It’s important to get the dental coverage you and your family need. Gulfstream’s Dental HMO plan offers you valuable features that are sure to keep you smiling.
Your Dental HMO benefit plan provides you with access to essential dental care while helping to protect you against the rising costs of dental services. The copayments may be considerably lower than your cost would be without this dental plan1. For a full listing of all covered services and copayments, please refer to the Schedule of Benefits below.
Participating general dentists and specialists must meet well-established credentialing standards. Each dentist and specialist is pre-screened and subject to regular audits, including onsite visits to the dental offices. Remember that each enrolled family member may select a different participating general dentist.
Because dental care can be an important part of good overall health, we provide you access to valuable tools that can help you and your dentist make informed decisions about your dental benefits and oral health.
With this benefits plan, you don’t have to worry about deductibles, yearly maximums or filling out paperwork for claims. All you have to do is select a participating dentist at enrollment. Then just call to schedule your appointment after your plan’s effective date. When you receive dental services from your selected dentist, you are only responsible for the copayment for any covered services received.
Plus, if you need specialty care, no problem. Your selected participating dentist will provide you with the name of a participating specialist1. Just call that specialist to schedule your appointment. Any copayment amount for services is listed on your Schedule of Benefits. This copayment applies whether the services are provided by your selected participating general dentist or by a participating specialist.
The Nexus 150 plan offered by your organization includes the following:
No calendar year maximum, no yearly deductions, no claim forms, and no waiting period.
Your basic care is provided by a general dentist you select at enrollment from the participating dentist directory.
You can change dentists during the year – changes are effective on the first of the month following the change request (if they are received and processed by the 27th of the month).
Each enrolling family member may select a different general dentist (remember to include the chosen facility numbers when completing the enrollment form).
Covered procedures and your copayments are listed on the Schedule of Benefits provided below.
Adult & child orthodontics are covered benefits.
This plan uses direct referral for most specialty care. If your general dentist determines you are required the services of an oral surgeon, endodontist or periodontist, he or she will refer you directly to a SafeGuard contracted specialty care provider.There is no need for a pre-authorization. Orthodontic and pedodontic specialty care will require a pre-authorization from SafeGuard, which your general dentist will facilitate.2
You have only one opportunity each year to change plans and that’s at open enrollment. Important enrollment tips to remember:
Review the Schedule of Benefits and Evidence of Coverage before making your decision. They have important information that will help you get the most from your dental benefits. If after reviewing the plan documents you have any questions our Customer Service Representatives will be happy to assist you.
Remember to select a general dentist from the participating dentist directory for you and each of your enrolling family members.
Write the Facility Number in the space allotted on your enrollment form.
When you enroll, you will pre-select a general dentist using the list of participating dentists. To search the directory of participating dentists:
Visit our Find a Dentist directory.
Select "Dental Health Maintenance Organization (DHMO)" as your plan type, and enter Nexus 150 as the plan name (this does not commit you to the plan; you can do another search using the alternate plan if you are undecided).
Search and filter results by city, county, ZIP code, or by a particular dentist's name.
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.