Frequently Asked Questions

Get answers to your questions about the MetLife VA Dental Insurance Program

FAQ for Members enrolled pre-2/1/17
When is the New VADIP program effective?

The new VADIP program is effective on December 1st, 2017, with enrollment starting on November 15, 2017.

Can I enroll in the New VADIP program before my VADIP Pilot plan expires?

Yes. All eligible Veterans can enroll in the new VADIP program, beginning on November 15th, 2017 for the effective date of December 1, 2017.

How do I enroll in the new VADIP program, if I’m still enrolled in the VADIP Pilot program?

In order to enroll in the new VADIP program prior to February 1, 2018, the Members enrolled in the Pilot VADIP must first cancel their Pilot program membership. This can be expedited by contacting our call center.  Our representatives will process both the enrollment and cancellation at the same time, to ensure that your dental insurance coverage remains in force. If you take no action and do not cancel your Pilot VADIP coverage, that coverage will automatically terminate on January 31, 2018, and you will be automatically enrolled in the new VADIP program starting February 1, 2018.

I have enrolled in the VADIP Pilot and have been in it for less than 12 months, can I enroll in the new VADIP program before the 12 month lock-in is satisfied? Will I be penalized?

Yes, MetLife will waive the 12-month lock in period for Members who enroll in the new VADIP program with MetLife. Eligible Members can enroll in the new VADIP program, regardless of the amount of time contributed to their 12 month lock-in.  There will be no penalties associated with this change.  

My family is enrolled in the High Plan with Orthodontia coverage, but we have been in it less than 24 months, what do we need to do, to make sure that we get orthodontia coverage?

Should you decide to continue your VADIP enrollment with MetLife, we will credit you for the time you have contributed to the VADIP Pilot program, so that you can continue accruing time to satisfy the 24-month waiting period for Orthodontia benefits, or begin using your Orthodontia benefit with the new program. 

When is the Graduated Maximum earned under the New VADIP program?

The Garduated Maximum is a benefit introduced by MetLife to both Standard and High Plans.  This benefit rewards Members for their participation in MetLife’s VADIP plans, by increasing their annual maximum.  Once the member satisfies the 12 month enrollment period in their selected plan option, their annual maximum will increase on the next January 1. 

Please go to www.metlife.com/vadip to find out more about these incentives.

I’m an eligible Veteran, but my Spouse is not eligible for the New VADIP program, does MetLife offer a dental coverage where we both can enroll for dental coverage?

Dependents of Veterans, except those eligible under CHAMPVA, are not authorized to enroll in VADIP. Dependents may be eligible for separate coverage offered by MetLife that is not affiliated with VADIP or endorsed by the VA. Contact our Customer Service Representative for additional information.

MetLife VADIP Call Center:
1-888-310-1681
TDD: 888-638-4863
Monday - Friday 8am-11pm EST

What happens if I don’t take any action when the pilot ends on January 31, 2018?

If you take no action by January 31, 2018 we will automatically enroll you in the new VADIP program to ensure that you do not lose your dental insurance coverage.  If you do not want to continue in the VADIP program please contact us:

MetLife VADIP:
1-888-310-1681
TDD: 888-638-4863
Monday - Friday 8am-11pm EST

Where can I find out more information about MetLife’s VADIP program?

Please visit our MetLife VADIP website to find out more information about the new VADIP program: www.metlife.com/vadip.

You can also call our call center, and speak directly with one of our representatives:

MetLife VADIP:
1-888-310-1681
TDD: 888-638-4863
Monday - Friday 8am-11pm EST

Plan Information
Do you offer Orthodontia, and who can enroll?

Yes, MetLife's VADIP High Plan offers Orthodontia to children under the age of 19.  Please note that there is 24 month waiting period for Orthodontia services.  

How does the Veteran Affairs Dental Insurance Program (VADIP) work?

With the MetLife VADIP you receive a wide range of benefits if you and/or each eligible dependent visit an in-network dentist or choose to see an out-of-network dentist. In addition, referrals are not necessary for specialty care. When you visit an in-network dentist, you have the opportunity to make the most of your benefit plan because your out-of-pocket expenses may be lower. For further information about the VADIP, please visit the Veterans Affairs site at www.va.gov/healthbenefits/VADIP. Once you enroll in the VADIP dental program offered by MetLife, you and your eligible dependents must remain in the plan for a period of 12 months. The rates quoted at the time of enrollment are valid until the end of the calendar year.

Do my dependents have to visit the same dentist that I select?

No. You and your dependents each have the freedom to choose any dentist, in or out-of-network, at any time.

What services are covered by the VADIP Plan?

The services covered by the VADIP Plan are those defined under your group dental benefits plan located in the Plan Benefits section of this site.

