Dental HMO Insurance/Managed Care Plans

Yes. At the time of enrollment, you will select two participating dentists. This will help ensure you are able to receive the care you need if your first choice is unable to accept new members. The participating dentist you select at enrollment will provide your routine dental care. You may schedule an appointment with your dentist anytime after your plan’s effective date.

You can find the names, addresses, languages spoken and telephone numbers of participating dentists by searching our online Find a Dentist directory.

Please refer to your Schedule of Benefits to locate the plan name to be used in the search.

MetLife and its affiliates contracts with dentists who work in private practices and clinics. Every dentist who participates in the network has been thoroughly screened prior to acceptance. Participating dentists are also subject to regular audits, including onsite visits to their offices.

Yes. You and your enrolled dependents can each select different participating dentists and may change dentists as often as once per month. As long as you are registered with the MyBenefits website, you can conveniently change dentists online. Your transfer will be effective the first of the following month. Please note: any requests made after the 25^th of the month will change effective the first of the following month (e.g., a facility change requested on March 28 will go into effect on May 1). You should ensure any dental work in progress is completed prior to transitioning to a new dentist. Refer to your Evidence of Coverage included with your enrollment materials for more information.

The Schedule of Benefits includes covered services, information on any limitations and additional charges for certain procedures, and services that are not covered by the plan. It’s important that you review this information before you see your dentist for the first time.

All dental offices that participate in our network provide emergency access 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 the Evidence of Coverage located in your enrollment materials. Or you may click below to view the information specific to your state.

• California
  • Emergency Dental Care means dental screening, examination, and evaluation by a dentist, or, to the extent permitted by applicable law, by appropriate personnel under the supervision of a dentist to determine if an Emergency Dental Condition exists, and, if it does, the care and treatment necessary to relieve or eliminate the Emergency Dental Condition.
  • All selected General Dental Offices provide treatment for Emergency Dental Conditions twenty-four (24) hours a day, seven (7) days a week, and We encourage the Member to seek care from the selected General Dental Office. If treatment for an Emergency Dental Condition is required, the Member may go to any dental provider, go to the closest emergency room, or call 911 for assistance, as necessary. Prior authorization is not required.
  • The reimbursement from Us for treatment for an Emergency Dental Condition, if any, is limited to the extent the treatment the Member received directly relates to the evaluation and stabilization of the Emergency Dental Condition. All reimbursements will be allocated in accordance with the group contract, subject to any exclusions and limitations. Hospital charges and/or other charges for care received at any hospital or outpatient care facility are not Covered Services.
  • If the Member receives treatment for an Emergency Dental Condition, the Member will be required to pay the charges to the dentist and submit a claim to SafeGuard for a benefits determination. If the Member seeks treatment for an Emergency Dental Condition from a provider located more than 50 miles away from the selected General Dentist, the Member will receive coverage for the treatment of the Emergency Dental Condition up to a maximum of $50.
  • To be reimbursed for treatment of an Emergency Dental Condition, the Member must notify Us after receiving such treatment. If the Member’s physical condition does not permit such notification, the Member must make the notification as soon as it is reasonably possible to do so. Please include your name, ID number, address and telephone number on all requests for reimbursement.
     
• Florida
  • Emergency Dental Care means procedures administered in a dentist’s office, dental clinic, or other comparable facility, to evaluate and stabilize dental conditions of a recent onset and severity accompanied by excessive bleeding, severe pain, or acute infection that would lead a reasonably prudent lay person possessing average knowledge of dentistry to believe that immediate care is needed.
  • All Selected General Dental Offices provide treatment for Emergency Dental Conditions twenty-four (24) hours a day, seven days a week and We encourage You or Your dependent to seek care from Your Selected General Dental Office. If treatment for an Emergency Dental Condition is required, You or Your dependent may go to any dental provider, go to the closest emergency room, or call 911 for assistance, as necessary. Prior authorization is not required.
  • Your reimbursement from Us for treatment for an Emergency Dental Condition, if any, is limited to the extent the treatment You or Your dependent received directly relates to the evaluation and stabilization of the Emergency Dental Condition. All reimbursements will be allocated in accordance with the group contract, subject to any exclusions and limitations. Hospital charges and/or other charges for care received at any hospital or outpatient care facility are not Covered Services.
  • If You or Your dependent receive treatment for an Emergency Dental Condition, You will be required to pay the charges to the Dentist and submit a claim to Us for a benefits determination. If You or Your dependent seek treatment for an Emergency Dental Condition from a provider located more than fifty (50) miles away from Your or Your dependent’s Selected General Dentist, You or Your dependent will receive coverage for the treatment of the Emergency Dental Condition up to a maximum of fifty dollars ($50).
  • To be reimbursed for treatment of an Emergency Dental Condition, You must notify Us after receiving such treatment. If You or Your dependent’s physical condition does not permit such notification, You must make the notification as soon as it is reasonably possible to do so. Please include your name, ID number of the person who received treatment, address and telephone number on all requests for reimbursement.
     
