MetLife /FEDVIP-Dental (888) 865-6854 TDD (888) 260 .
The MetLife Federal Dental PlanMetLife.com/FEDVIP-Dental(888) 865-6854 TDD (888) 260-53762021A Nationwide Dental PPO PlanIMPORTANT Rates: Back Cover Changes for 2021: Page 5 Summary of Benefits: Page 56Who may enroll in this Plan: All Federal employees and annuitants in the United States and overseas whoare eligible to enroll in Federal Employees Dental and Vision Insurance Program.Enrollment Options for this Plan: High Option – Self Only High Option – Self Plus One High Option – Self and Family Standard Option – Self Only Standard Option – Self Plus One Standard Option – Self and FamilyThis Plan has 5 enrollment regions, including international; please see the end of this brochure to determineyour region and corresponding rates2021 The MetLife Federal Dental Plan1
IntroductionOn December 23, 2004, President George W. Bush signed the Federal Employee Dental and Vision Benefits EnhancementAct of 2004 (Public Law 108-496). The law directed the Office of Personnel Management (OPM) to establish supplementaldental and vision benefit programs to be made available to Federal employees, annuitants, and their eligible family members.In response to the legislation, OPM established the Federal Employees Dental and Vision Insurance Program (FEDVIP).OPM has contracted with dental and vision insurers to offer an array of choices to Federal employees and annuitants. Section715 of the National Defense Authorization Act for Fiscal Year 2017 (FY 2017 NDAA), Public Law 114-38, expandedFEDVIP eligibility to certain TRICARE-eligible individuals.This brochure describes the benefits of The MetLife Federal Dental Plan under Metropolitan Life Insurance Company(MetLife) contract OPM02-FEDVIP-02AP-11 with OPM, as authorized by the FEDVIP law. The address for ouradministrative office is:MetLife501 US Highway 22Bridgewater, NJ 08807(888) 865-6854 TDD (888) 260-5376MetLife.com/FEDVIP-DentalThis brochure is the official statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations,and exclusions of this brochure. It is your responsibility to be informed about your benefits.If you are enrolled in this Plan, you are entitled to the benefits described in this brochure. If you are enrolled in Self PlusOne, you and your designated family member are entitled to these benefits. If you are enrolled in Self and Family coverage,each of your eligible family members is also entitled to these benefits, if they are also listed on the coverage. You and yourfamily members do not have a right to benefits that were available before January 1, 2021 unless those benefits arealso shown in this brochure.OPM negotiates rates with each carrier annually. Rates are shown at the end of this brochure.The MetLife Federal Dental Insurance Plan is responsible for the selection of In-Network providers in your area. Contact usat (888) 865-6854 TDD (888) 260-5376 for the names of participating providers or to request a provider directory. You mayalso view current In-Network providers via our web website at MetLife.com/FEDVIP-Dental. Continued participation of anyspecific provider cannot be guaranteed. Thus, you should make coverage decisions based on the plan benefits, not based on aspecific provider. When you phone for an appointment, please remember to verify that the provider is currently in theMetLife network. If your provider is not currently participating in the provider network, you can ask him or her to join; orask your dentist to visit www.metdental.com or call (877) MET-DDS9. Note this website and phone number are specificallyfor dentists and not accessible to employees/annuitants. You cannot change plans, outside of Open Season, because ofchanges to the provider network.Provider networks may be more extensive in some areas than others. We cannot guarantee the availability of every specialtyin all areas. If you require the services of a specialist and one is not available in your area, please contact us for assistance.This MetLife Federal Dental Plan and all other FEDVIP plans are not a part of the Federal Employees HealthBenefits (FEHB) Program.We want you to know that protecting the confidentiality of your individually identifiable health information is of the utmostimportance to us. To review full details about our privacy practices, our legal duties, and your rights, please visit our websiteat MetLife.com/FEDVIP-Dental and link to the “Privacy Policy” at the bottom MetLife Federal Dental's home page. If youdo not have access to the internet or would like further information, please contact us by calling1-888-865-6854. Furthermore, you may view the HIPAA information and other Personal Health Information beginning onpage 49 of this document.Discrimination is Against the LawThe MetLife Federal Dental Plan complies with all applicable Federal civil rights laws, to include both Title VII of the CivilRights Act of 1964 and Section 1557 of the Affordable Care Act. Pursuant to Section 1557, MetLife does not discriminate,exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex.2021 The MetLife Federal Dental Plan2Enroll at www.BENEFEDS.com
