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Frequently Asked Questions

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General Questions

What is FEDVIP? Collapsed Expanded

The Federal Employees Dental and Vision Insurance Program (FEDVIP) is a voluntary, enrollee-pay-all dental and vision program that offers eligible participants a choice between 10 dental and four vision carriers, with some plans offering both high and standard options. Enrollee-pay-all means there are no government contributions toward premiums.

What is BENEFEDS? Collapsed Expanded

BENEFEDS is the government-authorized and U.S. Office of Personnel Management (OPM)-sponsored enrollment portal that you'll use to enroll in FEDVIP coverage. BENEFEDS also manages the billing systems and customer service functions necessary for the collection of FEDVIP premiums.

What is open season? Collapsed Expanded

The Federal Benefits Open Season (or open season) is your annual opportunity to enroll in, change, or cancel a FEDVIP dental and/or vision plan. Each year, it runs from the Monday of the second full work week in November through the Monday of the second full work week in December.

When did Open Season end? Collapsed Expanded

The 2018 Federal Benefits Open Season ended on December 10, 2018 for coverage effective January 1, 2019. Open Season is your annual opportunity to enroll in or change your Federal Employees Dental and Vision Insurance Program (FEDVIP) coverage. Per FEDVIP regulations, belated enrollments were allowed from December 11, 2018 through March 10, 2019 which allowed participants to enroll in 2019 FEDVIP coverage if they were unable to during Open Season due to extenuating circumstances. FEDVIP regulations do not permit extending the belated enrollment timeframe past three months.

I missed Open Season. How can I enroll in FEDVIP now? Collapsed Expanded

You must now either be newly eligible or have experienced a FEDVIP Qualifying Life Event (QLE). You may visit BENEFEDS.com for more detail regarding enrollment in FEDVIP outside of Open Season.

If you are not newly eligible or you have not experienced a FEDVIP QLE, the next opportunity for you to enroll in FEDVIP dental coverage will be during the 2019 Federal Benefits Open Season with coverage effective January 1, 2020. Open Season begins the second Monday in November and runs through the second Monday in December each year.

How or where do I enroll? Collapsed Expanded

You'll enroll through the BENEFEDS enrollment portal.

 

What services are covered by the MetLife Federal Dental Plan? Collapsed Expanded

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 2019 MetLife FEDVIP Plan 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 an in-network dentist for such non-covered services.

What is an Explanation of Benefits (EOB) Statement? Collapsed Expanded

An Explanation of Benefits (EOB) Statement is a summary of your processed claim or pretreatment estimate, including services rendered, costs, and benefits paid.

How will Dependent Orthodontic benefits be calculated? Collapsed Expanded

Benefits for dependent orthodontic treatment will be payable at 50% (under the Standard Option) or 70% (under the High Option) up to a lifetime maximum which varies, depending on the plan option under which you have coverage. Dependent Orthodontic services are limited to children up to their maximum limiting age, which is age 22 for dependents of federal civilian employees and age 21 (23 if full-time student) for dependents of military retirees. Please refer to the 2019 MetLife FEDVIP Plan Brochure for dependent orthodontia details and prorating examples.

What is MetLife Claim Review (MCR) and how does it work? Collapsed Expanded

MetLife Claim Review is a review of certain types of dental claims that is conducted by licensed Dentist Consultants. The Dentist Consultants review the clinical information submitted by your treating dentist, and check for whether the services rendered, such as a crowns, bridges, onlays, implants, periodontal treatments, or other services, were dentally necessary. The Dentist Consultants may also recommend that an alternate benefit be applied to a service in accordance with the terms of the plan. We recommend that you get a pre-treatment estimate for the types of services listed above, so that both you and your dentist are aware of what benefits will be paid for the services.

What is an Alternate Benefit and how does it work? Collapsed Expanded

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.

How will Adult Orthodontic benefits be calculated? Collapsed Expanded

Benefits for adult orthodontic treatment will be payable at 50% (under the Standard Option) or 70% (under the High Option) up to a lifetime maximum which varies, depending on the plan option under which you have coverage. Please refer to the 2019 MetLife FEDVIP Plan Brochure for orthodontia details and prorating examples.

