GROUP DENTAL INSURANCE: Enrollment Available Immediately. No Underwriting Required
The FPA group dental plan is provided by MetLife (Metropolitan Life insurance Company) – a leading global provider of dental insurance. Get the protection you need in maintaining your oral and overall health while making it easier and more affordable to see your dentist regularly. Take advantage of competitive group rates offered through your association membership. Features of the plans:
Instructions on how to use the RATE CHART:
To determine the appropriate premium rates, look up the state of residence on page 1 of the Area Schedule, if applicable, look up the 3-digit zip code. Use the Area number that applies to your state/zip to determine the premium rate from the page 2 Dental Rate Addendum.
Monthly premiums are specific to your demographics, plans, and ZIP codes. Rates are subject to change.
Download the Dental High and Low Plan Summary here.
Visit MetLife Dental Insurance to find a provider.
The FPA group dental plan is provided by MetLife (Metropolitan Life insurance Company) – a leading global provider of dental insurance. Get the protection you need in maintaining your oral and overall health while making it easier and more affordable to see your dentist regularly. Take advantage of competitive group rates offered through your association membership. Features of the plans:
- Two national Dental PPO plans available to you. Pick the plan that is right for you.
- DHMO plan available to those in New York, Texas, Florida and California.
- Coverage is effective on the first of the month following enrollment.
- All preventive care — periodic exams and cleanings — is covered immediately up to 100% with no waiting period and no deductible up to the plan maximums. Basic Restorative care is also covered with no waiting period. Major Restorative and Orthodontia are covered after a twelve-month waiting period.
- One of the largest dental PPO networks, PDP Plus Network (MetLife's Preferred Dentist Program).
Instructions on how to use the RATE CHART:
To determine the appropriate premium rates, look up the state of residence on page 1 of the Area Schedule, if applicable, look up the 3-digit zip code. Use the Area number that applies to your state/zip to determine the premium rate from the page 2 Dental Rate Addendum.
Monthly premiums are specific to your demographics, plans, and ZIP codes. Rates are subject to change.
Download the Dental High and Low Plan Summary here.
Visit MetLife Dental Insurance to find a provider.
HOW TO APPLY
To begin your application, click on the link below. You will be directed to the Ryan Insurance Strategy Consultants application website. Be sure to answer all questions related to the application to the best of your knowledge.
To begin your application, click on the link below. You will be directed to the Ryan Insurance Strategy Consultants application website. Be sure to answer all questions related to the application to the best of your knowledge.
CUSTOMER SERVICE PORTAL
Visit our customer service portal to view your policy information, update your personal information, change the bank account used to pay your premiums and update your monthly earnings for your disability policy(s). Once on the customer service portal homepage, click the red button to download the user guide and information on how to register. If you have additional service and/or administrative questions you can call the customer service center at: (866)809-3899 or email the customer service center at: [email protected]. The customer service center fax number is: (816)-968-0660.
COVERAGE DETAILS AND FEATURES
Eligibility
All active members of the FPA association and their employees, working 20 hours per week.
Calendar Year Deductible
Low PPO Plan: There is a $50 per person deductible ($150 family maximum), which is waived for preventive and diagnostic treatment. The deductible is applied against insurance-covered expenses, not billed charges.
High PPO Plan: There is a $25 person deductible ($75 family maximum), which is waived for preventive and diagnostic treatment. The deductible is applied against insurance-covered expenses, not billed charges.
Managed Dental Plan Option: Only available to those members who reside in: Texas, New York, Florida and California.
Dependent Child Definition: A Child is covered up to age 26, A student is covered up to age 26.
Maximum Benefits
Low Plan: The insured member and covered dependents are entitled to receive up to $1,500 each in payments in any calendar year for dental procedures performed.
High Plan: The insured member and covered dependents are entitled to receive up to $2,000 each in payments in any calendar year for dental procedures performed.
Orthodontia
Available only with the High Plan. Children only. Children are covered for orthodontia to age 19.
The Lifetime Maximum Benefit for Orthodontia is $1,500.
