MetLife TakeAlong Dental
PPO or HMO/Managed Care Program Questions
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What are the Dental benefits available through MetLife?
We are currently offering a Preferred Provider Organization (PPO) program nationwide as an individual dental insurance policy. A Dental HMO/Managed Care program is available to residents of California, Florida, New York and Texas.
How is the monthly rate calculated?
The monthly rate is calculated based on your residential ZIP Code.
How would I pay for coverage?
The choice is yours. Your monthly premiums can be paid by credit card or bank draft. At time of enrollment, you will choose how you want to pay. Other payment frequencies are also available.
Would I be able to change my Dental program after I enroll?
Yes. You may elect to change your Dental program on the policy renewal date or at any other time. However, you must apply for a new policy in order to become insured for another coverage option. If you do not apply for a new policy within 60 days of the date you request to end this policy, you may not be eligible to apply for a new dental policy from MetLife or there may be time restrictions on when you may apply for a new policy.
Can I enroll my dependents for Dental coverage?
Yes. At time of enrollment, you are able to elect coverage for your dependents. If you decide after the policy takes effect that you would like to enroll additional dependents, you simply need to provide MetLife with advance written notice along with any required premium. After we receive your written notice to add dependents, your premium rates will be adjusted as of the date insurance takes effect for the newly added dependent(s). The effective date of insurance for newly added dependent(s) will depend on when we receive notice and required premium.
When would these Dental insurance policies end?
If you are enrolled in one of the individual Dental programs, the policy may end for non-payment of premiums, or if MetLife or the applicable affiliate stops renewing individual dental policies in the jurisdication in which the policy is issued. MetLife will provide 60 days advance written notice if discontinuing an individual dental policy.
Preferred Dentist Program - PPO
What is a participating dentist?
A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees* as payment in full for covered services. Negotiated fees typically range from 30% - 45% less than the average charges in a dentist’s community for similar services.
*Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, coinsurance and benefit maximums. Negotiated fees are subject to change.
How do I find a participating dentist?
You can find the names, addresses, specialties, languages spoken and telephone numbers of participating dentists in a given area by searching our online directory – Find a Provider .
Am I covered if I go to a non-participating dentist?
You can use any licensed dentist. However, if you visit an out-of-network dentist you may have higher out-of-pocket costs than if you use a dentist that is in-network. In most states, the TakeAlong Dental programs have maximum allowable charges that in-network providers have agreed to accept as payment in full for covered services*. We pay a percentage (% varies by type of procedure) of those agreed upon charges, and you are responsible for the remaining balance of those charges. In most states, out-of-network benefits are also based on a percentage of the maximum allowable charge. If you visit an out-of-network dentist, in addition to any applicable deductible, you would be responsible for the percentage of the maximum allowable charge that MetLife does not pay (the coinsurance amount) as well as for the amount of the out-of-network dentist’s fee that is in excess of the maximum allowable charge.
* Maximum allowable charges refer to the charges that in-network dentists have agreed to accept as payment in full for covered services, subject to any deductibles, copayments, coinsurance and benefit maximums. Maximum allowable charges are subject to change. In most states, out-of-network benefits are also based on a percentage of the maximum allowable charge.
What services are covered under this Dental program?
To find out more about covered services, go to the Dental Program Option page and enter your zip code to see the programs available in your area. NOTE: Services started under another policy or plan do not carry over to these programs – check with your dental carrier to be sure all services associated with that policy or plan are completed before enrolling in TakeAlong Dental.
If I want my current dentist to join the network, how would he/she apply?
If your dentist does not participate in our network, and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application. The website and phone number are for use by dental professionals only.
What is a pre-treatment estimate and when should I request one?
A pretreatment estimate is requested before you get care. Your general dentist or specialist sends MetLife a plan for your care and asks for an estimate of benefits. We recommend that you or your dentist request a pretreatment estimate for any service(s) that may cost more than $300. This often applies to services such as crowns, bridges, inlays and periodontics.
To get an estimate, simply ask your dentist to submit a request online at www.metdental.com or call 1-877-MET-DDS9 (638-3379). You and your dentist will receive a benefit estimate – online or by fax – for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.