What is First Payor? Collapsed Expanded

If you have dental coverage through your Federal Employee Health Benefits (FEHB) plan and coverage under FEDVIP, your FEHB plan will be the first payor of any benefit payments. When services are rendered by a dentist who participates with both your FEHB and your FEDVIP plan, the the amount charged by your dentist will be the prevailing charge. You are responsible for the difference between the FEHB and FEDVIP benefit payments and the FEDVIP plan allowance. Please see the 2019 MetLife FEDVIP Plan Brochure for examples.

Why do you pay an alternate benefit for white composites when it is the only type of service my dentist will perform? Collapsed Expanded

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.

Do I have to pay to participate in the MetLife Dental Health ManagerSM? Collapsed Expanded

No. This is a value-added program for participants that is a part of your MetLife Group Dental Benefits plan.

What are the rates? Collapsed Expanded

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

Are Orthodontia benefits available for adults? Collapsed Expanded

Yes, we have Adult Orthodontia coverage in both Standard and High Plan Options.  Please refer to the 2019 MetLife FEDVIP Plan Brochure for orthodontia details and prorating examples.

Do you cover crowns? Collapsed Expanded

Yes. Crowns are covered under the FEDVIP plan. Please review the 2019 MetLife Federal Dental Plan Brochure for details.

Do different procedures have different age limitations? Collapsed Expanded

Yes. There are certain procedures with different age limitations. Please refer to the 2019 MetLife Federal Dental Plan Brochure for details.

Are implants covered under the plan? Collapsed Expanded

Yes. Implant Services are a covered expense subject to plan guidelines. Please refer to your 2019 MetLife Federal Dental Plan Brochure for a complete listing of covered implant services and pre-certification provisions. Prior to having implant services done, we recommend you submit a pre-certification and/ or pre-treatment estimate since an alternate benefit may apply.

Are Invisalign braces covered by the plan? Collapsed Expanded

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

Does the 2010 Healthcare Reform Act affect the dependant age for coverage under FEDVIP? Collapsed Expanded

No. Eligible family members include your spouse and unmarried dependent children under age 22 for dependents of federal civilian employees and age 21 (23 if full-time student) for dependents of military retirees.

How do I review my personal claim information? Collapsed Expanded

Please access/register for the MyBenefits site from the home page. MyBenefits allows you to manage your benefits more easily. You may view your claims and personal information.

Enrollment

How do I enroll myself for coverage? Collapsed Expanded

You can enroll yourself for coverage in the MetLife Federal Dental Plan via online or the phone. 
Online: 
- Visit www.benefeds.com- Choose Dental Coverage - Select MetLife 
Or call BENEFEDS at 1-877-888-FEDS (3337)

If I am currently enrolled in FEDVIP, do I need to re-enroll? Collapsed Expanded

No. If you want to continue your current enrollment, do nothing. You will receive a MetLife confirmation letter in January confirming your continued enrollment.

What do I need to do if I want to add a family member to my coverage? Collapsed Expanded

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 2019 MetLife FEDVIP Plan Brochure or visit www.BENEFEDS.com.

Plan Information

How does the Federal Dental plan work? Collapsed Expanded

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, plus referrals are not necessary for specialty care. However, when you visit an in-network dentist, your out-of-pocket expenses may be lower. If you choose an out-of-network dentist, 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 an out-of-network dentist, a deductible will apply for most covered services. If you receive services from an in-network dentist, you are only responsible for the difference between the negotiated fee and your plan's payment.

Is my SSN required to receive Dental services? Collapsed Expanded

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.

Do my dependents have to visit the same dentist that I select? Collapsed Expanded

No. You and your dependents each have the freedom to choose any dentist, in or out-of-network, at any time. However, if you choose an out-of-network dentist, your out-of-pocket expenses may be higher.

What services are covered by the MetLife Federal Dental Plan? Collapsed Expanded

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 2019 MetLife FEDVIP Plan 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 if they use an in-network dentist for such non-covered services.

