questions, require additional information, or would like to sign up Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to guarantee another party compensation in the event of a certain loss, damage, or injury. Utica, NY 13504. Life Insurance: For Group Life Insurance (Basic, Optional, Dependent, GUL and GVUL), there are no policy limitations that would limit a claim payment resulting from COVID-19, provided the individual met all other certificate requirements. For self-funded business or for absence administration, the terms of the applicable Administrative Service Agreement will apply. LifeWorks has a nationwide network of over 30,000 counselors. Voluntary Supplemental Benefits offers eligible employees with additional choices that could meet the needs of your family. If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality, as required by the Americans with Disabilities Act (ADA). directly through Tesia-PCI, Inc., or have Practice Management Software office information include the following information: See MetLifes Disclosure Statement or Outline of Coverage/Disclosure Document for full details. party forwarded the claim, payment will be issued to the dentist. Does MetLife issue ID cards for Studies have linked oral health to several chronic diseases, including diabetes, heart disease and stroke. browser properties be set to 128-bit encryption and cookies enabled and that regardless of whether or not the orthodontic care was completed. Critical Illness/Cancer Insurance: COVID-19 must be listed as a covered condition for a benefit to be payable under the critical illness plan. That means you can pay monthly for dental care and spread the cost. Teladoc is a convenient and affordable healthcare alternative to expensive and time-consuming E.R. Some praised the service received, while others were frustrated with long wait times on phones, and lack of payments where cover was allegedly not fairly dealt out. Most Alaska hospitals and facilities outside of the Anchorage area are network providers, but outside of Alaska there are some out-of-network facilities, so its important to check before receiving services. normally would. receive general anesthesia to have the dental work performed, general Please note this does not affect over-the-counter medications required to be covered under the Affordable Care Act, such as aspirin. Where is the plan limitations information? If a lockout is activated, you will we offer interpreter services in over 170 languages and dialects. area. Street If thats an option under your plan, there are benefits to filling out the SOH digitally. Or clicking here: https://info.legalplans.com/9790010/CoveredServices/?coveragecode=979#tab-forms. There are several reasons for It offers affordable dental plans for single people, and has an extensive network of dentists to pick from in over 330,000 locations nationwide. There are varying costs for procedures, but you can get an idea for how much a procedure will cost on FAIR Health Consumer's Dental Cost Estimator." This insurer also offers good rates on its PPO plans, starting from as low as $24 per month. Employees, spouses andchildren who meet the eligibility requirements below are eligible for coverage by ourbenefits program. More premium plans can reach up to $60 plus a month per person (depending on where you live). Lyra, with MetLife, has prepared this guide to provide you with best practices. Whether you need a quick answer, help with a difficult issue or someone to explain your benefits, you have an advocate dedicated to your needs. The Grief Counseling program does not provide support for issues such as: domestic issues, parenting issues, or marital/relationship issues (other than a finalized divorce). MetLife can fax plan design information to Click here if you have feedback (1-877-638-3379). Most claims flow through our system quickly and efficiently, These requests should be sent to the following address: If you are servicing a member within the CONUS service area, You received this letter because the Centers for Medicare & Medicaid Services (CMS or Medicare) indicated that you have alternative prescription drug coverage under another plan that may be receiving subsidies from Medicare for providing that coverage. Long Term Disability Insurance replaces a portion of your income during a disability that is expected to last for an extended period of longer than 180 days. at 855-MET-TDP2 (855-638-8372). Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. Note: eligibility or benefits described in this video are subject to change. Electronic claim submission If visually impaired and using a screen reader, press: TAB = Next, Shift-TAB = Back, Spacebar = Expand, ENTER = Select. If a second or additional qualifying event occurs during the initial 18 month continuation coverage period (or during a 29 month maximum coverage period in the case of a disability), the qualified beneficiary may elect to extend the continuation coverage period for a period of up to 36 months from the date of the earlier qualifying event. These claims should be sent to: The policies provide benefits only for disabilities that result from a sickness or injury. The AlaskaCare Employee Health Plan has partnered with Teladoc since September 1, 2018 to provide you with a convenient and affordable way to receive quality medical care. There are four options available to submit claims and requests for Delta Dental of Alaska is the AlaskaCare dental claim administrator. For all other plans, If I have a patient that has a group specific fee Check your patient's plan design. Lexington, KY 40512. of eligibility, and are primarily used for easy reference to commonly There have been several news articles over the last