Participating Dentists
As part of the PDP Plus network, insured members have the freedom to choose from a list of participating dentists and specialists for the MetLife Preferred Dentist Program, a Dental PPO plan. Insured members can visit any licensed dentist or specialist; however, your out-of-pocket costs are usually lower when you go to a participating dentist.
No Waiting Period for Preventive Care and Basic Restorative Care
Coverage is effective on the 1st of the next month after enrollment. Preventive care and Basic Restorative care benefits are payable immediately from the effective date. Major Restorative procedures are covered after a twelve-month waiting period. Orthodontia procedures are covered, on the High-plan only, after a twelve-month waiting period.
Cancelation of coverage – Lifetime lockout to re-enroll
There is a lifetime lockout for those who cancel coverage and wish to re-enroll at a later date.
Eligibility
All active members of the FPA association and their employees, working 20 hours per week.
Calendar Year Deductible
Low PPO Plan: There is a $50 per person deductible ($150 family maximum), which is waived for preventive and diagnostic treatment. The deductible is applied against insurance-covered expenses, not billed charges.
High PPO Plan: There is a $25 person deductible ($75 family maximum), which is waived for preventive and diagnostic treatment. The deductible is applied against insurance-covered expenses, not billed charges.
Managed Dental Plan Option: Only available to those members who reside in: Texas, New York, Florida and California.
Dependent Child Definition: A Child is covered up to age 26, A student is covered up to age 26.
Maximum Benefits
Low Plan: The insured member and covered dependents are entitled to receive up to $1,500 each in payments in any calendar year for dental procedures performed.
High Plan: The insured member and covered dependents are entitled to receive up to $2,000 each in payments in any calendar year for dental procedures performed.
Orthodontia
Available only with the High Plan. Children only. Children are covered for orthodontia to age 19.
The Lifetime Maximum Benefit for Orthodontia is $1,500.
Participating Dentists
As part of the PDP Plus network, insured members have the freedom to choose from a list of participating dentists and specialists for the MetLife Preferred Dentist Program, a Dental PPO plan. Insured members can visit any licensed dentist or specialist; however, your out-of-pocket costs are usually lower when you go to a participating dentist.
No Waiting Period for Preventive Care and Basic Restorative Care
Coverage is effective on the 1st of the next month after enrollment. Preventive care and Basic Restorative care benefits are payable immediately from the effective date. Major Restorative procedures are covered after a twelve-month waiting period. Orthodontia procedures are covered, on the High-plan only, after a twelve-month waiting period.
Cancelation of coverage – Lifetime lockout to re-enroll
There is a lifetime lockout for those who cancel coverage and wish to re-enroll at a later date.
Exclusions and Limitations for the High Plan (Please see your Certificate for a full list of Exclusions)
For example, we will not pay Dental Insurance benefits for changes incurred for:
For example, we will not pay Dental Insurance benefits for changes incurred for:
- 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.
- 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.
- 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.
Exclusions and limitations for the Low Plan:
- 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.
