Dental Insurance

 

 

You can smile knowing you're protected against the rising cost of dental care when you enroll
in the Dental Insurance Plan from MetLife.

Dental insurance helps pay for dental care, lowering or eliminating your out-of-pocket expense. The AFA-sponsored plan offers two coverage options:

  • Basic Plan – covers preventive care, such as exams, x-rays and cleanings, and basic restorative care.
  • Comprehensive Plan – includes all Basic Plan benefits plus provides coverage for major restorative services such as crowns, bridges, dentures and orthodontia.

Choose any dentist you prefer for dental care. MetLife will reimburse your dentist according to a fee schedule based on reasonable and customary charges for dental service in your area.

Save more when you choose a dentist who participates in a MetLife network. MetLife participating dentists typically charge lower, negotiated fees, which help lower your out-of-pockets expense.

Benefit Highlights

Both the Basic Plan and the Comprehensive Plan cover Type A Preventive and Type B Basic Restorative services as follows:

  • Prophylaxis and oral examinations once every six months.
  • Topical Fluoride treatment once in a 12-month period for dependent children up to 19th birthday.
  • Bitewing X-rays - one set per calendar year.
  • Sealants - one application every 60 months for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to 19th birthday.
  • Palliative care periodontal maintenance four times in any calendar year less the number of teeth cleanings received during the 12-month period.
  • One space maintainer per lifetime for premature loss of primary teeth for dependent children to age 19.
  • Full mouth and Panorex X-rays once per 60 consecutive months.

The Comprehensive Plan also covers Type C Major Restorative (crowns/inlays/onlays, root canal treatment, implants and more) and Type D Orthodontia services.

The following chart outlines the reimbursements levels, deductibles and maximum benefits available through each plan:

Coverage Type Comprehensive Plan Pays Basic Plan Pays
Type A – Cleanings, oral exams 100% of MAC 100% of MAC
Type B – Fillings 80% of MAC 60% of MAC
Type C – Bridges and Dentures1 50% of MAC not covered
Type D – Orthodontia 50% of MAC not covered
Deductible Comprehensive Plan2 Basic Plan3
Individual $50 $75
Family $150 $225
Annual Maximum Benefit Comprehensive Plan Basic Plan
Per Person $2,000 $750
Orthodontia Lifetime Maximum Comprehensive Plan4 Basic Plan
Per Person $1,000 not covered

MAC refers to the lesser of the amount charged by the dentist; or the maximum amount which the In-Network dentist has agreed to accept as payment in full for the dental service, subject to any co-payments, deductibles, cost sharing and benefit maximums.

  1. There is a waiting period of six months for all Type C services.
  2. Applies only to Type B and C Services.
  3. Applies only to Type Services.
  4. For a child under 19, or 23 if a full-time student*, if the orthodontic appliance is initially installed while dental insurance is in effect for such child.

 

* Dependent ages in Washington and Texas may vary; please refer to Certificate of Insurance.

 

The service categories shown above represent an overview of each plan’s benefits but are not a complete description of each plan. An insurance certificate describing all benefits and limitations will be made available following your plan’s effective date and will govern if any discrepancies exist between this overview and the certificate of insurance and group insurance policy.

Freedom to Choose Your Dentist

The MetLife plans enable you to see the dentist of your choice. However, if your dentist does not participate in the MetLife PDP Plus Network, your out-of-pocket expense may be higher. You will be responsible to pay any difference between the dentist’s fee and your plan’s payment.

If you receive services from a participating dentist, you are only responsible for the difference between the negotiated in-network fee and your plan’s payment.

MetLife participating dentists typically charge negotiated fees from 30-45% below the average fees charged by dentists in your area for the same or substantially similar services, helping you save money.1

For a list of participating dentists, visit www.metlife.com/dental or call 1-800-291-8480. If your current dentist is not a participant and you would like him/her to consider it, please have your dentist visit www.metdental.com or call 1-877-MET-DDS9 for an application. 2

  1. Based on internal analysis by MetLife. Savings from enrolling in a dental plan will depend on various factors, including how often participants visit the dentist and the costs for services rendered.
  2. Due to contractual requirements, MetLife is prohibited from soliciting certain providers.

