Group Dental Insurance
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Dental coverage is an important health benefit, especially if you have a family. As an AFSA member, you can now get quality dental treatment at discounted costs for yourself and your family. Whether you need treatment for current problems or to prevent serious diseases of the teeth or gums, both of the AFSA Member Group Dental Plan options enable you to obtain professional dental coverage at an afforable price.

The MetLife AFSA Group Dental Insurance Plan can help you keep up with your dental cleanings and other preventative care and avoid expensive dental problems and costly treatments later on. These are great reasons to make good dental care a priority.

Plan at a Glance:

  • A Comprehensive, nationwide network of dentists.
  • Typical savings of 30%-45% on covered services when you use an in-network dentist.1
  • Freedom to choose any dentist2.
  • Members3 of AFSA, their spouses/domestic partners, and dependent children4 may enroll.
  • As an insured member, you can also cover your unmarried, dependent children under age 26 too.
  • You have two plan choices to suit your needs and budget.
    • Plan Option 1 : AFSA Scheduled Dental Plan
    • Plan Option 2 : AFSA MAC (Maximum Allowable Charge) Dental Plan
  • Dental procedures covered include exams and cleanings, X-rays, fillings, root canals and much more.5
  • Up to $1,000 annual maximum per person AFSA Scheduled Dental Plan – combined in- and out-of-network.
  • Up to $1,500 annual maximum per person AFSA MAC Dental Plan – combined in- and out-of-network.
  • Up to $850 orthodontia lifetime maximum AFSA Scheduled Dental Plan combined in- and out-of-network for children up to age 19.
  • Up to $1,000 orthodontia lifetime maximum AFSA MAC Dental Plan combined in- and out-of-network for children up to age 19.

Get started today:

If you have any questions, please call us at 1-800-882-5541.

 

1Based on internal analysis by MetLife. Savings from enrolling in a dental plan will depend on various factors, including how often participants visit the dentist and the costs for services rendered.

2Your out of pocket costs may be greater if you visit a dentist who does not participate in the network.

3You must be a member of the Air Force Sergeants Association to qualify for this insurance plan.

4Refers to your unmarried dependent children under age 26.

5Those services set forth under your dental benefits summary are covered. Please review your certificate of insurance or contact your plan administrator at 1-800-882-5541 or afsa.service@mercer.com for a more detailed list of covered services.

Coverage may not be available in all states. Please contact your plan administrator at 1-800-882-5541 or afsa.service@mercer.com for more information.

Rates may be changed on the entire group plan or on a class basis and on any premium due date on which benefits are changed. A class is a group of people defined in the group policy / policy exhibits. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and Air Force Sergeants Association.

The association and/or the plan administrator incurs costs in connection with providing oversight and administrative support for this sponsored plan. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs.

All insurance and insurance effective dates are subject to final underwriting approval.

Like most insurance policies, insurance policies offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact your plan administrator at 1-800-882-5541 for costs and complete details.

Group insurance coverage is issued by Metropolitan Life Insurance Company, New York, NY 10166.

Group policy form GPNP99-ASSN
Policy number 211269-1-G

L0218503058[exp0319][All States][DC,GU,MP,PR,VI]

Plan Details

Network: PDP Plus


 

PLAN OPTION 1
AFSA Scheduled Dental Plan

PLAN OPTION 2***
AFSA MAC Dental
Plan

Coverage Type

Schedule A with Orthodontia

In-Network
% of Negotiated Fee*

Out-of-Network
% of Negotiated Fee*

Type A: Preventive
(cleanings, exams, X-rays)

Based on Schedule**

100%

100%

Type B: Basic Restorative
(fillings, simple extractions)

Based on Schedule**

80%

80%

Type C: Major Restorative
(bridges, dentures, crowns)

Based on Schedule**

50%

50%

Type D: Orthodontia

50%

50%

50%

 

 

 

 

 

 

 

Deductible†

 

 

 

 

Individual

$50

$50 Type A
$100 Type B&C

$50 Type A
$100 Type B&C

Family

$150

$150 Type A
$300 Type B&C

$150 Type A
$300 Type B&C

Annual Maximum Benefit

 

Per Person

$1,000

$1,500

$1,500

Orthodontia Lifetime Maximum

Per Person

$850

$1,000

$1,000

 

Waiting period following coverage effective date:
Type A & B Services (except Fillings) - No waiting period
Fillings – 6 months
Type C Services – 12 months
Orthodontia Services – 12 months

Waiting period following coverage effective date:
Type A & B Services (except Fillings) - No waiting period
Fillings – 6 months
Type C Services – 12 months
Orthodontia Services – 24 months

Child(ren)’s eligibility for dental coverage is from birth up to age 26.

*Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.

**See below list of Scheduled Dental Plan Covered Services.

***Not available for Members residing in Alaska, Massachusetts, Montana and Nevada.

Applies to Type A, B and C Services.


Scheduled Dental Plan List of Maximum Benefits for Type A, B and C Services under Plan Option 1

The following is a listing of the maximum benefits MetLife will consider for covered Type A, B and C services under Plan Option 1. Covered services not listed will be considered by MetLife in accordance with MetLife’s standard practices.

Description of Service

Maximum We Will Pay

PERIODIC ORAL EXAMINATION

$15.00

LIMITED ORAL EVALUATION - PROBLEM FOCUS

$25.00

COMPREHENSIVE ORAL EVALUATION

$25.00

COMPREHENSIVE PERIODONTAL EVALUATION

$23.00

COMPLETE SET X-RAY IMAGES

$45.00

PERIAPICAL (WHOLE TOOTH) X-RAY IMAGE

$10.00

ADDITIONAL X-RAY IMAGES

$5.00

OCCLUSAL X-RAY IMAGE

$10.00

BITEWING X-RAY - SINGLE IMAGE

$15.00

BITEWINGS X-RAY - TWO IMAGES

$15.00

BITEWINGS X-RAY - FOUR IMAGES

$20.00

PANORAMIC X-RAY IMAGE

$35.00

PROPHYLAXIS (CLEANING) - ADULT

$40.00

PROPHYLAXIS (CLEANING) - CHILD

$25.00

TOPICAL FLUORIDE VARNISH

$11.00

TOPICAL APPLICATION OF FLUORIDE

$22.00

SEALANT - PER TOOTH

$10.00

AMALGAM - (FILLING) 1 SURFACE PRIMARY/PERMANENT

$30.00

AMALGAM - (FILLING) 2 SURFACES PRIMARY/PERMANENT

$35.00

AMALGAM -(FILLING) 3 SURFACES PRIMARY/PERMANENT

$35.00

RESIN COMPOSITE - ONE SURFACE ANTERIOR

$30.00

RESIN COMPOSITE - 2 SURFACES ANTERIOR

$35.00

RESIN COMPOSITE - 3 SURFACES ANTERIOR

$45.00

RESIN COMPOSITE - 4+ SURFACE OR INCISAL ANGLE

$50.00

RESIN COMPOSITE - 1 SURFACE POSTERIOR

$33.00

RESIN COMPOSITE - 2 SURFACES POSTERIOR

$44.00

RESIN COMPOSITE - 3 SURFACES POSTERIOR

$53.00

CROWN - PORCELAIN/CERAMIC SUBSTRATE

$215.00

CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL

$230.00

CROWN - PORCELAIN FUSED TO BASE METAL

$220.00

CROWN - PORCELAIN FUSED TO NOBLE METAL

$220.00

CROWN - FULL CAST HIGH NOBLE METAL

$225.00

CROWN - FULL CAST NOBLE METAL

$215.00

RE-CEMENT CROWN

$15.00

STAINLESS STEEL CROWN - CHILD

$50.00

PROTECTIVE RESTORATION

$21.00

CORE BUILDUP INCLUDING ANY PINS

$45.00

PREFABRICATED POST & CORE ADDITION CROWN

$63.00

PULP CAP - INDIRECT

$14.00

ENDODONTIC (ROOT CANAL) ANTERIOR TOOTH

$125.00

ENDODONTIC (ROOT CANAL) BICUSPID TOOTH

$135.00

ENDODONTIC (ROOT CANAL) MOLAR

$140.00

PERIODONTAL SCALING & ROOT PLANING 4+TEETH/QUADRANT

$30.00

PERIODONTAL SCALING & ROOT PLANING 1-3 TEETH

$33.00

FULL MOUTH DEBRIDEMENT

$33.00

LOCALIZED DELIVERY ANTIMICROBIAL AGENTS

$18.00

PERIODONTAL  MAINTENANCE

$35.00

COMPLETE UPPER DENTURE

$250.00

COMPLETE LOWER DENTURE

$250.00

SURGICAL PLACEMENT ENDOSTEAL IMPLANT

$418.00

PONTIC - PORCELAIN FUSED TO HIGH NOBLE

$200.00