What is the MetLife Dental Health ManagerSM? Collapsed Expanded

An online, easy to use, interactive program designed to help you understand your risk for oral disease and your current dental health status, with the goal of helping you improve your oral health. The MetLife Dental Health Manager is a proprietary program consisting of two primary components. The first is a report card that illustrates your risk and disease score — utilizing an interactive oral health risk assessment and data analysis derived from dental utilization (claim) data as well as systemic disease data — to help you understand and track changes in your dental risk and disease over time. The second component is the online MetLife Oral Health Library, which contains oral health educational articles and tools, designed to help you take a more active role in managing your oral health. The Library can also help you to ask informed questions about your benefits, dental care and risk for dental disease, and offers relevant information specific to your oral health needs.

MetLife Federal Dental participants can access this online tool via the MyBenefits website. Just complete the Oral Health Risk Assessment questionnaire (OHRA) to get access to education that is relevant to you and receive an action plan that may help you make more informed oral health decisions.

How do I review my personal claim information? Collapsed Expanded

Please access/register for the MyBenefits site from the home page. MyBenefits allows you to manage your benefits more easily. You may view your claims and personal information.

  • If you are enrolled in a Federal Employee Health Benefits (FEHB) plan that provides dental benefits, the FEHB plan is "First Payor" and the FEDVIP Plan is the secondary payor.
  • 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 coordination of benefits rules. For specific details, please refer to the 2019 MetLife FEDVIP Plan Brochure and/or contact MetLife at 1-888-865-6854 / TDD 1-888-260-5376.

What is the maximum allowable dental fee a MetLife in-network provider, who also has a contractual relationship with an FEHB carrier, can charge me for service? Collapsed Expanded

The MetLife contractual schedule amount will be considered the maximum allowable charge accepted for FEDVIP plan participants when dental benefits are coordinated with other "First Payor" Federal Employee Health Benefit (FEHB) plans. An in-network provider who also has a contractual relationship with a FEHB carrier cannot charge FEDVIP patients a dental service fee greater than the MetLife negotiated fee. If you have any questions, please contact us at 888-865-6854.

What is the effective date of my coverage? Collapsed Expanded
  • 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 the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment.

Do I need to re-enroll in FEDVIP during open season? Collapsed Expanded

Current FEDVIP enrollees will automatically renew. You will receive a confirmation letter from MetLife in January.

If you are currently enrolled in the TRDP plan, you will not be automatically enrolled in a FEDVIP plan for 2019. You must enroll during open season.

May I choose an out-of-network dentist? Collapsed Expanded

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 Federal Dental (FEDVIP) Network, 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, you are only responsible for the difference between the negotiated fee and your plan's payment.

How do I stop receiving paper Explanation of Benefits (EOB) Statements at my home? Collapsed Expanded

Sign into MyBenefits, click on the subscription button located at the top of the page, then select "Go Paperless".

If I elect to stop receiving paper Explanation of Benefits (EOB) Statements at my home, how do I view my EOB Statements? And can I still print them? Collapsed Expanded

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.

If I have dental coverage from a non-FEHB plan, how will my benefits be coordinated? Collapsed Expanded

If you are covered under a non-Federal Employee Health Benefits (FEHB) plan, your MetLife Federal Dental benfits will be coordinated using traditional coordination of benefits provisions for determining payment.

When benefits are coordinated between MetLife and a non-FEHB carrier, the amount you are charged may vary, depending on whether MetLife or the non-FEHB carrier has a contract with your dentist limiting your dentist to a negotiated fee. You will be responsible for the difference between the benefits payments made by the non-FEHB carrier and MetLife and your dentist's allowable charge. Please see the 2019 MetLife FEDVIP Plan Brochure for examples.

Does the 2010 Healthcare Reform Act affect the dependent age for coverage under FEDVIP? Collapsed Expanded

No. Eligible family members include your spouse and unmarried dependent children under age 22.

Are you an International Participant? Collapsed Expanded

Beginning in 2012, all services rendered by an International Provider will be paid as in-network benefits.

