performed, could have been performed to treat a dental condition, we will pay benefits based upon the less costly service if such services would produce a professionally acceptable result under generally accepted dental standards.
For example, when an amalgam filling and a composite filling are both professionally acceptable methods for filling a molar, or when a partial denture and fixed bridgework are both professionally acceptable methods for replacing multiple missing teeth in an arch we may base our benefit determination upon the amalgam filling or partial denture which is the less costly service.
If we pay benefits based upon a less costly service in accordance with this section the Dentist may charge you or your dependent for the difference between the service that was performed and the less costly service. This is the case even if the service is performed by an in-network dentist.
|
| 22. |
How long will it take to process my Dental claim?
The time it takes to process a claim depends on the type of service performed. Most claims flow through our system quickly and efficiently, with 95% being processed within 10 business days. If additional information is needed for a claim, it may take longer.
|
| 23. |
Who do I contact if I have any additional questions about dental coverage from MetLife?
MetLife is committed to making sure you have all the information you need to make the right decision for you and your family. If you'd like to know more about the MetLife Federal Dental Plan call us at 1-888-865-6854/TDD 1-888-260-5376. Customer service representatives are available Monday through Friday, 8am EST to 11pm EST.
|
| 24. |
How do I stop receiving paper Explanation of Benefits (EOB) Statements at my home?
Sign into MyBenefits, click on the subscription button located at the top of the page, then select "Go Paperless".
|
| 25. |
If I elect to stop receiving paper Explanation of Benefits (EOB) Statements at my home, how do I view my Explanation of Benefits (EOB) Statements? And can I still print them?
Once you turn off your paper Explanation of Benefits (EOB) Statements, you will receive email alerts to notify you when a Dental claim is processed. You can view and print your Dental Explanation of Benefits (EOB) Statements from MyBenefits. Your Dental Explanation of Benefits (EOB) Statement history will remain online for a minimum of two years plus the current year.
|
| General Questions |
| 26. |
Do I need an ID Card?
No, you do not need to present an ID card to prove coverage or confirm that you are eligible for the MetLife Federal Dental Plan. However, for your convenience, a dental ID card will be mailed to you after you've enrolled. This card is not a guarantee of coverage or eligibility but does highlight toll free numbers and URLs used to access benefit information about the MetLife Federal Dental Plan. To access your online ID card, sign into MyBenefits and select Get ID card from the left navigation bar.
|
| 27. |
Can I find out how much services will cost and what will be covered prior to treatment?
MetLife recommends that you have your dentist submit a request for a pretreatment estimate for services in excess of $300. This often applies to services such as crowns, bridges, inlays, and periodontics. A pretreatment estimate of what services your plan will pay and at what payment level will be sent to you and your dentist. In addition, you can visit the Go2Dental area of MyBenefits to view MetLife PDP procedure costs in a zip code area.
|
| 28. |
How do I file a claim?
To avoid a delay in the payment of your claim we recommend your dentist submit your claims directly to MetLife. Download a claim form now.
Approximately 70% of Federal employees and annuitants have some dental benefit coverage available under Federal Employee Health Benefits (FEHB) Plan. Federal Law requires that benefits for all dental procedures under the MetLife Federal Dental Plan must be coordinated with the FEHB Plan. The FEHB Plan will be the first/primary payor of any benefit payments. The MetLife Federal Dental Plan is secondary to the FEHB Plan.
For quicker, more accurate claim processing be sure to:
- Advise your dentist if you are covered by/enrolled in a FEHB plan.
- Provide your dentist your FEHB Plan Name and Plan Code (in most instances this information can be found on your FEHB ID Card).
- Inform your dentist if your FEHB plan has dental benefits coverage and provide them a copy of your FEHB Plan Brochure.
Submit Completed Claims To:
MetLife Dental
P.O. Box 981282
El Paso, TX 79998-1282
|
