Below are the most frequently asked questions about the two dental benefit plans offered by the City.
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.
This plan’s network includes both private practice dentists and those who are in a clinic environment. Every dentist in the network has been thoroughly screened prior to acceptance. Participating dentists are also subject to regular audits, including onsite visits to the dental offices. You can find the names, addresses, languages spoken and telephone numbers of participating dentists by searching our online Find a Dentist directory for the most up to date information.
Yes. You and your enrolled dependents may each select different participating dentists and may change dentists as often as once per month. You can change dentists for you and your enrolled dependents online or by calling Customer Service. Your transfer will be effective the first of the following month. Please note: you should ensure any dental work-in-progress is completed prior to transferring to a new dentist. Refer to your DHMO Evidence of Coverage for more information.
All participating dental offices 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 DHMO Evidence of Coverage.
While these facilities cannot accept new patients, you may not have to change dentists if you are currently a patient in one of those offices. It is important that you contact Customer Service in order to ensure that you can continue using your current facility under the plan.
Specialty care services are available only when the necessary treatment cannot be provided by your selected general dentist due to the severity of the problem. Your dentist has a list of participating specialty care providers in your area and will give you the information you need to make an appointment. There is no need to contact us for a referral.
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.
No. We will provide you with an ID card when you enroll, but it is not necessary to receive services. The card is not a guarantee of coverage or eligibility, but does highlight toll free numbers and the web address that can be used to access benefit information about your dental plan.
Your selected general dentist receives a list every month of all DHMO members enrolled in his or her practice and may also verify eligibility with us prior to your appointment.
If you would like a card, there is also a temporary ID card in the front of your enrollment kit, or you can print one from our interactive website.
No. You and your dependents may select different dentists. Just make sure you include the facility numbers on the Provider Selection Form for the facilities each family member has chosen. If your form is submitted without facility numbers, there could be a delay in being able to access care.
Our interactive website gives you instant access to find a new dentist, check eligibility, print an ID card, print plan information, and email Customer Service. There are no extra fees and no limitations on your use of this service, just a really convenient way to access your benefit information.
Important: The information you enter must be exactly as it appears on your ID card in order to register.
When you enroll in the CitiDent Dental PPO plan, you may choose to see any dentist in-network or out-of-network. Out-of-pocket expenses may be higher when using an out-of-network dentist.
The CitiDent Dental PPO plan has a calendar year maximum, a yearly deductible, and co-insurance for each type of procedure covered.
The calendar year maximum is $1,200 – this is the amount that can be paid in claims for each enrolled member of your family, each year.
The deductible is $50 per person with a maximum family deductible of $150. This is the amount you pay out-of-pocket before your claims will be paid. (The deductible is waived on any Preventive Services you may require.)
Co-insurance is the percentage the plan pays of the cost of dental treatment you receive.
No. The Dental PPO offers you the flexibility to choose any dentist in-network or out-of-network and still receive benefits. Out-of-pocket expenses may be higher when using an out-of-network dentist.
In most instances, your dental office staff will ask you to sign an assignment form that allows them to file the claim for you. Both you and your dentist will receive an Explanation of Benefits that details how the claim was paid.
If your dentist prefers that you file the claim, complete a standard claim form and submit it to:
SafeGuard Dental Claims
PO Box 981987
El Paso, TX 79998
Check your Certificate of Insurance for complete instructions.
Yes. MetLife’s negotiated fees with PDP (in-network) dentists extend to services not covered under your plan and services received after your plan maximum has been met. If you receive services from a PDP dentist that are not covered under your plan, you are only responsible for the PDP (in-network) fee.
We coordinate benefits with those you may be entitled to from other policies. Your combined benefits may pay up to, but no more than, the total covered expense.
Dental PPO benefits are underwritten by SafeHealth Life Insurance Company, a MetLife Company, Aliso Viejo, CA.
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.
† U.S. Dept. of Health and Human Services, Oral Health in America: A Report of the Surgeon General-Executive Summary. Rockville, MD: U.S. Dept. of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.