When I am enrolled in a Federal Employee Health Benefit (FEHB) Plan and also enrolled in the MetLife Federal Dental Plan, how should I submit my claims? Collapsed Expanded

Approximately 70% of Federal employees and annuitants have some dental benefit coverage available under a Federal Employee Health Benefits (FEHB) Plan. Federal Law requires that the FEHB plan is the “First Payor” of any benefit payments for all dental procedures and MetLife is the secondary payor. 

To avoid a delay in the payment of your claim, we recommend your dentist submit your claims directly to MetLife. 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 (download a claim form now) to: 

MetLife Dental 
P.O. Box 981282 
El Paso, TX 79998-1282 

Why do you pay an alternate benefit for white composites when it is the only type of service my dentist will perform? Collapsed Expanded

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.

Are benefits available to me if I don’t use an in-network dentist? Collapsed Expanded

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 Federal Dental (FEDVIP) Network, 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, you are only responsible for the difference between the negotiated fee and your plan's payment.

What is the difference between in and out-of-network benefits? Collapsed Expanded
  • An in-network dentist is a general dentist or specialist who participates in MetLife's Federal Dental (FEDVIP) Network and has agreed to accept negotiated fees for services rendered to eligible plan members. This negotiated fee is typically 30% to 45% below the average fee charged by dentists for the same services in a given geographical area. There are over 393,000 in-network dentist locations nationwide, including over 95,000 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's Federal Dental (FEDVIP) Network.

  • 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. We encourage you to consider using a MetLife in-network dentist to help maximize the value of your plan. However, remember you are always free to select a dentist of your choice. 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 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.

How can I find a dentist in the network? Collapsed Expanded

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.

Can I order a brochure on-line? Collapsed Expanded

No, but you may view/download the 2019 MetLife Federal Dental Plan brochure through the home page of this website.

How do I review my personal claim information? Collapsed Expanded

Please access/register for the MyBenefits site from the home page. MyBenefits allows you to manage your benefits more easily. You may view your claims and personal information.

What if I have limited dental benefits available through my Federal Employee Health Benefit (FEHB) Plan? How does this affect my MetLife dental claims? Collapsed Expanded

Approximately 70% of Federal employees and annuitants have some dental benefit coverage available under a Federal Employee Health Benefits (FEHB) Plan. Federal Law requires that the FEHB plan is the "First Payor" of any benefit payments for all dental procedures and MetLife is the secondary payor. 
To avoid a delay in the payment of your claim, we recommend your dentist submit your claims directly to MetLife. 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). If you are enrolled in a BC/BS FEHB plan, please be sure to provide your 9 digit BC/BS R# to your dental provider as well to help ensure accurate claim processing.

  • Inform your dentist if your FEHB plan has dental benefits coverage and provide them a copy of your FEHB Plan Brochure.

 Submit completed claims (download a claim form now) to: 

MetLife Dental 
P.O. Box 981282 
El Paso, TX 79998-1282

How long will it take to process my Dental claim? Collapsed Expanded

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.

Who do I contact if I have any additional questions about dental coverage from MetLife? Collapsed Expanded

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.

What plan options are available to me and my family? Collapsed Expanded
  • Standard Option — Covers Basic, Intermediate and Major Services with a $1,500 In-Network Annual Maximum. 
     
    View 2019 Plan Benefits 

  • High Option — Covers Basic, Intermediate and Major Services with an Unlimited Annual Maximum both in- and out-of-network.

    View 2019 Plan Benefits

What are the rates? Collapsed Expanded

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

How do I review my personal claim information? Collapsed Expanded

Please access/register for the MyBenefits site from the home page. MyBenefits allows you to manage your benefits more easily. You may view your claims and personal information.

Claims

What services are covered by the MetLife Federal Dental Plan? Collapsed Expanded

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 2019 MetLife FEDVIP Plan 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 an in-network dentist for such non-covered services.

What is an Explanation of Benefits (EOB) Statement? Collapsed Expanded

An Explanation of Benefits (EOB) Statement is a summary of your processed claim or pretreatment estimate, including services rendered, costs, and benefits paid.

