Frequently Asked Questions

• If you enrolled during Open Season your coverage will begin on January 1.

• If you are a new hire, you can enroll 60 days after you become eligible. Your enrollment will be effective date the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment.

No. Your coverage will automatically renew. You will receive a confirmation letter from MetLife in January.

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 127,000 in-network PDP dentist locations nationwide, including over 31,000 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.

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.

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.

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

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.

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.

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.

• 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 127,000 in-network PDP dentist locations nationwide, including over 31,000 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.

• An Out-of Network Provider is a dental provider who does not belong to the MetLife Network. 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. 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

Access a list of MetLife's in-network dentists now or call 1-888-865-6854/TDD 1-888-260-5376 to find a listing of dentists in your area. These lists include name, address, specialties, languages spoken, telephone numbers, and maps/driving directions.

No, but you may view/ download the 2010 MetLife FEDVIP Brochure through the home page of this website.

No. There is no discounted premium rate when enrolled in both the Life and Dental Plan.

Frequency limit “1 in 60 months” means 1 tooth every 60 months .

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 2010 MetLife FEDVIP Brochure and/or contact MetLife at 1-888-865-6854/ TDD 1-888-260-5376.

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.

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 dependent child's effective date of coverage. Please refer to the 2010 MetLife FEDVIP Brochure for orthodontia details and prorating examples.

*Dependent children receiving orthodontic services must be covered under the same plan option for the entire waiting period. Orthodontia services are limited to dependent children up to age 19."

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.

• Standard Option — Covers Basic, Intermediate and Major Services with a $1,200 In-Network Annual Maximum. View 2010 Plan Benefits.

• High Option — Covers Basic, Intermediate and Major Services with a $3,000 In-Network Annual Maximum. View 2010 Plan Benefits.

Please refer to the “Rates” tab at the top of this page.

Yes. There is a 24 month waiting period for orthodontic services, Orthodontia services are limited to dependent children only up to age 19.Dependent children receiving orthodontic services must be covered under the same plan option for the entire 24 month waiting period.

No. Orthodontic care is only available for dependent children under age 19.

Yes. Crowns are covered under the FEDVIP plan. Please review the 2010 MetLife FEDVIP Brochure for details.

Yes. There are certain procedure with different age limitations. Please refer to the 2010 MetLife FEDVIP Brochure for details.

Yes. Implant Services incurred in 2009, will now be considered a covered expense subject to plan guidelines. Please refer to your  2010 MetLife FEDVIP Brochure for a complete listing of covered implant services and pre-certification provisions.

Yes. Invisalign braces are covered. However, In-Network Rates may not apply.

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

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 99% being processed within 10 business days. If additional information is needed for a claim, it may take longer.

Rates are based on your home address. Please refer to the “Rates” tab at the top of this page. From the “Rates” area enter your home zip code to find your applicable premium rate.