AFGE offers you the opportunity to enroll in a DHMO dental plan. Below are highlights of your plan to help you determine if a DHMO plan meets your needs. See your Schedule of Benefits documents at the bottom of the chart for complete benefit details.
|Dental HMO / Managed Care|
|How the Plan Works||
When you enroll in the Dental HMO/ Managed Care plan, you will pre-select a primary care dentist from the network to provide your day-to-day care. Except for Emergency Dental Services, out-of-network benefits are not available through the Dental HMO/Managed Care plan. Each enrolled family member may select a different participating dentist and has the ability to change dentists up to one time each month.
Out-of-pocket costs for covered services are based on copayments as listed in the plan's Schedule of Benefits below.
|Benefit Waiting Period||None|
|Copayments & Coinsurance||
$5 office visit copay.
Copayments for covered services may be considerably lower1 than your cost without a dental plan.
|Specialty Care||This plan features “Direct Referral”. Your selected participating dentists will provide you with the name of a network specialist. Just call that specialist to schedule your visit. No pre-authorization is required.2 Any copayment amount for specialty services is listed on your plan’s Schedule of Benefits.|
|Quality of Network Dentists||All dentists and specialists who participate
must meet well-established credentialing standards.
Please see your plan documents below for complete details.
|Exclusions and Limitations||Please see your plan documents below for complete details.|
|Complete Benefit Details|
1 Savings from enrolling in a group benefit program will depend on various factors, including how often participants visit the dentist and the costs for services received.
2 In California, orthodontic and pedodontic specialty services require pre-approval. Your selected participating dentist will contact SafeGuard for pre-approval. Once approved, your dentist will contact you with the name of a participating specialist.
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 group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact MetLife or your plan administrator for complete details.