How will Dependent Orthodontic benefits be calculated? Collapsed Expanded

Benefits for dependent orthodontic treatment will be payable at 50% (under the Standard Option) or 70% (under the High Option) up to a lifetime maximum which varies, depending on the plan option under which you have coverage. Dependent Orthodontic services are limited to children up to their maximum limiting age, which is age 22 for dependents of federal civilian employees and age 21 (23 if full-time student) for dependents of military retirees. Please refer to the 2019 MetLife FEDVIP Plan Brochure for dependent orthodontia details and prorating examples.

What is MetLife Claim Review (MCR) and how does it work? Collapsed Expanded

MetLife Claim Review is a review of certain types of dental claims that is conducted by licensed Dentist Consultants. The Dentist Consultants review the clinical information submitted by your treating dentist, and check for whether the services rendered, such as a crowns, bridges, onlays, implants, periodontal treatments, or other services, were dentally necessary. The Dentist Consultants may also recommend that an alternate benefit be applied to a service in accordance with the terms of the plan. We recommend that you get a pre-treatment estimate for the types of services listed above, so that both you and your dentist are aware of what benefits will be paid for the services.

What is an Alternate Benefit and how does it work? Collapsed Expanded

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.

How will Adult Orthodontic benefits be calculated? Collapsed Expanded

Benefits for adult orthodontic treatment will be payable at 50% (under the Standard Option) or 70% (under the High Option) up to a lifetime maximum which varies, depending on the plan option under which you have coverage. Please refer to the 2019 MetLife FEDVIP Plan Brochure for orthodontia details and prorating examples.

What is First Payor? Collapsed Expanded

If you have dental coverage through your Federal Employee Health Benefits (FEHB) plan and coverage under FEDVIP, your FEHB plan will be the first payor of any benefit payments. When services are rendered by a dentist who participates with both your FEHB and your FEDVIP plan, the the amount charged by your dentist will be the prevailing charge. You are responsible for the difference between the FEHB and FEDVIP benefit payments and the FEDVIP plan allowance. Please see the 2019 MetLife FEDVIP Plan Brochure for examples.

Why do you pay an alternate benefit for white composites when it is the only type of service my dentist will perform? Collapsed Expanded

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.

Do I have to pay to participate in the MetLife Dental Health ManagerSM? Collapsed Expanded

No. This is a value-added program for participants that is a part of your MetLife Group Dental Benefits plan. 

What are the rates? Collapsed Expanded

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

Are Orthodontia benefits available for adults? Collapsed Expanded

Yes, we have Adult Orthodontia coverage in both Standard and High Plan Options. Please refer to the 2019 MetLife FEDVIP Plan Brochure for orthodontia details and prorating examples.

Do you cover crowns? Collapsed Expanded

Yes. Crowns are covered under the FEDVIP plan. Please review the 2019 MetLife Federal Dental Plan Brochure for details.

Do different procedures have different age limitations? Collapsed Expanded

Yes. There are certain procedures with different age limitations. Please refer to the 2019 MetLife Federal Dental Plan Brochure for details.

Are implants covered under the plan? Collapsed Expanded

Yes. Implant Services are a covered expense subject to plan guidelines. Please refer to your 2019 MetLife Federal Dental Plan Brochure for a complete listing of covered implant services and pre-certification provisions. Prior to having implant services done, we recommend you submit a pre-certification and/ or pre-treatment estimate since an alternate benefit may apply.

Are Invisalign braces covered by the plan? Collapsed Expanded

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

Does the 2010 Healthcare Reform Act affect the dependant age for coverage under FEDVIP? Collapsed Expanded

No. Eligible family members include your spouse and unmarried dependent children under age 22 for dependents of federal civilian employees and age 21 (23 if full-time student) for dependents of military retirees.

How do I review my personal claim information? Collapsed Expanded

Please access/register for the MyBenefits site from the home page. MyBenefits allows you to manage your benefits more easily. You may view your claims and personal information.

Network-Dental

How do I review my personal claim information? Collapsed Expanded

You may view your claims and manage your benefits online by registering for MyBenefits

What is an Explanation of Benefits (EOB) Statement? Collapsed Expanded

An Explanation of Benefits (EOB) Statement is a summary of your processed claim or pretreatment estimate, including services rendered, costs, and benefits paid.

