Dental Health Maintenance Organization (HMO) / Managed Care

Safeguard
State of California
Dental Health Maintenance Organization (HMO) / Managed Care

Dental Health Maintenance Organization (HMO) / Managed Care

Keep your smile and your bank account healthy

The State offers two dental benefits plans through SafeGuard. Check with your Human Resource contact to verify which plan(s) is available to you.

With these plans you have no co-payments for cleanings, x-rays, or exams, no deductibles, and no claims to file. Check out the plans below:

State of California Standard Dental Plan (SOC Standard)
State of California Enhanced Dental Plan (SOC Enhanced)
Summary of Dental Benefits and Coverage Disclosure Matrix (SOC Standard)
Summary of Dental Benefits and Coverage Disclosure Matrix (SOC Enhanced)
Summary of Dental Benefits and Coverage Disclosure Matrix (SOC Enhanced – Retirees)

To access a video that will help you better understand your DHMO benefits, click here." Have "Click here" link to the video

State of California - DHMO Insurance

If you are an active employee and have questions, you can contact your Personnel/Human Resources Office or contact SafeGuard at 1-800-880-1800.

If you are a retiree and have questions about your enrollment or eligibility, you can contact:
CalPERS Customer Service Center
1-888-CALPERS (1-888-225-7377)

RESOURCES

Having access to the dental care you and your family need to keep a healthy regimen is more important than you might think. In fact, more and more studies are finding links between your oral health and your overall health. That’s why we believe it’s important for a dental plan provider to go beyond offering the typical services by providing access to educational resources that help you and your dentist make better choices about your dental benefits.

Through the Oral Health Library,¹ you have access to valuable resources including:

Risk Assessment Guides for you and your child
Information about specific oral health diseases
FAQs about dental procedures

Dental Insurance FAQs

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MetLife’s Dental HMO/Managed Care option is as dental benefit plan that provides benefits when dental care is received by a provider or facility participating in the network. DHMO coverage is available if you live in parts of NY, NJ, CA, FL, or TX. Coverage is for in-network dentists only. Each family member must pre-select an in-network dentist in order to receive benefits. You can change dentists up to once a month. You pay a copay for the services you receive. In some locations, the name of MetLife’s wholly owned DHMO company, SafeGuard, will appear.²

In order to access care, you will need to pre-select a Dental HMO provider for yourself and any other covered person in your family. The participating dentist you select will provide your routine dental care. You may schedule an appointment with your dentist after you have pre-selected them and any time after your plan’s effective date. You need to confirm the selected dentist is accepting new patients.

Yes. You and your enrolled dependents can each select different participating dentists and may change dentists as often as once a month. Your transfer will be effective the first day of the next month. Change requests made after the 25^th of the month will be effective the first day of the second following month (e.g., a dentist change requested on March 28^th will go into effect on May 1^st). You should ensure any dental work-in-progress is completed prior to transitioning to a new dentist. Refer to your Schedule of Benefits and Evidence of Coverage for more details. These documents are state specific and can be found by logging onto www.metlife.com/mybenefits.

MetLife and its affiliates contract with both private practice dentists and those who are in a clinic environment. Every dentist who participates in the network has been thoroughly screened³ prior to acceptance. Participating dentists are also subject to regular audits, including onsite visits to the dental offices.

All dental offices that participate in the network provide information on how to obtain emergency care 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 Schedule of Benefits and Evidence of Coverage documents.

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 MetLife Customer Service in order to ensure that you can continue using your current facility under the plan. You can reach MetLife’s DHMO Customer Service by dialing 1-800-880-1800 from 8:00 am – 11:00 pm EST.

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 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.

In California, orthodontic and pedodontics 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.

Yes. If your current dentist does not participate in the DHMO/Manage Care network and you would like to encourage him or her to apply, ask your dentist to visit metdental.com, or call 1-866-PDP-NTWK for an application. The website and phone number are for use by dental professionals only. Due to contractual requirements, MetLife is prevented from soliciting certain providers.

The State may have a waiting period before you are eligible to enroll in the SafeGuard plans but there are no waiting periods once you enroll.

You do not need an ID card to receive dental services. However, all members will receive an ID card as part of the transition to MetLife. ID cards will have the member name on them only. If you have a covered spouse and/or dependent(s) enrolled their name will not appear on the dental ID card. This ID card will remain good for as long as you are enrolled in the DHMO plan administered by MetLife. New cards will not be sent each year. If your card is lost or damaged, you can obtain a replacement card by logging onto www.metlife.com/mybenefits and printing one.

Dentists will submit your claims for you which means you will have no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed.

You can reach MetLife’s Customer Service by dialing 1-800-880-1800 from 8:00 am – 11:00 pm EST.

¹ All information provided on this website is intended for your general knowledge only and is not a substitute for obtaining medical or dental advice for specific medical or dental conditions or other advice from your dentists or doctors. By making this website available to you, Metropolitan Life Insurance Company and its affiliates (collectively, “MetLife”) is not engaged in rendering any such advice. Use of this website is subject to all the terms stated herein. The website is developed, provided and maintained by Verifpoint. Insofar as the information provided on this website is from third parties or links to third party websites, it has no association whatsoever with MetLife, unless expressly stated.

² Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of the plan, how often participants visit a dentist and the cost of services rendered.

³ Certain providers may participate with MetLife through an agreement that MetLife has with a vendor. Providers available through a vendor are subject to the vendor’s credentialing process and requirements, not MetLife’s. If you should have any questions, contact MetLife Customer Service.

Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. You may be financially responsible for copayments, deductibles, or any other amounts in excess of those MetLife is required to pay for covered services as described in your dental certificate and/or policy. Ask your MetLife representative for costs and 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 HealthPlans, 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.