Table of ContentsIntroduction .2Table of Contents .3How We Have Changed for 2021 .5FEDVIP Program Highlights .6A Choice of Plans and Options .6Enroll Through BENEFEDS .6Dual Enrollment .6Coverage Effective Date .6Pre-Tax Salary Deduction for Employees .6Annual Enrollment Opportunity .6Continued Group Coverage After Retirement .6Waiting Period .6Section 1 Eligibility .7Federal Employees .7Federal Annuitants .7Survivor Annuitants .7Compensationers .7Family Members .7Not Eligible .8Section 2 Enrollment .9Enroll Through BENEFEDS .9Enrollment Types .9Dual Enrollment .9Opportunities to Enroll or Change Enrollment .9When Coverage Stops .11Continuation of Coverage .11FSAFEDS/High Deductible Health Plans and FEDVIP .12Section 3 How You Obtain Care .13Identification Cards / Enrollment Confirmation .13Where You Get Covered Care .13Plan Providers .13In-Network .13Out-of-Network .13Emergency Services .13Plan Allowance .13Pre-Treatment Estimate .14Alternate Benefit .14Dental Review .14FEHB First Payor .15Coordination of Benefits .15Right of Recovery .16Rating Areas .16Limited Access Area .17Claim Determination Period .17Section 4 Your Cost For Covered Services .18Deductible .182021 The MetLife Federal Dental Plan3Enroll at www.BENEFEDS.com
Coinsurance .18Annual Benefit Maximum .18Orthodontia Lifetime Benefit Maximum .18In-Network Services .19Out-of-Network Services .19Calendar Year .19Prorated Orthodontia Benefits .19Section 5 Dental Services and SuppliesClass A Basic .22Class B Intermediate .26Class C Major.30Class D Orthodontic .37General Services .39Section 6 International Services and Supplies .44Section 7 General Exclusions – Things We Do Not Cover.45Section 8 Claims Filing and Disputed Claims Processes .47How to File a Claim for Covered Services .47Deadline for Filing Your Claim.47Disputed Claims Process .47Initial Determination .49Overpayments .49HIPAA Privacy Practices .49Section 9 Definitions of Terms We Use in This Brochure .54Summary of Benefits .56 High Option Benefits .56 Standard Option Benefits.56Stop Health Care Fraud! .58Rate Information .592021 The MetLife Federal Dental Plan4Enroll at www.BENEFEDS.com
How We Have Changed for 2021Standard Option: The Standard Option Plan Allowance for Out-of-Network services will be equal to the In-Network Plan Allowance for thecovered service. The following procedure codes have changed classes:- D2390-Resin Crown. From Class C to Class B.- D2620-2 surface porcelain inlay. From Class C to Class B.- D2630-3 or more surface porcelain inlay. From Class C to Class B.- D2921-Reattachment of tooth. Now Class B as it previously was not covered.- D3355-Pulpal regeneration initial. From Class C to Class B.- D3356-Pulpal regeneration interim medication replacement. From Class C to Class B.- D3357-Pulpal regeneration completion of treatment. From Class C to Class B.- D4381-Localized delivery of antimicrobial agents. From Class C to Class B.- D7921-Collect-apply autologous product. From Class C to Class B.- D9310-Consultation. From Class B to Class A- D9311-Consultation with medical professional. From Class B to Class A.- D9440-Office visit-after hours. From Class B to Class A.2021 The MetLife Federal Dental Plan5
FEDVIP Program HighlightsA Choice of Plans andOptionsYou can select from several nationwide, and in some areas, regional dental PreferredProvider Organization (PPO) or Health Maintenance Organization (HMO) plans, and highand standard coverage options. You can also select from several nationwide vision plans.You may enroll in a dental plan or a vision plan, or both. Some TRICARE beneficiariesmay not be eligible to enroll in both. Visit www.opm.gov/dental or www.opm.gov/vision for more information.Enroll ThroughBENEFEDSYou enroll online at www.BENEFEDS.com. Please see Section 2, Enrollment, for moreinformation.Dual EnrollmentIf you or one of your family members are enrolled in or covered by one FEDVIP plan, thatperson cannot be enrolled in or covered as a family member by another FEDVIP planoffering the same type of
The MetLife Federal Dental Insurance Plan is responsible for the selection of In-Network providers in your area. Contact us at (888) 865-6854 TDD (888) 260-5376 for the names of participating providers or to request a provider directory.
The MetLife Federal Dental Insurance Plan is responsible for the selection of In-Network providers in your area. Contact us at (888) 865-6854 TDD (888) 260-5376 for the names of participating providers or to request a provider directory.
1 Savings from enrolling in the MetLife Federal Dental Plan will depend on various factors, including the cost of the plan, how often participants visit . www.BENEFEDS.com 1-877-888-FEDS (3337) TTY 1-877-889-5680 FIND OUT MORE METLIFE federaldental.metlife.com 1-888-865-6854 TDD 1-888-260-5376
What does FEDVIP dental cover? FEDVIP dental offers: a choice of 12 dental carriers regional, national, and international plans in-network preventive services, such as cleanings, are covered no deductibles when using in-network dentists no waiting period for major services such as crowns, bridges, dentures, and implants under most plans, there is no 12-month waiting period
Dental Plan Benefits Centura Health 3 Preventive Dental Plan Preferred Dental Program (PDP) Accessing your benefits Find a MetLife dentist Call MetLife at 1-800-942-0854 for the Preventive or Preferred Plan. Go online with MetLife Accessing information about your dental plan through MetLife’s website is easy. Simply go to www .
more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of .
more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of .
MetLife Federal Dental Plan 5 More coverageWith the MetLife Federal Dental Plan, it’s even easier Covered Dental Services to get the coverage you need. Covered Dental Services Here is a summary of dental services covered in each category: Class A - Basic Diagnostic and Treatment Periodic oral evaluations; one every 6 months.
Cambridge IGCSE Accounting is accepted by universities and employers as proof of an understanding of the theory and concepts of accounting, and the ways in which accounting is used in a variety of modern economic and business contexts. Candidates focus on the skills of recording, reporting, presenting and interpreting financial information; these form an ideal foundation for further study, and .