few months detailing how customers of a number of financial services companies have fallen victim to social engineering scams. Currently, members who have services performed by a network provider should not incur any additional costs for infection control, including PPE, per our network contracts with our providers. Ages may differ depending on certain We We continue to monitor the impact of COVID-19 and will revisit this position if needed. to complete the form and click submit. Up to dependent age limit $1000 per Person 1. Doctors To improve our network and customer service, AlaskaCare selected Aetna to administer all medical and pharmacy claims and Moda Health to administer all dental claims. Are routine dental cleanings a covered benefit? Individuals seeking protections under the ADA must meet the definition of disability under the law. Phone: 1-800-635-4238 payment under this provision, the treatment actually performed must be consistent with sound professional standards of Is there an OCONUS PDP Network? Equal Employment Opportunity Commission (EEOC) updated itsCOVID-19 technical assistance, adding a new section to clarify under what circumstances COVID-19 may be considered a disability under the Americans with Disabilities Act (ADA) and the Rehabilitation Act. Once attachments have been sent to NEA, MetLife has the ability to If an employer mandates an employee to not work due to potential COVID-19 exposure or symptoms (i.e., mandatory quarantine), the employee may qualify for ADA protections on the ground that he or she is being perceived as having an impairment. The normal reasonable accommodation review should take place, and a reasonable accommodation may include job protected leave. Equal Employment Opportunity Commission, https://www.eeoc.gov/facts/pandemic_flu.html, https://info.legalplans.com/9790010/CoveredServices/?coveragecode=979#tab-forms, MetLife and U.S Chamber of Commerce Small Business Index. MetLife Provider Control "Dentists love to tell their patients they 'create smiles'. We understand that the COVID-19 pandemic may require customers to unexpectedly furlough, temporarily lay-off or reduce hours/salary for employees. Documents Guardian Direct Dental Insurance is a division of Guardian Life Insurance Company of America, which is one of the biggest mutual insurance companies in America. to respond. most being handled within 10-15 business days. Enrollment may occur at time of hire (within 30 days), during open enrollment, or when you have a qualifying status change. If they do, we will inform and guide the employee so they can understand and use the benefits available to them. 7 p.m. (Updated July 23, 2020) We are no longer offering grace period extensions outside of those in our contract or those required to comply with state specific mandates. Coverage could be for a percentage of the fee, or it might be capped at a specific amount. page for your specific patient. The U.S. attach the approved estimate form to the claim you are submitting. The U.S. IDI policies have elimination periods of 90 or 180 days, which must be satisfied before benefits become payable. intra-oral pictures, narratives, or Explanation of Benefits (EOB) MetLife dental plans provide coverage for dental services delivered through tele-dentistry. What are MetLife's guidelines regarding full-time services on a new claim form not linked to the original New York, There is no additional cost to you to participate. What work do you expect youll need in the next two to three years? Accidental Death and Dismemberment (AD&D): AD&D policies do not cover diseases. How do I know what procedures are covered for my For more on whats top of mind, explore the current Index findings. Whether you purchased your policy on your own or obtained it through your employer, log in to your personal account. Currently, If your current provider is not listed as a network provider, you can ask your provider to contact Aetna at (800) 720-4009 or Moda at (855) 718-1768 for a participation application. If you enroll in AD&D you must enroll in a minimum of $10,000 of Supplemental Life Benefits. How do I verify eligibility for MetLife covered The EEOC updated their guidance regarding this situation, which is available at https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws. If a claimant develops COVID-19 or some other qualifying sickness while quarantined, and it meets the definition of disability within the policy, benefits would be reviewed for payment. When you add new dependents on our benefit plans (during initial or annual enrollment, or following a qualified life event), you will receive a request from the Dependent Verification Center. Teladoc can resolve your skin issues within days by web or mobile app. When I use an out-of-network provider, how much of the bill am I responsible for? All providers who wish to participate in the Preferred Dentist Program insured. the date of service MetLife recommends that a request for pretreatment is submitted for If a member receives services from an out-of-network provider, they may be responsible for any additional PPE charges billed by the provider. The OptumRx home delivery unit reaches out to members to assist with setting up their home delivery accounts and to verify the prescriptions they want delivered. AlaskaCare plan pays: $300 (30% of $1,000), Potential balance bill amount: $500 ($1,000 - $500). automated phone system at 1-877-MET-DDS9 (1-877-638-3379). Where can I get a TRICARE Dental Program claim form? Unfortunately, MetLife is unable to support direct billing when MetLife is not the recordkeeper. information to 1-859-389-6505, send information on a copy of your The Better Business Bureau has accredited Physicians Mutual with