How do I stop receiving paper Explanation of Benefits (EOB) Statements at my home? Collapsed Expanded

Sign into MyBenefits, click on the subscription button located at the top of the page, then select "Go Paperless". 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.

When I am enrolled in a Federal Employee Health Benefit (FEHB) Plan and also enrolled in the MetLife Federal Dental Plan, how should I submit my claims? Collapsed Expanded

Approximately 70% of Federal employees and annuitants have some dental benefit coverage available under a Federal Employee Health Benefits (FEHB) Plan. Federal Law requires that the FEHB plan is the “First Payor” of any benefit payments for all dental procedures and MetLife is the secondary payor.

To avoid a delay in the payment of your claim, we recommend your dentist submit your claims directly to MetLife. 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.

Download a claim form and submit to:

MetLife Dental

P.O. Box 981282

El Paso, TX 79998-1282 

Why do you pay an alternate benefit for white composites when it is the only type of service my dentist will perform? Collapsed Expanded

If MetLife determines that a less costly covered service 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 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.

What if I have limited dental benefits available through my Federal Employee Health Benefit (FEHB) Plan? How does this affect my MetLife dental claims? Collapsed Expanded

Approximately 70% of Federal employees and annuitants have some dental benefit coverage available under a Federal Employee Health Benefits (FEHB) Plan. To avoid a delay in the payment of your claim, we recommend your dentist submit your claims directly to MetLife. 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). If you are enrolled in a BC/BS FEHB plan, please be sure to provide your 9 digit BC/BS R# to your dental provider as well to help ensure accurate claim processing.

            - Inform your dentist if your FEHB plan has dental benefits coverage and provide them a copy of your FEHB Plan Brochure.

Download a claim form form and submit completed claims to:

MetLife Dental

P.O. Box 981282

El Paso, TX 79998-1282

How long will it take to process my Dental claim? Collapsed Expanded

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.

What is MetLife Claim Review (MCR) and how does it work? Collapsed Expanded

MetLife Claim Review is a review of certain types of dental claims that is conducted by licensed Dentist Consultants. The Dentist Consultants review the clinical information submitted by your treating dentist, and check for whether the services rendered, such as a crowns, bridges, onlays, implants, periodontal treatments, or other services, were dentally necessary. The Dentist Consultants may also recommend that an alternate benefit be applied to a service in accordance with the terms of the plan. We recommend that you get a pre-treatment estimate for the types of services listed above, so that both you and your dentist are aware of what benefits will be paid for the services.

FSA

What is an in-network dentist and how do I find one? Collapsed Expanded

An in-network dentist is a general dentist or specialist who participates in MetLife's Federal Dental (FEDVIP) Network and has agreed to accept a negotiated fee for services rendered to eligible plan members. This negotiated* fee is typically 30% to 45% below the average fee charged by dentists for the same services in a given geographical area. There are over 393,000 in-network dentist locations nationwide, including over 95,000 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 Federal Dental (FEDVIP) Network.

 

What if my dentist is not in MetLife's network? Collapsed Expanded

We encourage you to consider using a MetLife in-network 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 Federal Dental (FEDVIP) Network 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.

Can an in-network dentist charge me his or her "usual" fee when a dental procedure is not covered under my dental plan? Collapsed Expanded

An in-network dentist should not bill you for amounts that are in excess of the negotiated 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 at the time of your appointment. To search for an in-network 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.

What is the difference between in and out-of-network benefits? Collapsed Expanded
  • An in-network dentist is a general dentist or specialist who participates in MetLife's Federal Dental (FEDVIP) Network and has agreed to accept a negotiated fee for services rendered to eligible plan members. This negotiated* fee is typically 30% to 45% below the average fee charged by dentists for the same services in a given geographical area. There are over 393,000 in-network dentist locations nationwide, including over 95,000 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's Federal Dental (FEDVIP) Network. 

  • 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 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 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

What is a negotiated fee? Collapsed Expanded

A negotiated fee refers to the maximum charge for a service that an in-network dentist may charge to MetLife Federal Dental Plan participants. These fees are typically 30% to 45% 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, you are responsible only for the difference between MetLife's benefits payment amount and the negotiated fee for the services rendered.