How can I determine my Out of Pocket expenses?

MetLife recommends that you have your dentist submit a request for a pretreatment estimate for services in excess of $300. This often applies to services such as crowns, bridges, inlays, and periodontics. A pretreatment estimate of what services your plan will pay and at what payment level will be sent to you and your dentist. In addition, you can use the Procedure Fee Tool within MyBenefits to view MetLife procedure costs in a zip code area. Once you register, the Procedure Fee Tool is available within the Quick Links on the right hand side of the page or from the Tools and Resources tab.

What is the effective date of my coverage?

Your coverage will be effective on the first day of the month following the month of your enrollment.

What is a Graduated Maximum?

A Graduated Maximum is a feature of the plan that encourages participation in the plan by increasing your Annual Maximum by $500 (in the high plan option) or $200 (in the standard plan option), effective on January 1st, following the completion of 12 months of enrollment in your selected plan.

May I choose an out of network dentist?

Yes. You are always free to select the dentist of your choice. However, if you choose a dentist who does not participate in MetLife's Network, your out-of-pocket expenses may be higher, since you will be responsible for any difference between the dentist's fee and your plan's payment.

Provider
What is an in-network dentist and how do I find one?

An in-network dentist is a general dentist or specialist who participates in MetLife's PPO Network and has agreed to accept a negotiated fee for services rendered to eligible Veterans. This negotiated fee is typically 30% to 45% below the average fee charged by dentists for the same services in a given geographical area. Over 85% of U.S. dental offices participate in the MetLife Preferred Dentist Program PDP Plus Network.

Access a list of MetLife's in-network dentists now

Continued participation of any specific provider cannot be guaranteed. Thus, you should make coverage decisions based on the plan benefits, not based on a specific provider. When you call for an appointment, please remember to verify that the selected provider is currently in the MetLife PPO Network.

What if my dentist is not in the network?

We encourage you to consider using a MetLife in-network dentist to help maximize the value of your plan. Of course, you can visit any dentist and still receive some benefits under your plan although your out-of-pocket expenses may be higher. If your dentist does not participate in your network, it’s easy to submit a nomination online. Just complete the required information. Once submitted, we will contact that dentist with an invitation to join our dental networks.

Do my dependents have to visit the same dentist that I select?

No. You and your dependents each have the freedom to choose any dentist, in or out-of-network, at any time.

May I choose an out of network dentist?

Yes. You are always free to select the dentist of your choice. However, if you choose a dentist who does not participate in MetLife's Network, your out-of-pocket expenses may be higher, since you will be responsible for any difference between the dentist's fee and your plan's payment.

What is a negotiated fee*?

A negotiated fee refers to the maximum charge for a service that an in-network dentist may charge to VADIP Plan participants. These fees are typically 30% to 45% below the average fee charged by a dentist for the same services in your area. Your plan may reimburse you for all or part of this fee. When you use an in-network dentist, you are responsible only for the difference between your plan's benefits payment amount and the negotiated fee for the services rendered.

* Occasionally, there may be a service for which the dentist's fee is the same or less than the MetLife negotiated fee for that service.

Can an in-network dentist charge me his or her "usual" fee when a dental procedure is not covered under my dental plan?

An in-network dentist should not bill you for amounts that are in excess of the negotiated fees that your dentist has agreed to accept as payment for services. This rule applies even if services are not covered under your specific dental plan. You should always verify that your dentist is a MetLife in-network dentist at the time of your appointment. To search for an in-network dentist near your job or home (including a map and driving directions), use the Find a Dentist function on this site or call a MetLife Customer Service Specialist - 1-888-310-1681/TDD 1-888-638-4863.

Why aren't there any in-network dentists in my area?

Not all dental practices join a dental network. This may be due to their unique circumstances or a philosophical difference. 

How do I review my personal claim information?

Please access/register for the MyBenefits site from the home page. MyBenefits allows you to manage your benefits easily. You may view your claim and personal information.

Benefits
What services are covered by the plan?

The services covered by the Veterans Affairs Dental Plan are those defined under your group dental benefits plan located in the Plan Benefits section of this site.

What is my Explanation of Benefits (EOB) Statement?

An Explanation of Benefits (EOB) Statement is a summary of your processed claim or pretreatment estimate, including services rendered, costs, and benefits paid.

How will Orthodontic benefits be calculated?

Benefits for orthodontic treatment will be payable at 50% up to a lifetime maximum for only Dependent children who are enrolled in the High Option. Orthodontic benefits are subject to a 24-month waiting period which begins on the dependent child's effective date of coverage. Please refer to the Plan Benefits section for orthodontia coverage and details.