an A+ rating. Program individually. SurgeryPlus covers hundreds of non-emergent surgery types within most of the surgical specialties including, but not limited to, the following: This is not an exhaustive list. If you are presented Accidental Annual Maximum Benefit This information is only a summary. Other states' legislation may vary with respect to Password will be needed each time you sign in to the MetDental.com website. reimbursed by the government for Command Sponsored beneficiaries. When submitting a claim to MetLife for coordination under the TDP as secondary coverage, a copy of the Qualifying events include: If a qualifying event occurs to a qualified beneficiary, then that qualified beneficiary may elect to continue coverage under the medical plan, dental plan and/or vision plan. MetLife can fax plan design information These costs are not considered a separate billable dental procedure and cannot be billed to a participant or to MetLife. Even if the primary owner(s) of a group practice are in the U.S. and they will have to pay the applicable cost shares, You may also request a predetermination from MetLife to determine the patient's cost share. If additional companions wish to accompany the member, you may coordinate with the SurgeryPlus Care Advocate, but the additional costs (airfare, hotel, etc.) notice of disability entitlement or cessation of disability. expedite the processing of claims containing crowns, bridges, or Experienced dentists are used as consultants to review complex dental If a member exceeds the age limitation (as described under the Orthodontic "Eligibility" section of the additional information is needed for a claim, it may take up to 30 Theres no age limit for wanting to have a beautiful smile, and seniors often have special dental needs. The provider verification process is a routine provider As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) All address and then to select a User name and Password. All others will pay cost-shares as shown in Section 4 of the TRICARE Dental Program Benefit Booklet. Upon diagnosis, it provides you with a lump-sum payment of $15,000 or $30,000 in initial benefits. Each procedure is covered under a bundled rate, and the only cost to you is the remaining balance on your deductible, if applicable. You can verify eligibility of a patient through Eligibility & Plan Like most group accident and health insurance policies, MetLifes CII policies contain certain exclusions, limitations and terms for keeping them in force. State See a full list of our exclusions here: No service provided, not even consultation for: Looking for information about how Coronavirus (COVID-19) might impact your current policy? Voluntary Supplemental Benefits offer you the opportunity to obtain additional benefits that best suit the needs of you and your family. To learn more about the coverage available under the vision plan, refer to the Vision Service Plan (VSP) Brochure . Portions of the episode of care that are not covered include, but are not limited, to durable medical equipment (braces, crutches, walkers, etc. Enroll in OptumRx home delivery to get up to a 90-day supply of the medications you take regularly. dental service line at 1-866-PDPNTWK (1-866-737-6895) and requesting one. 2 EAP services provided through an agreement with LifeWorks US Inc. (LifeWorks by Morneau Shepell). Most cover two exams, cleanings and x-rays per year, and will partially cover additional work. Dental Claims the "Help" button on your browser menu bar. El Paso, TX 79998-0930. MetLife remains committed to ensuring our customers,planmembers, and dentists get the service they expect. View $28/HR or Less GuideSEQA eligibleView +$28/HR GuideEQA eligible. The voice of small business owners. We are working remotely and operating our regular business hours. Once you are age 60, if you work for a reporting unit, and were a retiree working at a Michigan public school when PA 184 of 2022 went into effect, you will be able to continue working, will have no earnings limit, and any suspended pension or insurance premium subsidy will View the document.write(ThisYear); Preventive/Economy Dental plan summary for detailed service class coverages. You or another qualified beneficiary, or a representative acting on behalf of you or another qualified beneficiary, may provide this notice. Will we know how many of our clients are using the MetLife Legal Plans Disaster Relief Plan? If you and/or your dependents lose coverage due to a qualifying event, you and/or your dependents may continue coverage under the plan by electing COBRA coverage and paying the required premium as described in this section. Limitations and coordination with medical coverage may apply. TRICARE Dental Program Benefits Booklet. If we do not receive your confirmation or updated Their network includes over 690,000 primary care doctors and specialists and more than 5,700 hospitals. A qualified beneficiary is a person who is covered under the plan on the day before a qualifying event (but also including dependent children born to or placed for adoption with you during the continuation coverage) who is: The right to continued coverage is triggered by a qualifying event, which, but for the continued coverage, would result in a loss of coverage under the plan. information can be mailed to: Contact Delta Dental of Alaska toll free at (855) 718-1768. identification number, we ask that you accept and use it as the Procedure codes for the treatment performed Think about whether superb customer service and a large network of dentists are most important to you, or whether you just need routine preventive care and low monthly costs. mid-treatment? Retinal Screening for eligible members with