Below are the most frequently asked questions about the dental benefit plans offered by Pasco County Schools:

Questions about the Dental HMO – SGC1027

Yes. 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. Each enrolled family member may select a different participating dentist and has the ability to change dentists up to one time each month. Please note: Except for Emergency Dental Services, out-of-network benefits are not available through this DMHO plan.

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 Evidence of Coverage located in the “Your Benefits” section of this site and in your enrollment materials 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 Evidence of Coverage located in your enrollment booklet, on the “Your Benefits” tab of this site, and on the Pasco Employee Benefits Department website.

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.

This is a “direct referral” plan which means your selected participating dentist will refer you to a participating specialist in your area – there is no need to wait for approval.* Any co-payment amount for services is listed on your Schedule of Benefits. This co-payment applies whether the services are provided by your selected participating general dentist or by a participating specialist.

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.

Yes. If your current dentist does not participate in the network, we will be happy to accept your nomination. Just call Customer Service, or to submit your nomination online, sign into MyBenefits and click the “Find a Dentist” link. Once submitted, we will contact that dentist with an invitation to join our dental network.

Your organization may have a waiting period before you are eligible to enroll in the plan but there are no waiting periods once you enroll.

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.

You have access to MyBenefits, our interactive website. It gives you instant access to find a new dentist, check eligibility, print an ID card, print plan information, or 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. Sign in on this site or at www.metlife.com/mybenefits.

Questions about the Dental PPO Plans

A participating dentist is a general dentist or specialist who has agreed to accept MetLife’s negotiated fees as payment in-full for services provided to plan participants. PDP fees typically range from 15-45%‡ below the average fees charged in a dentist’s community for the same or substantially similar services.

‡ Based on internal analysis by MetLife

There are over 125,000 participating PDP dentist locations nationwide, including over 30,000 specialist locations. To get a list of these participating PDP dentists, visit our online Find a Dentistwww.metlife.com/mybenefits, or call 1-800-942-0854 to have a list faxed or mailed to you.

All services defined under your group dental benefits plan are covered. Please review your Summary of Benefits to learn more.

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.

ay I choose a non-participating dentist?

Yes. You are always free to select the dentist of your choice. However, if you choose a dentist who does not participate in the MetLife PDP, your out-of-pocket expenses may be more, since you will be responsible to pay for any difference between the dentist’s fee and your plan’s payment for the approved service. If you receive services from a participating PDP dentist, you are only responsible for the difference between the PDP in-network fee for the service provided and your plan’s payment for the approved service. Please note: any plan deductibles must be met before benefits are paid.

Yes. If your current dentist does not participate in the PDP and you'd like to encourage him or her to apply, tell your dentist to visit www.metdental.com, or call 1-877-MET-DDS9 for an application. The website and phone number are designed for use by dental professionals only.

Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed. If you need a claim form, you can find one online at www.metlife.com/mybenefits or request one by calling 1-800-942-0854.

Yes. With pre-treatment estimates, you never have to wonder what your out-of-pocket expense will be. MetLife recommends that you request a pre-treatment estimate for services in excess of $300 (this often applies to services such as crowns, bridges, inlays, and periodontics). To receive a benefit estimate, simply have your dentist submit a request for pretreatment estimate online at www.metdental.com or call 1-877-MET-DDS9 (638-3379). You and your dentist will receive a benefit estimate (online or by fax) for most procedures while you’re still in the office, so you can discuss treatment and payment options, and have the procedure scheduled on the spot. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.

MyBenefits Login

Once you enroll, MyBenefits is there to help you manage your dental plan. It's your secure member website. You can review your plan information, check your claim history, download a claim form and more.

Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166.

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.

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.