MetLife
TakeAlong Dental Medium
Keeping your teeth healthy without a dental program can be expensive. Having the right dental coverage makes it easier to visit the dentist and helps lower your costs. That’s where MetLife TakeAlong Dental comes in! It offers competitive pricing and great benefits today and in the future, providing you with continuous coverage.
This is a brief description of services covered under the MetLife TakeAlong Dental, Medium Option Benefit PPO program:
- Flexibility to choose any licensed dentist, in or out of the network, and still receive benefits.
- In-network providers accept negotiated fees, which are typically 30-45% less than the average charges in the same area.
- No referral needed for specialty care.
- Access to thousands of participating dental locations.
Note: MetLife TakeAlong Dental availability varies by state.
For more details and program information, please see the Additional Network Information section towards the bottom of this page.
Please read the Schedule of Benefits including the exclusions and limitations before beginning your enrollment.
| Common procedures: | |
|---|---|
| Cleaning: | 100% of maximum allowable charge * |
| White Filling: | 70% of maximum allowable charge * |
| Crown: | 50% of maximum allowable charge * |
| Root Canals: | 50% of maximum allowable charge * |
| Simple Extractions: | 70% of maximum allowable charge * |
| Plan Maximum: | $1500 per Calendar Year per person |
| Waiting Periods: | Preventive-None, Basic-6 months, Major-12 months Waiting Periods: For Vermont residents, any applicable waiting periods are limited to a maximum of 6 months. For Maine residents, waiting periods do not apply to children under 19 years of age. Once enrolled, this will be reflected in your policy. |
| Deductible: | $50 per person / $150 per family per Calendar Year |
May be subject to certain limitations and exclusions, please review the full Schedule of Benefits *Maximum allowable charges refer to the charges that in-network dentists have agreed to accept as payment in full for covered services, subject to any deductibles, copayments, coinsurance and benefit maximums. Maximum allowable charges are subject to change. In most states, out-of-network benefits are also based on a percentage of the maximum allowable charge. If you visit an out-of-network dentist you may have higher out-of-pocket costs than if you use a dentist that is in-network. | |
| Details: |
|---|
| Full Schedule of Benefits | Dentist Search | Exams: |
| Routine oral examinations – two per calendar year In Network – 100% Out of Network – 100% of the Maximum Allowed Charge* Preventive – No waiting period | Cleanings: |
| Teeth Cleanings – two per calendar year In Network – 100% Out of Network – 100% of the Maximum Allowed Charge* Preventive – No waiting period | X-Rays: |
| Bitewing x-rays only – Adults – one time in a calendar year Child – one time in 6 months In Network – 100% Out of Network – 100% of the Maximum Allowed Charge* Preventive – No waiting period | Fillings: |
| Fillings – initial placement – unlimited Replacement fillings – Replacement once every 24 months In Network – 70% Out of Network – 70% of the Maximum Allowed Charge* Basic – 6 months waiting period | Extractions: |
| Simple extractions - unlimited In Network – 70% Out of Network – 70% of the Maximum Allowed Charge* Basic – 6 months waiting period | Crowns: |
| Crowns – No more than one replacement for the same tooth within 10 years In Network – 50% Out of Network – 50% of the Maximum Allowed Charge* Major – 12 months waiting period (6 months in VT) | Root Canals: |
| Root canal treatment – no more than once for the same tooth In Network – 50% Out of Network – 50% of the Maximum Allowed Charge* Major – 12 months waiting period (6 months in VT) | Dentures: |
| Prosthodontic Services (see Schedule of Benefits for details) In Network – 50% Out of Network – 50% of the Maximum Allowed Charge* Major – 12 months waiting period (6 months in VT) | Deep Cleanings: |
| Periodontics maintenance – four treatments in 1 year, less any cleanings. Periodontal scaling & root planning –1 per quadrant, or area, in Any 36 Consecutive Month Period In Network – 70% Out of Network – 70% of the Maximum Allowed Charge* Basic – 6 months waiting period | Implants: |
| Implant Services – No more than once for the same tooth position in a 10-year period Missing tooth clause applies, see Schedule of Benefits. In Network – 50% Out of Network – 50% of the Maximum Allowed Charge* Major – 12 months waiting period (6 months in VT) | Braces/Orthodontia: |
| Not Covered Service | Teeth Whitening: |
| Not Covered Service | Additional Network Information: |
In-network refers to benefits provided under this program for covered dental services that are provided by a participating dentist. Out-of-network benefits refer to benefits provided under this program for covered dental services that are not provided by a participating dentist. If a Covered Service is performed by an In-Network Dentist, We will base the benefit on the Covered Percentage of the Maximum Allowed Charge. If an In-Network Dentist performs a Covered Service, You will be responsible for paying:
If a Covered Service is performed by an Out-of-Network Dentist, We will base the benefit on the Covered Percentage of the Maximum Allowed Charge. Out-of-Network Dentists may charge You more than the Maximum Allowed Charge. If an Out-of-Network Dentist performs a Covered Service, You will be responsible for paying:
*The maximum allowed charge for a covered service is the amount that in-network dentists have agreed to accept as payment in full for the covered service. Percentages shown are based on the maximum allowed charge, even when a covered service is provided by an out-of-network dentist, except in AK, NV, MA and MT. In these states, out-of-network percentages shown are based on a percentile of the reasonable and customary (R&C) charge. The R&C charge is based on the lowest of: (1) the dentist’s actual charge for a covered service; (2) the dentist’s usual charge for the same or similar service; or (3) the amount charged by most dentists in the same geographic area for the same or similar service as determined by MetLife. Exclusions and LimitationsPrivacy Policy Plan Brochure | Notes: |
Disclosure For New Mexico Residents: This type of plan is NOT considered minimum essential coverage under the Affordable Care Act and therefore does NOT satisfy the individual mandate that you have health insurance coverage. If you do not have other health insurance coverage, you may be subject to a federal tax penalty. For Colorado Residents: This policy DOES NOT include coverage of pediatric dental services as required under the Affordable Care Act. Coverage of pediatric dental services is available for purchase in the State of Colorado and can be purchased as a stand-alone Program. Please contact your insurance carrier, agent, or Connect for Health Colorado to purchase either a Program that includes pediatric dental coverage or an Exchange-qualified stand-alone dental Program that includes pediatric dental coverage. Certain exclusions and limitations may apply to these programs. Please view the covered services/limitations and exclusions which can be found in the schedule of benefits for each program. |
FAQ:
Am I covered if I go to a non-participating dentist?
You can use any licensed dentist. However, if you visit an out-of-network dentist you may have higher out-of-pocket costs than if you use a dentist that is in-network. In most states, the TakeAlong Dental programs have maximum allowable charges that in-network providers have agreed to accept as payment in full for covered services*. We pay a percentage (% varies by type of procedure) of those agreed upon charges, and you are responsible for the remaining balance of those charges. In most states, out-of-network benefits are also based on a percentage of the maximum allowable charge. If you visit an out-of-network dentist, in addition to any applicable deductible, you would be responsible for the percentage of the maximum allowable charge that MetLife does not pay (the coinsurance amount) as well as for the amount of the out-of-network dentist’s fee that is in excess of the maximum allowable charge.
* Maximum allowable charges refer to the charges that in-network dentists have agreed to accept as payment in full for covered services, subject to any deductibles, copayments, coinsurance and benefit maximums. Maximum allowable charges are subject to change. In most states, out-of-network benefits are also based on a percentage of the maximum allowable charge.
How do I find a participating dentist?
You can find the names, addresses, specialties, languages spoken and telephone numbers of participating dentists in a given area by searching our online directory.
What is a participating dentist?
A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees* as payment in full for covered services. Negotiated fees typically range from 30% - 45% less than the average charges in a dentist’s community for similar services.
*Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, coinsurance and benefit maximums. Negotiated fees are subject to change.
What services are covered under this Dental program?
To find out more about covered services, see Full Schedule of Benefits.
NOTE: Services started under a different carrier’s policy do not carry over to these programs – check with your dental carrier to be sure all services associated with that policy are completed before enrolling in TakeAlong Dental.
Who can enroll in this plan?
Any individual over the age of 18 may apply for a policy for themselves and their dependents.
* Not available in PR and VI.
New York, NY 10166
SafeGuard Health Plans Inc.
Irvine, CA 92614
Disclaimers and Disclosures:
Dental benefits are provided by Metropolitan Life Insurance Company (MetLife) or an affiliate of MetLife. Certain administrative services are provided by Careington BenefitSolutions (Careington), Frisco, TX. Careington is not affiliated with MetLife or its affiliates. In certain states, availability of the individual dental product is subject to regulatory approval. Like most benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. For complete details and cost, please refer to policy form IND-DENTAL-2015 or contact MetLife for more information.
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
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