• Texas
  • All SafeGuard Selected General Dental Offices and Specialty Care Dentists provide emergency dental services twenty-four (24) hours a day, seven (7) days a week. In the event of a dental emergency, simply contact Your Selected General Dentist who will make arrangements for emergency dental care, including the treatment and stabilization of an Emergency Dental Condition.
  • If You cannot reach Your Selected General Dentist or SafeGuard’s Customer Service., you may obtain emergency dental services from any Dentist. SafeGuard will provide coverage for the following emergency dental services without regard to whether the Dentist or provider furnishing the services has a contractual or other arrangement to provide services to covered individuals:
  • Examples of dental emergency treatment include procedures. administered in a Dentist’s office, dental clinic, or other comparable facility, to evaluate and stabilize dental conditions of a recent onset and severity accompanied by excessive bleeding, severe pain, or acute infection that would lead a prudent layperson to believe that immediate care is needed.
  • If medically necessary covered dental services are not available through a Selected General Dentist or Specialty Care Dentist, SafeGuard will, within the time appropriate to the circumstances relating to the delivery of the services and the condition of the patient, but in no event more than five (5) business days after receipt of reasonably requested documentation, allow a referral to an Out-of-Network Dentist and shall fully reimburse the Out-of-Network Dentist at the Reasonable and Customary Charge or an agreed upon rate.
  • Dental screening examinations and other evaluations required by state or federal law, which are necessary to determine whether an Emergency Dental Condition exists.
  • Necessary emergency dental care services, including the treatment and stabilization of an Emergency Dental Condition.
  • Services originating in a dental office following treatment or stabilization of an Emergency Dental Condition, providing a prudent layperson possessing an average knowledge of medicine and health has made inquiry to and received authorization from SafeGuard for the post stabilization services. SafeGuard shall respond to the treating Dentist within the time appropriate to the circumstances relating to the delivery of the services and the condition of the Member, but in no case to exceed one (1) hour.
     
• New York
  • Emergency Dental Care means dental screening, examination, and evaluation by a Dentist, or, to the extent permitted by applicable law, by appropriate personnel under the supervision of a Dentist to determine if an Emergency Dental Condition exists, and, if it does, the care and treatment necessary to relieve or eliminate the Emergency Dental Condition.
  • All Selected General Dental Offices provide treatment for Emergency Dental Conditions twenty-four hours a day, seven days a week and We encourage You or Your Dependent to seek care from Your Selected General Dental Office. If treatment for an Emergency Dental Condition is required, You or Your Dependent may go to any dental provider, go to the closest emergency room, or call 911 for assistance, as necessary. Prior authorization is not required.
  • Your reimbursement from Us for treatment for an Emergency Dental Condition, if any, is limited to the extent the treatment You or Your Dependent received directly relates to the evaluation and stabilization of the Emergency Dental Condition. All reimbursements will be allocated in accordance with the group contract, subject to any exclusions and limitations. Hospital charges and/or other charges for care received at any hospital or outpatient care facility are not Covered Services.
  • If You or Your Dependent receive treatment for an Emergency Dental Condition, You will be required to pay the charges to the Dentist and submit a claim to Us for a benefits determination. If You or Your Dependent seek treatment for an Emergency Dental Condition from a provider located more than 25 miles away from Your or Your Dependent's Selected General Dentist, You or Your Dependent will receive coverage for the treatment of the Emergency Dental Condition up to a maximum of $50.
  • To be reimbursed for treatment of an Emergency Dental Condition, You must notify Us after receiving such treatment. If You or Your Dependent's physical condition does not permit such notification, You must make the notification as soon as it is reasonably possible to do so. Please include your name, family ID number, address and telephone number on all requests for reimbursement.
     
• New Jersey
  • Emergency Dental Care means dental screening, examination, and evaluation by a Dentist, or, to the extent permitted by applicable law, by appropriate personnel under the supervision of a Dentist to determine if an Emergency Dental Condition exists, and, if it does, the care and treatment necessary to relieve or eliminate the Emergency Dental Condition.
  • All Selected General Dental Offices provide treatment for Emergency Dental Conditions twenty-four (24) hours a day, seven (7) days a week and We encourage You or Your Dependent to seek care from Your Selected General Dental Office. If treatment for an Emergency Dental Condition is required, You or Your Dependent may go to any dental provider, go to the closest emergency room, or call 911 for assistance, as necessary. Prior authorization is not required.
  • Your reimbursement from Us for treatment for an Emergency Dental Condition, if any, is limited to the extent the treatment You or Your Dependent received directly relates to the evaluation and stabilization of the Emergency Dental Condition. All reimbursements will be allocated in accordance with the group contract, subject to any exclusions and limitations. Hospital charges and/or other charges for care received at any hospital or outpatient care facility are not Covered Services.
  • If You or Your Dependent receive treatment for an Emergency Dental Condition, You will be required to pay the charges to the Dentist and submit a claim to Us for a benefits determination. If You or Your Dependent seek treatment for an Emergency Dental Condition from a provider located more than 25 miles away from Your or Your Dependent's Selected General Dentist, You or Your Dependent will receive coverage for the treatment of the Emergency Dental Condition up to a maximum of $50.
  • To be reimbursed for treatment of an Emergency Dental Condition, You must notify Us after receiving such treatment. If You or Your Dependent's physical condition does not allow for such notification, You must make the notification as soon as it is reasonably possible to do so. Please include your name, family ID number, address and telephone number on all requests for reimbursement.

If your selected participating dentist determines that you need specialty care, you have access to a network of specialty care providers. Most plans are Direct Referral Plans―your selected participating dentist will provide you with the name of a network specialist. Because no pre-authorization is required, you can just call that specialist to schedule your visit.*

Co-payment amounts for specialty services are listed on your Schedule of Benefits.

Yes. Just contact Customer Service to let us know that you would like another clinical opinion, and we will provide the name of a dentist for you to see.

We are dedicated to protecting your right to privacy.

If you would like to authorize someone, such as a spouse, relative or friend to help you with matters concerning your dental benefits, please click on the Dental HIPAA Authorization for Disclosure of Personal Health Information.

Note that the completion and return of this authorization is completely voluntary. This will allow us to release information about your dental benefits, including health information to the person(s) authorized by you. Please remember this authorization concerns your personal records and can only be signed by you or your legal representative (such as a power of attorney, guardian or conservator).