diabetes. For accident and health coverage, unless coverage was continued under the plan during the period of unemployment, any limitations for pre-ex conditions will be applied from the reinstatement date. According to Consumer Advocate, Guardian Direct Dental has a 4.8 rating out of 5. most accurate information possible. Critical Illness Insurance provides financial support in the form of a payment if you or a covered family member is diagnosed with a serious illness. The amount of time depends on your groups plantypically, you have around 60 days to complete and return the form. residence. * This statement does not apply to providers who participate in the Preferred Dentist Program through an agreement that MetLife has with a vendor. procedure codes submitted office. patients? While the Affordable Care Act prevented any limits on health care coverage from being applied in a given year, even the best dental insurance often comes with annual limits as low as $750 per person. treatment is rendered, MetLife does not require submission of a second NARF. In order to receive OCONUS cost shares, beneficiaries must be Command Sponsored. You can expect access to world-class surgeons that have been rigorously screened, not only for their education and training, but also for their volume and complication rates. Phone MetLife will continue to review the needs of our clients during this time and if additional flexibility is needed based on the duration of this pandemic, we may modify our reinstatement position. website at: Discount plans usually only cost around $10 per month per person and the benefits can be used immediately, without a waiting list. Representative by clicking You can talk to a doctor in minutes. Accident Insurance: The definition of an accident includes that it is not a sickness so this condition would not be covered under our standard accident plan for COVID-19. a replacement, please indicate the original placement date and reason provision may be set out in the plan itself, or governed by industry Quick and easy access to MetLife customer support services and resources. You can download a digital copy of your ID card online: You can request a new physical ID card by calling: Plan Booklets are available for all members of the AlaskaCare health plans, they are designed to help you understand your plan and the benefits it provides. A more detailed description of the benefits, limitations, and exclusions can be found in the applicable Disclosure Statement or Outline of Coverage/Disclosure Document available at time of enrollment. Financial rating and assurance is important too, so we only considered dental insurance companies with a strong financial score. These can quickly add up, so make sure you can get the care you need without having to pay through the nose once you exceed any annual maximum limits. LifeWorks is not an affiliate of MetLife, and the services LifeWorks provides are separate and apart from the insurance provided by MetLife. When applicable, Plan Maximum &Deductibles are available What can I do if a procedure is not pre-authorized or pre-certified? With COB, if you are covered by more than one health care plan, the plans work together to provide benefits. Where can I obtain an overview of a patient's dental benefits and coverage? Address*: For other questions and assistance please reach out to your MetLife Representative. request direct reimbursement. Equal Employment Opportunity Commission (EEOC) updated itsCOVID-19 technical assistance, adding a new section to clarify under what circumstances COVID-19 may be considered a disability under the Americans with Disabilities Act (ADA) and the Rehabilitation Act. Insurance. State and federal guidelines were developed to address the opioid epidemic in the United States and Alaska. When it comes to picking a dental plan, make a list of your main oral care needs and balance those against a list of nice to have benefits. The Funeral Director should call MetLife at 1-800-638-6420 to have an Affidavit sent. plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. A tool called a formulary is used to assign medications to different tiers. submission as a prior pretreatment. Here youll find customer letters, presentations and replays from MetLife on some of the various federal and state leave programs addressing COVID-19. LifeWorks is not an affiliate of MetLife, and the services LifeWorks provides are separate and apart from the insurance provided by MetLife. TDP "non-command sponsored" enrollees are eligible lifetime orthodontic benefit. Some employers utilize reimbursement and/or copayment schedules as The time it takes to process a claim depends on its If you are diabetic or pregnant in your third trimester, the Oral Health, Total Health program offers more ways to care for your teeth and mouth. There were 65 complaints in the last three years, and 25 were resolved in the last year. Learn about each benefit by visiting metlife.com/stateofalaska . Find the best dental insurance plans and you can secure the cover you need at the ideal price point, whether you want a basic policy or a more comprehensive package. Enrollment is optional, pays in a lump sum, and only covers the employee. These services vary based on the procedure type and can be covered by your traditional medical insurance, and are subject to standard costs for utilizing your traditional medical insurance. understand the circumstances of the services you are requesting Premium dental plans However, individually. Accidental Death and Dismemberment Insurances, Disability Benefits (short-term and long-term). MetLife will evaluate each claim in accordance with the terms of the policy and use claim processes already in place for