Current members of the Air & Space Forces Association (AFA) and their spouse or partner and dependent children under age 19, or age 23 if a full-time student. Dependent ages in Washington and Texas may vary; please refer to Certificate of Insurance.

A member must be enrolled for coverage under this policy to enroll a spouse or dependents for coverage. A member may not elect coverage for his or her spouse if such spouse is covered as a member under the policy. No person can be unsured as a dependent of more than one member under the policy.

Coverage Effective Date

Your coverage will be effective on the first day of the month following receipt of your completed enrollment and premium payment.

Cancellation/Termination of Benefits

Coverage is provided under a group insurance policy (Policy form GPNP99 ASSN) issued by MetLife. Coverage terminates under any of the following conditions:

  • Your AFA membership ceases
  • Your dental contributions cease
  • Upon termination of the group policy by the Policyholder or MetLife or insurance ends for your class
  • Nonpayment of premium 
  • The Policyholder fails to perform any obligations under the policy

 

In addition, coverage for dependents ends if:

  • Your insurance ends
  • You die 
  • The group policy ends
  • The date dependents’ insurance ends under the group policy
  • Insurance ends for your class 
  • The covered person ceases to be a dependent
  • Premium is not paid for the dependent when due

 

Certain services in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after termination of coverage. These include completion of a prosthetic device, crown or root canal therapy.

Exclusions

Plan 1 does not cover the following services, treatments, and supplies:

  • Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards 
  • 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 you would not be required to pay in the absence of dental insurance 
  • Services or supplies received by you or your dependent before the dental insurance starts for that person 
  • Services not performed 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 and polishing of teeth or fluoride treatments
  • 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 picks, toothbrushes, or dental floss
  • 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 member or 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 or appliances
  • Prescription drugs
  • The following when charged by the dentist on a separate basis: claim form completion; infection control such as gloves, mask, and sterilization or supplies; or local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide
  • Dental service arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food
  • Services for which the submitted documentation indicates a poor prognosis
  • Caries susceptibility tests
  • Diagnosis and treatment of temporomandibular joint (TMJ) disorders
  • Initial installation of a denture to replace one or more natural teeth which were missing before such person was insured for dental insurance, except for congenitally missing natural teeth
  • 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 appliance
  • Replacement of a lost or stolen appliance or crown, inlay/onlay, or denture

 

Plan 2 does not cover the above services plus it also excludes Type C (Major) and Type D (Orthodontia) services.

Alternate Benefits

Where two or more professionally acceptable dental treatments for a dental condition exist, the MetLife Dental Plan bases reimbursement and the associated procedure charge on the least costly treatment alternative.

If you and your dentist have agreed on a treatment that is costlier than the treatment upon which the plan benefit is based, you will be responsible for any additional payment. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high-cost services such as crowns, bridges or dentures.

You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.

Payment Options

Once your insurance coverage has been approved, there are three methods of payment from which you may choose:

  • Monthly automated bank withdrawal. Payment options for monthly automated withdrawal from a checking or savings account.
  • Credit or debit card. You can choose monthly, quarterly, semiannual or annual payment when you pay by credit card or debit card.
  • Direct bill. You can choose to receive a monthly, quarterly, semiannual or annual premium notice in the mail.
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Not available in AK, DE, FL, ME, MD, MA, MT, NV, NM, NC, UT, WV and Puerto Rico.

 

 

Underwritten by:

Metropolitan Life Insurance Company
200 Park Avenue
New York, NY 10166
www.metlife.com

 

 

Administered by:

Forrest T. Jones & Company*
P.O. Box 418131
Kansas City, MO 64141-8131
www.ftj.com

 

* For Arizona residents, the administrator is Forrest T. Jones Consulting Company

 

Arkansas Insurance License #100107380
California Insurance License #0592939


This website explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between the website and the policy (Master Policy 74570-2-G), the terms of the policy apply.

All benefits are subject to the terms and conditions of the policy. Policies underwritten by Metropolitan Life Insurance Company detail exclusions, limitations, and terms under which the policies may be continued in full or discontinued.

Complete details are in the certificate of insurance issued to each insured individual and the Master Policy issued to the policyholder.

This program may vary and may not be available to residents of all states.

Like most group benefit programs, benefit programs 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.
 

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