MetLife Federal Dental Plan FAQs

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 are usually 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.

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.

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.

The services covered by the MetLife Federal Dental Plan are set forth in your group dental benefits plan located in the Plan section of this site. Please refer to your 2020 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.

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.

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.

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.

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

If you are a new hire, you can enroll within 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.

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

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.

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?

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 you are covered under a non-Federal Employee Health Benefits (FEHB) plan, your MetLife Federal Dental benefits 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 2020 MetLife FEDVIP Plan Brochure for examples.

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

We will pay benefits subject to plan provisions, in an amount equal to the covered percentage for the charges incurred by you.  All payments will be made in U.S. currency.

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

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.

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.

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. Based on MetLife data, negotiated fees are typically 30% to 45% below the average fees charged by dentists for the same services in a given geographical area. There are over 434,000 in-network dentist locations nationwide, including over 99,000 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. 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. 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 when you visit an out-of-network dentist. 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.

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 2020 MetLife Federal Dental Plan Brochure through the home page of this website.

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.

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

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.

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.

Standard Option — Covers Basic, Intermediate and Major Services with a $1,500 In-Network Annual Maximum. View the 2020 Plan Benefits tab for details.

High Option — Covers Basic, Intermediate and Major Services with an Unlimited Annual Maximum both in- and out-of-network. View the 2020 Plan Benefits tab for details.

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

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.

The services covered by the MetLife Federal Dental Plan are set forth in your group dental benefits plan located in the Plan section of this site. Please refer to your 2020 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.

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

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 2020 MetLife FEDVIP Plan Brochure for dependent orthodontia details and prorating examples.

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 have an estimate of what benefits will be paid for the services.

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.

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 2020 MetLife FEDVIP Plan Brochure for orthodontia details and prorating examples.

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 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 2020 MetLife FEDVIP Plan Brochure for examples.

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.

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

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

Yes, we have Adult Orthodontia coverage in both Standard and High Plan Options. Please refer to the 2020 MetLife FEDVIP Plan Brochure for orthodontia details and prorating examples.

Yes. Crowns are covered under the FEDVIP plan. Please review the 2020 MetLife Federal Dental Plan Brochure for details.

Yes. There are certain procedures with different age limitations. Please refer to the 2020 MetLife Federal Dental Plan Brochure for details.

Yes. Implant Services are a covered expense subject to plan guidelines. Please refer to your 2020 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.

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

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.

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.

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

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

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.

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

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.

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 and submit completed claims to:

MetLife Dental

P.O. Box 981282

El Paso, TX 79998-1282

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.

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 have an estimate of what benefits will be paid for the services.

Yes. You are free to make an FSA election amount during your annual open season to use for qualified health and medical expenses.

The FSAFEDS can be contacted at 1-877-FSAFEDS (1-877-372-3337), TTY: 866-353-8058 or at http://www.fsafeds.com.

Yes.

Yes, with the exception of Orthodontia Claims. All Orthodontia claims will continue to be submitted manually via paper in order to be considered.

You can download an FSAFEDS claim form at www.FSAFEDS.com or click on the following link: https://www.fsafeds.com/forms/FSAFEDS_HC_Claim.pdf. Instructions on how to submit the claim, including submission methods, are included.

Please refer to date shown on your dental explanation of benefits (EOB) to review your claim and to determine when MetLife processed your claim. You can review/ download your dental EOB from the MetLife MyBenefits site. Note: Not all dental procedures are eligible covered expenses under the FSAFEDS rules. Please contact FSAFEDS for further details about qualified expenses.

You can submit your FSA claims by toll free fax to 1-866-643-2245 or to

1-502-267-2233 or by mail to:

FSAFEDS Program

PO Box 14127

Lexington, KY 40512-4127

You are free to contact FSAFEDS at 1-877-FSAFEDS (1-877-372-3337), TTY: 866-353-8058 or at http://www.fsafeds.com.

A uniformed services member entitled to retired, retainer, or equivalent pay and other benefits based on duty in the uniformed services or retired due to medical disability as determined by the U.S. Department of Defense. This includes Retired Reserve members who are age 60 and older and under age 60 (gray area reservists) not yet receiving retired pay.

A spouse, eligible child, or eligible dependent of a retired uniformed service member (sponsor) or Retired Reserve member (sponsor) who meets one of the following dental exceptions:

• the sponsor is receiving Veterans Affairs (VA) dental services
• the sponsor has dental insurance through his or her employer that doesn't cover family members
• the sponsor is unable to receive dental services due to a medical or dental condition

To see if you or a dependent are eligible to enroll you can visit BENEFEDS.com to confirm eligibility.

The following family members are typically eligible for enrollment in a FEDVIP dental plan under the sponsor's or certifying family member's coverage as dependents.

1. A spouse of an eligible member of the uniformed services (sponsor)

2. A child of an eligible member of the uniformed services: The child must be:

• under age 21 (non-student);
• under age 23 (full-time student)*; or
• incapable of self-support because of a mental or physical incapacity before age 21 (non-student) or age 23 (full-time student)**

A child's status as a student or of being incapable of self-support must be registered in the Defense Enrollment Eligibility Reporting System (DEERS).

3. A dependent of an eligible member of the uniformed services who is in legal custody of the sponsor for more than 12 months (including pre-adoptive children and eligible wards of state): The dependent must be:

• under age 21 (non-student);
• under age 23 (full-time student)*; or
• incapable of self-support because of a mental or physical incapacity before age 21 (non-student) or age 23 (full-time student)**

A dependent's status as a student or of being incapable of self-support must be registered in the Defense Enrollment Eligibility Reporting System (DEERS).

*A full-time student is an unmarried child or dependent who is enrolled full-time at an accredited educational institution and whose sponsor is providing at least 50% of his or her financial support while enrolled. Children and dependents who are full-time students are eligible for FEDVIP coverage until their 23rd birthday or graduation (whichever is first).

**An unmarried child or dependent incapable of self-support because of a mental or physical incapacity before age 21 (non-student) or age 23 (full-time student) must be financially dependent on the sponsor for more than 50% of his or her support.

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

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. You cannot request a new enrollment based on a QLE before the QLE occurs, with limited exceptions.

To see if you or a dependent are eligible to enroll you can visit BENEFEDS.com to confirm eligibility. You will be asked a few questions to determine what QLE you experienced and if it allows you or a dependent 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 the FEDVIP QLEs, visit the Qualifying Life Events section of BENEFEDS.com, found in the Education and Support tab of the site.

If you recently retired from the uniformed services, you are now newly eligible to enroll in FEDVIP dental coverage, but it is not considered 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.

If you are already retired from the uniformed services and you are now leaving or retiring from private sector employment, you can enroll in FEDVIP if you experienced a FEDVIP qualifying life event (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.

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 are 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.