Veterans Affairs Dental Insurance Program (VADIP)

Transcription

1 Veterans Affairs Dental Insurance Program (VADIP) Official Plan for the Department of Veteran Affairs Dental Insurance Program L [exp0216][All States][DC,GU,MP,PR,VI]

2 What is Veteran Affairs Dental Insurance Program (VADIP)? VADIP is 3 year national pilot sponsored by the Department of Veteran Affairs to give Veterans and CHAMPVA beneficiaries access to affordable dental care. Individuals interested in participating in VADIP may complete an application online, over the phone or by mail at any time throughout the year. There is no specific open enrollment period.

3 Who s Eligible for VADIP? Veterans currently enrolled in the VA healthcare system Beneficiaries enrolled in the CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) More information about these programs can be found on the VA website

4 Why is dental coverage so important? Protect yourself from the rising costs of dental treatments. Prevent more costly dental problems you re more likely to see your dentist regularly when you have dental coverage. Focused connection between oral health and overall health dentists now play a key role in identifying symptoms of larger conditions such as diabetes, heart disease and stroke.

5 Plan Highlights Choice Savings $ Access to one of the largest dental networks over 75% of dentist offices in the U.S. participate Freedom to visit any dentist but you ll save more with an in-network dentist Two plan options to choose from Standard and High 100% coverage for in-network cleanings, exams and X-rays Discounts on dental fees on average members save 33% on their dental costs Competitive monthly rates * Savings on dental plans will depend on various factors including the cost of the plan, how often the participants visits the dentist and the cost of services rendered. Lowest industry fees, no cost for cleanings exams and x-rays and no deductible apply when you visit one of the 200,000 FEDVIP in-network dentists.

6 Plan Options: Two Choices Standard Option High Option COVERAGE TYPE BASIC Class A cleanings, X-rays and oral examinations INTERMEDIATE Class B fillings and periodontal maintenance MAJOR Class C crowns, bridges, root canal treatment and dentures IN NETWORK 1 OUT OF NETWORK 2 IN NETWORK 1 OUT OF NETWORK 2 100% 60% 100% 90% 50% 40% 70% 60% 30% 20% 50% 40% ORTHODONTIA Class D comprehensive orthodontic treatment, fixed Not Covered Not Covered 50% 50% appliance 3 MAXIMUMS & DEDUCTIBLES Annual Maximum Per Person $1,300 $1,000 $3,000 $3,000 Dependent Child Ortho Lifetime Maximum Per Person Annual Deductible Per Person Applies to Basic, Intermediate and Major Services Not Covered Not Covered $3,000 $3,000 $50.00 $50.00 $0.00 $ In Network charges will be based on negotiated fees that participating dentists have agreed to accept as payment in full, for services rendered by them. Negotiated fees are subject to change. 2 Out of Network charges will be based on the Usual and Customary (U&C) charge, which is based on the lowest of (1) The dentist s actual charge, (2) The dentist s usual charge for the same or similar services, or (3) The charge of most dentists in the same geographic area for the same or similar services as determined by MetLife. You will be responsible for the difference between your dentist s charge and the covered percentage of the Usual and Customary Fee or a given service. Subject to any deductibles, cost sharing, benefit maximum and terms of the plan. Savings from enrolling in a dental benefits plan will depend on various factors, including plan design and premiums, how often participants visit the dentist and the cost of services rendered. This document is not a complete description of the plan options. The 2014 MetLife VADIP Plan Summary will govern these plan options and can be viewed by visiting metlife.com/vadip. 3 Orthodontia coverage is available in the High Option only for a Child under the age of 19

7 How can you save hundreds of dollars on your dental care? It s easy, let s take a look at Lucy s savings. In this example Lucy is: Enrolled in the MetLife VADIP high and she had two cleanings which are covered at 100% And one cavity filled which is covered at 70% All services were done by an in-network dentist Dental Service Lucy s costs [THESE NUMBERS NEED TO UPDATED PRIOR TO PRESENTING BY GOING TO MYBENEFITS AND USING THE FEE LOCATOR TOOL AND FINDING HE MOST RECENT COSTS PER LEGAL S APPROVAL] Without dental insurance she would pay about $ But, with the MetLife VADIP she pays only $23.70 With MetLife VADIP, Lucy saved hundreds of dollars on her dental care. 2 routine cleanings, exams and X-rays Average cost without dental insurance MetLife Dentist Fee Estimated Cost with the MetLife VADIP Plan $ $ $0.00 (100% covered) 1 Filling $ $79.00 $23.70 (70% covered) Total $ $ Savings from enrolling in a dental benefits plan will depend on various factors, including how often participants visit the dentist and the cost of services covered. 2 In-network preventive services (Type A) are 100% covered when you visit an in-network participating dentist 3 To see if your dentist participates in the PDP network go to to use the Find a Dentist tool. 4 The fee information presented provides you with a benchmark to use in understanding dentist fees and is for informational purposes only. 5 This is the standard fee that most dentists in Philadelphia, PA (zip code 19019) will charge. In some cases due to specialty or unique circumstances their fee may be different. Accessed from MyBenefits Go2dental tool October This savings example assumes that the member has enrolled in the High Dental Plan Option that covers filling at 70% when you visit and in-network MetLife dentist. Like most group benefits programs, benefit programs offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Ask MetLife for costs and complete details.

8 Tools & Technology deliver you value and support Online resources help make it easier for you to manage your health and benefits MyBenefits Secure member website Get plan and claim information quickly Find a dentist or print an ID card Look up the average cost of a dental procedure before getting care 1 Oral Health Library Watch informational videos and read up on trending oral health topics Take risk assessments Get oral health tips and guidance for children MetLife mobile app Find a dentist and get directions to his or her office View an ID card *2011 MyBenefits User Satisfaction Study. 1. The Dental Procedure Fee Tool application is provided by go2dental.com Inc., an independent vendor. Network fee information is supplied to go2dental.com by MetLife and is not available for providers who participate with MetLife through a vendor. Out-of-network fee information is provided by go2dental.com. This tool does not provide the payment information used by MetLife when processing your claims. Prior to receiving services, pretreatment estimates through your dentist will provide the most accurate fee and payment information.

9 Benefits made easy for you! Highly Recommended Join the over 21 million participants who have chosen MetLife. 95% of participants would recommend MetLife to a friend. Relax, we make it easy for you! ID cards are not required when you visit your dentist. Dentists generally handle claims for you. Once enrolled you can easily manage your plan online or by phone.

10 Enrolling is simple Online By Phone TDD :00am to 11:00pm EST Paper enrollment forms can be requested by calling Like most group benefits programs, benefit programs offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Ask your MetLife group representative for costs and complete details.