Why aren't there any in-network dentists in my area? Collapsed Expanded

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.

Retired Uniformed Services Members

Who's eligible for FEDVIP? Collapsed Expanded

In general, retired uniformed service members and their families are eligible for FEDVIP dental coverage beginning in 2019.

If you'd like more information, go to the eligibility section of BENEFEDS site.

How long do I have to enroll if I just became eligible for FEDVIP? Collapsed Expanded

If you're newly eligible for FEDVIP, you have 60 days from the date you became eligible to enroll in a FEDVIP dental plan.

Some examples of new eligibility include:

  • You're a newly retired uniformed service member.
  • You're a family member of a sponsor who became an active duty service member.
  • You recently became a survivor.

To enroll, you can visit BENEFEDS.com to confirm your eligibility and complete your enrollment.

 

I experienced a Qualifying Life Event (QLE). Can I enroll in FEDVIP now? Collapsed Expanded

Qualifying life events (QLEs) are certain life events that allow you to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP), or make changes to your existing FEDVIP plan, outside of open season. The QLEs for FEDVIP may differ from QLEs for other Federal benefits programs such as the Federal Employees Health Benefits (FEHB) program. Each program has its own law and regulations. The time frame for requesting a QLE change is from 31 days before to 60 days after the event.

To enroll, you can visit BENEFEDS.com to confirm your eligibility. You will be asked a few questions to determine what QLE you experienced and if it allows you to enroll outside of Open Season.

Examples of FEDVIP QLEs that allow you to enroll outside of Open Season include:

  • You got married.
  • You lost your other dental coverage.
  • Your military pay or Federal annuity or compensation was restored.

For a list of all of the FEDVIP QLEs, visit the Qualifying Life Events section of BENEFEDS.com, found in the Education and Support tab of the site.

Is retirement a Qualifying Life Event (QLE) in FEDVIP? Collapsed Expanded

If you recently retired from the uniformed services, you are now newly eligible to enroll in FEDVIP dental coverage, and if enrolled in a TRICARE health plan, but it is not a QLE. You are considered newly eligible for the program and have 60 days from the date you became eligible to enroll in a FEDVIP dental plan. If you miss your 60-day enrollment period, then you must wait until the next open season.

Uniformed Service Member Retirement Guidance Collapsed Expanded

Retirement is not considered a QLE in FEDVIP, but if you retire from the uniformed services you are considered newly eligible for the program. You will have 60 days from your retirement date to enroll in FEDVIP dental coverage, and if enrolled in a TRICARE health plan as well. You can enroll online at BENEFEDS.com or call BENEFEDS customer service on or after your retirement date to initiate the enrollment. Once enrolled, your coverage will be effective the first day of the following month.

If you are already retired from the uniformed services and you are now leaving or retiring from private sector employment, you are able to enroll in FEDVIP if you experienced a FEDVIP QLE. For instance, if you lost insurance as part of leaving the private sector, then you are eligible to enroll in FEDVIP within 31 days prior to and 60 days after the date of the QLE. However, if you are only canceling insurance with your employer but it is still available to you, then you must wait until the next open season to enroll

Will MetLife cover any treatments that were initiated when I was covered by TRDP? Collapsed Expanded

MetLife will cover in-progress treatment only for transitioning TRDP enrollees for the 2019 plan year, regardless of current plan exclusions for care initiated prior to the enrollee’s effective date. This includes assumption of payments for covered orthodontiaservices up to the FEDVIP policy limits, and full payment where applicable up to the terms of the FEDVIP policy for covered services completed (but not initiated) in the 2019 plan year such as crowns and implants.

I’m a Veteran and not eligible to participate in FEDVIP, are there other dental coverage options for me? Collapsed Expanded

Yes if you are currently enrolled in the VA health care system you can enroll in MetLife’s Veterans Affairs Dental Insurance Program (VADIP).  For more information on the program and how to enroll please visit our site www.metlife.com/vadip.  If you unsure of the eligibility requirements for participation in the VA health care system, please visit the VA’s web site at www.va.gov/healthbenefits/vadip.