Dental Insurance for first responders
for members of Thin Blue Line Benefits Association
What is the MetLife Preferred Dentist Program?
MetLife’s Preferred Provider Organization (PPO) plans feature the MetLife Preferred Dentist Program, which is designed to save you money on dental services. 1 You can choose from thousands of participating general dentists and specialists nationwide. Plus, you will enjoy lower out-of-pocket costs for in-network services, freedom to use any dentist, and less paperwork.
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.2 Negotiated fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing, and benefit maximums. Negotiated fees are subject to change.
What if I need emergency care?
All dental offices that participate in the network provide instructions on how to access emergency care 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 your policy, Certificate of Insurance, Evidence of Coverage or Summary Plan Description.
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 Dentist.
find a dentist
When prompted on search tool, enter your network= PDP Plus
The information contained in this directory is updated every business day. Please contact MetLife for additional confirmation of your provider’s network participation status. MetLife also recommends that you confirm with your provider his or her in-network status at the time services are rendered.
MetLife would like to remind you that you are entitled to full and equal access to covered services, including enrollees with disabilities as required under the federal American with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
Group dental insurance policies featuring the MetLife Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company.
To learn more about the MetLife family of companies providing Dental HMO/Managed Care plans and the states where they provide benefits, please open this document.
Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions exceptions, waiting periods, reductions, limitation and terms for keeping them in force. Ask your MetLife group representative for costs and complete details.
The information contained in this provider directory is supplied by the individual provider and is subject to regular audits by MetLife.
MetLife’s goal is to establish consistency in the selection and retention of providers in its networks. The decision to accept or retain a provider is based on all available information, including, but not limited to, information contained on the application and obtained through re-evaluation processes such as licensure, malpractice or sanctions history, and other relevant information.
The hours of operation listed in this directory are subject to change without notice. Contact the provider office directly for the most updated information.
| Class Description | Members | |
|---|---|---|
| In-Network | Out-of-Network | |
| Reimbursement | Negotiated Fee Schedule | R&C 90th Percentile |
| Type A – Preventive | 100% | 100% |
| Type B – Basic | 80% | 80% |
| Calendar Year Deductible applies to: Individual Family |
B & C $50 $150 Aggregate |
B & C $50 $150 Aggregate |
| Calendar Year Maximum (applies to A,B,C services) | $1,500 | $1,500 |
* Out of Network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary charge is based on the lowest of (1) the dentist’s actual charge (the ‘Actual Charge’), (2) the dentist’s usual charge for the same or similar services (the ‘Usual Charge’) or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the ‘Customary Charge’). Services must be necessary in terms of generally accepted dental standards.
Frequency & Allocations / Exclusions
(Custom Primary (Flex) – Custom Lower Cost (Flex))
| Class Description: All Active Full Time Employees | |
|---|---|
| TYPE A Benefits are payable immediately from the start date of an individual’s benefits |
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| TYPE B Benefits are payable immediately from the start date of an individual’s benefits |
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| TYPE C Benefits are payable immediately from the start date of an individual’s benefits |
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| Exclusions All Active Members |
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- Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature.
- Services for which a covered person would not be required to pay in the absence of dental insurance.
- Services or supplies received by a covered person before the insurance starts for that person.
- Services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for scaling or polishing of teeth or fluoride treatment.
- Services which are primarily cosmetic unless required for the treatment or correction of a congenital defect of a newborn child.
- Services or appliances which restore or alter occlusion or vertical dimension.
Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease. - Restorations or appliances used for the purpose of periodontal splinting.
Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco. - Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss.
- Initial installation of a Denture to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
- Decoration or inscription of any tooth, device, appliance, crown or other dental work.
- Missed appointments.
- Services covered under any workers’ compensation or occupational disease law.
- Services covered under any employer liability law.
- Services for which the employer of the person receiving such services is not required to pay.
- Services received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital.
- Services covered under other coverage provided by the Policyholder.
- Temporary or provisional restorations.
Temporary or provisional appliances. - Prescription drugs.
- Services for which the submitted documentation indicates a poor prognosis.
- Services, to the extent such services, or benefits for such services, are available under a government plan. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first.
- The following when charged by the dentist on a separate basis – Claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
- Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing and biting of food.
Caries susceptibility tests. - Precision attachments associated with fixed and removable prostheses.
Adjustment of a denture made within 6 months after installation by the same dentist who installed it. - Duplicate prosthetic devices or appliances.
- Replacement of a lost or stolen appliance, cast restoration or denture.
Intra and extraoral photographic images. - Fixed and removable appliances for correction of harmful habits.
- Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards.
- Treatment of temporomandibular joint disorder. This exclusion does not apply to residents of Minnesota.
- Orthodontia services or appliances.
- Repair or a replacement of an orthodontic appliance.
- Implants supported prosthetics to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth.
FAQ FOOTNOTES
- Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of the plan, how often participants visit the dentist and the cost of services rendered.
- Based on internal analysis by MetLife.
LEGAL FOOTNOTES
- 1 Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of the plan, how often participants visit the dentist and the cost of services rendered.
- American Dental Association; Dentists: Doctors of Oral Health, American Dental Association, Chicago, IL, http://www.ada.org/en/about-theada/dentists-doctors-of-oral-health. Accessed February 1, 2021.
- Your out-of-pocket costs may be greater when you visit a dentist who does not participate in the MetLife network.
- Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of the plan, how often members visit the dentist and the cost of services rendered. Office visit co-payment may apply. Please refer to your schedule of benefits.
- Based on internal analysis by MetLife. Negotiated fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefit maximums. Negotiated fees are subject to change.
- Based on MetLife data for a crown (D2740) in ZIP code 06340. This example is used for informational purposes only. Fees in your area may be different. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166.
Dental Managed Care plan benefits are provided by Metropolitan Life Insurance Company, a New York corporation, in NY. Dental HMO plan benefits are provided by: SafeGuard Health Plans, Inc. a California corporation, in CA; SafeGuard Health Plans, Inc. a Florida corporation, in FL; SafeGuard Health Plans, Inc., a Texas corporation, in TX; and MetLife Health Plans, Inc., a Delaware corporation, and Metropolitan Life Insurance Company, a New York corporation, in NJ. The Dental HMO/Managed Care companies are part of the MetLife family of companies. “DHMO” is used to refer to product designs that may differ by state of residence of the enrollee, including but not limited to: “Specialized Health Care Service Plans” in California; “Prepaid Lim ited Health Service Organizations” as described in Chapter 636 of the Florida statutes in Florida; “Single Service Health Maintenance Organizations” in Texas; and “Dental Plan Organizations” as described in the Dental Plan Organization Act in New Jersey. Dental benefits are provided by Metropolitan Life Insurance Company (MetLife) or an affiliate of MetLife. Certain administrative services are provided by Careington Benefit Solutions, Frisco, TX (Careington). Careington is not affiliated with MetLife or its affiliates. In certain states, availability of the individual dental product is subject to regulatory approval. Like most insurance policies, insurance policies offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact your plan administrator for costs and complete details