How are claims processed?
Dentists may submit your claims for you, which means you have little or no paperwork. You may also download a Dental Claim form. Just fill out the participant portion and have your dentist complete the rest. Either you or your dentist can submit the form, and benefits are paid to you, unless you have arranged for them to go directly to your dentist. Your completed claim form should be mailed to MetLife Dental Claims, PO Box 981282, El Paso, TX 79998-1282. You can also fax your form to 1-859-389-6505.
You are able to track your claims online at http://online.metlife.com and even receive email alerts when a claim has been processed. Once your claim is processed, you will receive an Explanation of Benefits statement.
How long will it take to process a Dental claim?
The time it takes to process a claim depends on its complexity. Most claims flow through our system quickly and efficiently, with 90% being handled within 10 business days. If additional information is needed for a claim, it may take up to 30 days.
Dental HMO/Managed Care Program (Available to residents of CA, FL, NY and TX)
How does the Dental HMO program work?
This Dental HMO/Managed Care program is designed to support you in maintaining and improving your oral health, providing coverage on hundreds of procedures. There are no deductibles or annual maximum, making it easier for you to receive the preventive care you need to help avoid more costly procedures.
Depending on your program, you may pay for dental care in one of two ways:
Copay: You pay a set dollar amount (copayment) associated with each covered procedure at the time of service.
Coinsurance: At the time of service, you are only responsible for the difference between the dentist’s contracted fee and the amount covered (“covered percentage”) for each covered procedure. For example, if fillings are covered at 90%, and the dentist’s contracted fee for this service is $100, your out-of-pocket cost will be $10.
For a full list of covered services including information on any limitations and additional charges for certain procedures as well as what is not covered by the program, please refer to the Schedule of Benefits located on the Dental Program Options page. You will need to enter your zip code to view the programs available in your area. Or you may find the program information in the printed enrollment material.
Would I need to select a dentist who participates in the network when I enroll?
Yes. At the time of enrollment, you will select two participating dentists. This will help ensure you are able to receive the care you need if your first choice is unable to accept new patients. The participating dentist you select at enrollment will provide your routine dental care. You may schedule an appointment with your dentist anytime after your program’s effective date.
Who are the dentists who participate in your network?
Every dentist in the network has been thoroughly screened prior to acceptance. Participating dentists are also subject to audits, including onsite visits to the dental offices. You can find the names, addresses, specialties, languages spoken and telephone numbers of participating dentists in a given area by searching our online directory – Find a Provider.
Would I be able to change dentists?
Yes. You and your enrolled dependents may each select different participating dentists and may change dentists as often as once per month. You can change dentists for you and your enrolled dependents online at http://online.metlife.com or by calling Customer Service. Your transfer will be effective the first of the following month. Please note: any requests made after the 25th of the month will take effect the first of the second following month (e.g., a facility request change made on March 28th will go into effect on May 1st). You should ensure any dental work-in-progress is completed prior to transferring to a new dentist. Refer to your Evidence of Coverage included with your enrollment materials for more information.
What if I need emergency care?
All participating dental offices in our network provide information regarding how to obtain emergency coverage 24 hours a day, 7 days a week. If you cannot reach your selected participating dentist, you may receive emergency care from any licensed dental care professional. The definition of what is considered “emergency care” and other specifics can be found in the Evidence of Coverage located in your enrollment material.
What if I need to see a specialist?
This is a “self referral” program and if your selected participating dentist determines that you need the services of a specialty care provider*, you may call a participating specialist directly. With this program, you will save 25% off the provider’s usual and customary fee. You can select a specialty care provider at Find a Dentist or by contacting Customer Service through the Customer Support section on this website.
*In California, orthodontic and pedodontic specialty services require pre-approval. Your selected participating dentist will contact MetLife or its affiliate for pre-approval. Once approved, your dentist will contact you with the name of a participating specialist.
Do these programs cover second opinions?
Yes. Just contact Customer Service to let us know that you would like another clinical opinion and we will provide the name of a dentist for you to see.
If I want my current dentist to join the network, how would he/she apply?
If your dentist does not participate in our network, and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com for an application. The website is for use by dental professionals only.