DHMO Features (for members who reside in Florida, Texas, New York and California only)
MANAGED DENTAL PLAN
MANAGED DENTAL PLAN
Code |
Discription |
Co-Payment |
Office Visit |
Copay |
$5 |
D0120 D0150 D0210 D0274 D0330 |
Periodic Oral Evaluation – established patient Comprehensive Oral Evaluation – New or Established Patient Intraoral – Complete Series of Radiographic Images Bitewings – Four Radiographic Images Panoramic Radiographic Image |
$5 $0 $0 $0 $0 $0 |
Preventive Services |
Description |
Co-Payment |
D1110 D1120 D1351 |
Prophylaxis – Adult Prophylaxis – Child Sealant – per tooth |
$0 $0 $0 |
Restorative Services |
Description |
Co-Payment |
D2140 D2330 D2391 |
Amalgam – One Surface, Primary or Permanent Resin-Based Composite – One Surface, Anterior Resin-Based Composite – One Surface Posterior |
$10 $10 $30 |
Crowns |
Description |
Co-Payment |
D2750 D2751 |
Crown-Porcelain Fused to High Noble Metal Crown-Porcelain Fused to Predominantly Base Metal |
$185 $185 |
Endodontics |
Description |
Co-Payment |
D3220 D3330 |
Therapeutic Pulpotomy (excluding final restoration)-removal of pulp coronal to the dentinocemental junction and application of medicament Endodontic therapy, Molar (excluding final restoration) |
$10 $200 |
Periodontics |
Description |
Co-Payment |
D4260 D4341 D4381 D4910 |
Osseous Surgery (Including Flap Entry and closure) – Four or more contiguous teeth or tooth bounded spaces per quadrant Periodontal scaling and root planing – Four or more teeth per quadrant Localized delivery of antimicrobial agents via controlled release vehicle into diseased crevicular tissue, per tooth Periodontal Maintenance |
$295 $40 $60 $30 |
Prosthodontics |
Description |
Co-Payment |
D5110 D5120 D5211 D5212 |
Complete Denture - Maxillary Complete Denture - Mandibular Maxillary partial denture – resin base (including, retentive/clasping materials, rests, and teeth) Mandibular partial denture – resin base (including, retentive/clasping materials, rests, and teeth) |
$210 $210 $240 $240 |
Implants |
Description |
Co-Payment |
D6010 D6059 |
Surgical placement of implant body: endosteal implant Abutment supported porcelain fused to metal crown (high noble metal) |
$1,005 $660 |
Crowns / Fixed Bridges |
Description |
Co-Payment |
D6241 D6750 |
Pontic – Porcelain fused to predominantly base metal Retainer Crown - Porcelain fused to high noble metal |
$185 $185 |
Oral Surgery |
Value |
Co-Payment |
D7140 D7210 D7220 D7240 |
Extraction, erupted tooth or exposed root (elevation and/or forceps removal) Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated Removal of impacted tooth – soft tissue Removal of impacted tooth – completely bony |
$0 $30 $45 $80 |
Orthodontics |
Description |
Co-Payment |
D8020 D8030 D8040 D8070 D8080 D8090 |
Limited orthodontic treatment of the transitional dentition Limited orthodontic treatment of the adolescent dentition Limited orthodontic treatment of the adult dentition Comprehensive orthodontic treatment of the transitional dentition Comprehensive orthodontic treatment of the adolescent dentition Comprehensive orthodontic treatment of the adult dentition |
$725 $725 $725 $1,695 $1,695 $1,695 |
Adjunctive General Services |
Description |
Co-Payment |
D9110 |
Palliative (emergency) treatment of dental pain – minor procedure |
$0 |
D9310 |
Consultation – diagnostic service provided by dentist or physician other than requesting dentist or physician |
$0 |
RATES: You will find MONTHLY PREMIUMS specific to your demographics, plans and ZIP codes at the APPLY NOW button at the top. After you enter your ZIP code, plan selection and family demographics, you will find the MONTHLY PREMIUMS applicable.
The above description is only a summary of the Managed Dental Plan being offered. A complete copy of all the terms, conditions, limitations and exceptions of the Managed Dental Plan can be found in the Policy Certificate.
The above description is only a summary of the Managed Dental Plan being offered. A complete copy of all the terms, conditions, limitations and exceptions of the Managed Dental Plan can be found in the Policy Certificate.
|
Underwritten by:
Metropolitan Life Insurance Company 200 Park Avenue New York, New York 10166 |
Administration by:
Forrest T. Jones and Company, Inc. 3130 Broadway Kansas City, Missouri 64111 |
The Group Dental plan is made available through the FPA professional association. This fact sheet merely describes the coverage and is not a contract of insurance. Complete terms and conditions are listed in the Group Policy issued to the FPA by Metropolitan Life Insurance Company. Each insured member will receive a Certificate of Insurance outlining his or her coverage under the plan.
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 Limited 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.
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.
L0822025450[exp0824][All States][DC,GU,MP,PR,VI] © 2022 MSS
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 Limited 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.
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.
L0822025450[exp0824][All States][DC,GU,MP,PR,VI] © 2022 MSS