disability claims. METLIFE CRITICAL ILLNESS INSURANCE (CII) IS A LIMITED BENEFIT GROUP INSURANCE POLICY. MetLife will evaluate each claim in accordance with the terms of the policy and use claim processes already in place for disability claims. That said, some reviewers experienced difficulties when getting dental procedures approved, leading to frustrating delays. Guidance and coaching online and by phone is provided by trained and credentialed financial planners through our alliance with EY (Ernst & Young LLP). Unfortunately, MetLife is unable to support direct billing when MetLife is not the recordkeeper. MetLife Dental Insurance user reviews and ratings. How can I tell if the Prior Authorization letter I received is accurate or not? You gain or lose a dependent, through birth or adoption, marriage, divorce, or death. If you are having any specific payment issues, please discuss them with your Account Manager, Account Executive or MetLife representative. Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). the parent with custody to be the primary plan. In addition to the TIN, we need the name of the provider of the service to process a payment. You will need to identify the To request electronic versions of TDP materials, please The ADA protects employees from disability discrimination by requiring reasonable accommodations to ensure equal access to employment (e.g. Security Number (SSN) or ID Number Why does the Pharmacy Benefit Manager change? Services are not available in all jurisdictions and are subject to regulatory approval. allowance for an alternative treatment may be paid toward the cost of the actual treatment performed. The EEOC also released FAQs regarding COVID-19 and the ADA. Please enable scripts and reload this page. Choosing to fill your prescription medications through mail order when appropriate, can save you money. This scamming can happen via text, email or websites set up to look like the trusted company. This information is available on the Eligibility & Plan Detail Simply dial 1-877-MET-DDS9(1-877-638-3379), and select Option 1. For example, in California, SB 137 requires that MetLife is committed to helping employees get maximum value from their benefits. open theLAP Notice of However, only command- sponsored members may pay the patients? Dental PPO Network Development For employees with MetLifes Employee Assistance Program (EAP)2we provide 24/7 confidential access to professional support to help employees manage stress, anxiety, grief, financial concerns, and much more. www.yourdependentverification/com/plan-smart-info. If you or your children are eligible for Medicaid or CHIPthe Childrens Health Insurance Programand youre eligible for health coverage from your employer, your state may have apremium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs. How do I request electronic version of TDP Materials? In addition, the pre-ex provision will be applied as if there was no interruption in coverage. that will help us better Effective as of January 1, document.write(ThisYear); The health benefits that the State of Alaska provides to its eligible employees is commonly referred to as AlaskaCare. 2. than Special Mobilization Category) members, such member's claims (as well as any other member who is not Command Sponsored) are MetLifes Issue Age CII is guaranteed renewable, and may be subject to benefit reductions that begin at age 65. For this guide to the best dental insurance, we consulted with three dentists to get their perspective on dental insurance providers. You may change your mind about any benefit choices as long as you re-enroll in your final choices before the enrollment deadline. If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality, as required by the Americans with Disabilities Act (ADA). system or online, you will need to speak directly with a Customer Service Representative. If you are expecting, you can enroll in the Oral Health, Total Health program to help prevent gum disease. To get started, call SurgeryPlus directly at (855) 715-1680. Eligible reimbursements will be paid directly to you, not your provider. You can also fill up to a 90-day prescription at a participating retail pharmacy; however, you will pay separate copays for each 30-day supply. for compatibility at You may carry over up to $550 of unused funds in your HFSA to the next benefit year, but unused amounts over $550 are forfeit. For more information, please read the Teladoc FAQs. In addition, destination countries are implementing more stringent screening practices at points of entry. All beneficiaries must obtain a Non-Availability and Referral Form (NARF) from their TRICARE Area Office (TAO) (or designee) Whereas the Affordable Care Act abolished limits to health care coverage within each year, most of the best dental insurance plans have annual limits as low as $750 per person. 6th Floor, State Office Building local anesthesia verification purposes. Guidance and coaching online and by phone is provided by trained and credentialed financial planners through our alliance with EY (Ernst & Young LLP). In addition, the pre-ex provision will be applied as if there was no interruption in coverage. MetLife dental plan is secondary, most coordination of benefits For a list of network providers, please contact the Aetna Concierge at (855) 784-8646 or visit the custom DocFind tool to help you find a provider that is part of the AlaskaCare network. Finally, if you're changing dental insurance providers yet want to continue using your current dentist, visit the website of the dental insurer youre thinking about signing up with and search to see if your dentist accepts the new type of insurance.
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