What is a Graduated Maximum?

A Graduated Maximum is a feature of the plan that encourages participation in the plan by increasing your Annual Maximum by $500 (in the high plan option) or $200 (in the standard plan option), effective on January 1st, following the completion of 12 months of enrollment in your selected plan.

What is MetLife Claim Review (MCR) and how does it work?

MetLife Claim Review is conducted by licensed Dentist Consultants who review the clinical documentation submitted by your treating dentist. These Dentist Consultants review this material checking for dental necessity for certain procedures such as crowns, bridges, onlays, implants, periodontal treatments, as well as other services. The Dentist Consultants may also recommend that an alternate benefit (please see below for the explanation of this benefit) be applied to a service in accordance with the terms of the plan. It is very important that these types of dental services are pre-estimated before services are provided, so that you and your dentist are aware of what the plan may pay for these services.

What is an Alternate Benefit and how does it work?

If MetLife determines that a less costly covered service other than the covered service the dentist performed, could have been performed to treat a dental condition, we will pay benefits based upon the less costly service if such services would produce a professionally acceptable result under generally accepted dental standards.

For example, when an amalgam filling and a composite filling are both professionally acceptable methods for filling a molar, or when a partial denture and fixed bridgework are both professionally acceptable methods for replacing multiple missing teeth in an arch we may base our benefit determination upon the amalgam filling or partial denture which is the less costly service.

If we pay benefits based upon a less costly service in accordance with this section the Dentist may charge you or your dependent for the difference between the service that was performed and the less costly service. This is the case even if the service is performed by an in-network dentist.

How long will it take to process my Dental claim?

The time it takes to process a claim depends on the type of service performed. Most claims flow through our system quickly and efficiently, with 99% being processed within 10 business days. If additional information is needed for a claim, it may take longer.

Who do I contact if I have any additional questions about dental coverage from MetLife?

MetLife is committed to making sure you have all the information you need to make the right decision for you and your family. If you'd like to know more about the MetLife VADIP Plan call us 1-888-310-1681 TDD 888-638-4863 8:00am to 11:00pm EST.

How do I stop receiving paper Explanation of Benefits (EOB) Statements at my home?

Sign into MyBenefits, click on the subscription button located at the top of the page, then select "Go Paperless".

If I elect to stop receiving paper Explanation of Benefits (EOB) Statements at my home, how do I view my EOB Statements? And can I still print them?

Once you turn off your paper Explanation of Benefits (EOB) Statements, you will receive email alerts to notify you when a Dental claim is processed. You can view and print your Dental Explanation of Benefits (EOB) Statements from MyBenefits. Your Dental Explanation of Benefits (EOB) Statement history will remain online for a minimum of two years plus the current year.

Is there a waiting period for services?

No, there is no waiting period for major services with the exception of a 24 month waiting period for orthodontic services. Only the High Option offers Orthodontia coverage and services are limited to dependent children only up to age 19. Dependent children receiving orthodontic services must be covered under the High option for the entire 24 month waiting period. If you change plan options, you will need to satisfy a new 24 month waiting period regardless of your plan history.

Are Orthodontia benefits available for adults?

No. Orthodontic care is only available for dependent children under age 19.

Do different procedures have different age limitations?

Yes. There are certain procedures with different age limitations. Please refer Plan Benefits section of this website for details.

Are implants covered under the plan?

Yes. Please refer Plan Benefits section of this website for details.

Enrollment
How does the Veteran Affairs Dental Insurance Program (VADIP) work?

With the MetLife VADIP you receive a wide range of benefits whether or not you and/or each eligible dependent visit an in-network dentist, plus referrals are not necessary for specialty care. But, when you visit an in-network dentist, you have the opportunity to make the most of your benefit plan because your out-of-pocket expenses may be lower. For further information about the VADIP, please visit the Veterans Affairs site at www.va.gov/healthbenefits/VADIP

Once you enroll in the VADIP dental program offered by MetLife, you and your eligible dependents must remain in the plan for a period of 12 months. The rates quoted at the time of enrollment are valid until the end of the calendar year.

How do I enroll?

You may enroll in the VADIP using the below options:

Online: visit MyBenefits

By Phone: call 1-888-310-1681 TDD 888-638-4863 8:00am EST to 11:00pm EST

By Mail: Please download, and print the enrollment form

Do I need an ID Card?

No, you do not need to present an ID card to prove coverage or confirm that you are eligible for the VADIP Plan. To access your online ID card, sign into MyBenefits and select "Get ID card" from the right navigation bar.

What do I need to do if I want to add a family member to my coverage?

If your dependents are eligible for VADIP coverage under CHAMPVA, they can enroll in the VADIP, even if the Veteran does not.