CROWN - PORCELAIN FUSED TO HIGH NOBLE

$180.00

EXTRACT ERUPTED TOOTH OR EXPOSED ROOT

$20.00

SURGICAL REMOVAL ERUPTED TOOTH

$30.00

SURGICAL REMOVAL IMPACTED TOOTH

$45.00

REMOVAL IMPACTED TOOTH - PARTLY BONY

$70.00

REMOVAL IMPACTED TOOTH - COMPLETELY BONY

$85.00

PALLIATIVE (EMERGENCY) TREATMENT PAIN - MINOR PROCEDURE

$15.00

DEEP SEDATION/GENERAL ANESTHESIA - ADDITIONAL 15 MIN INCREMENT

$50.00

CONSULTATION

$20.00

Economical group rates.

Because you’re an AFSA member, you qualify for members-only group rates.
Rates are subject to change.

Monthly Cost

The following monthly costs are effective through 12/31/2018. Monthly cost covers all eligible children.

Plan Option 1:
AFSA Scheduled Dental Plan

Plan Option 2:
AFSA MAC Dental Plan

Member Only

$29.33

Member Only

$43.50

Member + One Dependent

$45.33

Member + One Dependent

$91.34

Member + Family

$61.66

Member + Family

$143.54

You can choose between three premium payment options, whichever one best suits your budget.

  • Automatic monthly check withdrawal, which saves you time and money on checks and stamps and remembering payment due dates.
  • Credit card payment on a quarterly basis.
  • Direct bill on a quarterly basis.

If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.

Your coverage will terminate only if you cease to be a member of your association.

Your coverage will terminate only if you cease to be a member of AFSA; you fail to pay the appropriate premium when due; or the group policy is discontinued. Coverage for your dependents will be end if your insurance ends, dependents’ insurance ends under the group policy, the person ceases to be a dependent or premium is not paid for the dependent when due.

Goes with you wherever you go—change jobs, move, etc.

With this Group Dental Insurance Plan, it goes with you wherever you go—whether you travel, plan to move or switch jobs in the future.

Enroll conveniently right now—no salesperson will contact you.

It’s easy to enroll in the AFSA Group Dental Insurance Plan. Everything is handled the modern, convenient way through this secure site. No salesperson will call you. You can also download a no-obligation enrollment form and/or a dental plan summary containing detailed plan information and plan provisions, including costs, exclusions, limitations and terms of coverage.

Once you receive your Certificate of Insurance, if you're not satisfied within the first 30 days, we'll send you a full refund of any premiums paid during that period and your certificate will be considered never issued. You will be under no further obligation.

Exclusions keep your rates economical.

To keep your rates economical, there are some things the plan does not cover. To see the full list of exclusions this plan does not cover, see 'Exclusions' below.