If you are a non-CHAMPVA Dependent:

  • While non-CHAMPVA dependents are not eligible for the MetLife VADIP, there is a comparable plan you may be able to enroll in. However, you must enroll along with an eligible Veteran.
  • If the eligible Veteran has already completed enrollment, he or she must contact us at the number below to add you to his or her plan.
  • Please note that unless they meet certain disability requirements, comparable coverage for children of Veterans is available up to the age of 22. Also, after the age of 19, dependents must provide proof that they are students.

 

Please call us at 1-888-310-1681 TDD 888-638-4863 from 8:00am EST to 11:00pm EST.

Why am I having trouble enrolling online?

If you are a Veteran:

  • You must apply with the VA to be eligible for the VA health care benefits. Please visit www.va.gov/healthbenefits for more information.
  • If you just enrolled with the VA for health care benefits, it could take up to 10 days to receive your eligibility information.
  • If you are eligible, you may enroll yourself and up to 9 dependents online.
  • If you have more than 9 dependents, please call 1-888-310-1681 to enroll.

 

If you are a CHAMPVA Dependent:

  • You must apply with the VA to be eligible for the VA health care benefits. Please visit www.va.gov/healthbenefits for more information.
  • If you just enrolled with the VA for health care benefits, it could take up to 10 days to receive your eligibility information.
  • You must be at least 18 years or older to self-enroll. If you are under 18, a parent or legal guardian must complete the enrollment process for you.
  • Please note that unless they meet certain disability requirements, CHAMPVA dependents are eligible for coverage up to the age of 19 or up to the age of 23 if a full time student.

 

If you are a non-CHAMPVA Dependent:

  • While non-CHAMPVA dependents are not eligible for the MetLife VADIP, there is a comparable plan you may be able to enroll in. However, you must enroll along with an eligible Veteran.
  • If the eligible Veteran has already completed enrollment, he or she must contact us at the number below to add you to his or her plan.
  • Please note that unless they meet certain disability requirements, comparable coverage for children of Veterans is available up to the age of 22. Also, after the age of 19, dependents must provide proof that they are students.

 

If you are a non-dependent caregivers/family members:

  • If you would like to enroll a Veteran or a dependent, you may register with your information. After registration, you will be asked to provide the beneficiary's information to confirm eligibility.

 

Please note that once you complete the enrollment process online, to cancel or make changes to coverage you must contact us at the information below.

Contact MetLife VADIP:
1-888-310-1681
TDD: 888-638-4863
Monday - Friday 8am-11pm EST

What happens when my dependent child, ages out, but they are a full-time student?

A child loses eligible status when they turn 18, unless enrolled in an accredited school as a full-time student.  

To establish student status, and retain CHAMPVA eligibility, an unmarried child between the ages of 18 and 23 must attend school full time. Schools include, but are not limited to, high school, vocational/technical schools, and undergraduate, graduate or postgraduate levels of study. The student can remain eligible for CHAMPVA until the date of graduation or until his or her 23rd birthday, whichever comes first. 

CHAMPVA will send a letter to the student 90 days prior to his or her 18th birthday that provides notification of the potential change in CHAMPVA eligibility. This letter will also outline the steps necessary to extend CHAMPVA eligibility: 

To avoid an interruption of CHAMPVA benefits for the summer break between high school and the first term of the continuing education program, the student must send us proof of intent to continue his or her education (e.g., a letter of acceptance from the educational institution). Once we receive that letter, we will cover the break between high school and the start of the first term of the continuing full-time education program. 

Within one month after the first term begins, the student must submit a school certification verifying full-time enrollment. If CHAMPVA does not receive verification, benefits will be terminated and any payments made by CHAMPVA after the student turned 18 will be subject to recoupment. The certification letter should be on school letterhead and include: 

  • Student’s full name, 
  • Student’s Social Security number, 
  • Exact beginning date and ending date of school term (month, date, year), 
  • Projected graduation date (month, year), 
  • Number of semester hours or equivalent certification of full-time status and 
  • Title and signature of a school official. 

 

Can my non-CHAMPVA eligible dependents, enroll in VADIP?

Dependents of Veterans, except those eligible under CHAMPVA, are not authorized to enroll in VADIP. Dependents may be eligible for separate coverage offered by MetLife that is not affiliated with VADIP or endorsed by the VA. Contact our Customer Service Representative for additional information.

How can make premium payments?

Premium payments can be made either via Electronic Funds Transfer (EFT), where the money is drawn directly from your account, or you can receive paper bills, where payments need to be sent via check.

Like most group accident and health insurance plans, the MetLife VADIP Dental plan contains certain exclusions and limitations. Please download the plan summary to access these and other coverage details.