Exclusions

This plan does not cover the following services, treatments and supplies:

  • Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature;
  • Services for which you would not be required to pay in the absence of Dental Insurance;
  • Services or supplies received by you or your Dependent before the Dental Insurance starts for that person;
  • Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate);
  • Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for:
    • Scaling and polishing of teeth; or
    • Fluoride treatments;
  • Services or appliances which restore or alter occlusion or vertical dimension;
  • Restoration of tooth structure damaged by attrition, abrasion or erosion;
  • Restorations or appliances used for the purpose of periodontal splinting;
  • Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;
  • Personal supplies or devices including, but not limited to: water picks, toothbrushes, or dental floss;
  • Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work;
  • Missed appointments;
  • Services:
    • Covered under any workers’ compensation or occupational disease law;
    • Covered under any employer liability law;
    • For which the employer of the person receiving such services is not required to pay; or
    • Received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital;
  • Services covered under other coverage provided by the Policyholder;
  • Temporary or provisional restorations;
  • Temporary or provisional appliances;
  • Prescription drugs;
  • Services for which the submitted documentation indicates a poor prognosis;
  • The following when charged by the Dentist on a separate basis:
    • Claim form completion;
    • Infection control such as gloves, masks, and sterilization of supplies; or
    • Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
  • Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food;
  • Caries susceptibility tests;
  • Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;
  • Other fixed Denture prosthetic services not described elsewhere in the certificate;
  • Precision attachments, except when the precision attachment is related to implant prosthetics;
  • Initial installation of a full or removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;
  • Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;
  • Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it;
  • Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;
  • Fixed and removable appliances for correction of harmful habits;
  • Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards;
  • Diagnosis and treatment of temporomandibular joint (TMJ) disorders;
  • Repair or replacement of an orthodontic device;
  • Duplicate prosthetic devices or appliances;
  • Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and
  • Intra and extraoral photographic images

Answers about the plan, including eligibility, options, enrollment, customer service and more.

Because keeping your teeth healthy can be an important step in maintaining overall health. And because keeping up with your dental cleanings and other preventive care now can help you avoid expensive dental problems and costly treatments later on.
Active members in the Air Force Sergeants Association, their spouse/domestic partner, and children1 may enroll.

MetLife offers two dental plans — Plan Option 1 : AFSA Scheduled Dental Plan and Plan Option 2 : AFSA MAC Dental Plan. Coverage, deductibles and maximums may vary based on the plan selected.2

There are thousands of general dentists and specialists to choose from nationwide — so you are sure to find one who meets your needs. You can receive a list of these participating dentists online at www.metlife.com. Enter your ZIP code and select the PDP Plus network.

Yes, absolutely. Chances are your dentist participates in the MetLife network. But if not, you are always free to select any general dentist or specialist. However your out-of-pocket expenses may be greater if you visit a dentist who does not participate in the network.
Dental procedures covered include: exams and cleanings, X-rays, fillings, root canals and much more.2
Yes. We recommend that you request a pre-treatment estimate for services totaling more than $300. Ask your dentist to submit a request online at www.metdental.com or call 1-877-MET- DDS9. You and your dentist will receive an estimate for most procedures while you’re still in the office — however actual payments may vary depending on plan maximums, deductibles, frequency limits or other conditions.
Dentists may submit your claims for you, which means you have little or no paperwork. And no ID card is required to prove eligibility for coverage.
No. You do not need an ID card to access your benefits.
Your coverage can continue as long as you pay your premium when due, you remain an AFSA member, and the group policy remains in force. Please see the certificate of insurance for details.

To print an enrollment form, click the "Enrollment Form and Brochure" button, complete and mail in to the address provided.

1Refers to your unmarried, dependent children under age 26.
2Those services defined under your dental benefits summary are covered. Please review your certificate of insurance for more information on covered services.

Coverage may not be available in all states. The Plan Option 2 : AFSA MAC Dental Plan is not available to members residing in Alaska, Massachusetts, Montana and Nevada. Please contact your plan administrator for more information.

The association and/or the plan administrator incurs costs in connection with providing oversight and administrative support for this sponsored plan. To provide and maintain this valuable membership benefit, MetLife may compensate the association and/or the plan administrator for these and/or other costs.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact your plan administrator for costs and complete details.

Group insurance coverage is issued by Metropolitan Life Insurance Company, New York, NY 10166.

L0218503058[exp0319][All States][DC,GU,MP,PR,VI]

We're here to help! Please contact us in whatever manner is most convenient for you.

Administered by:

Mercer Consumer
12421 Meredith Drive
Urbandale , IA 50398

Phone: 1-800-882-5541

(Monday-Friday 7:30 a.m. to 5:00 p.m. and Saturday 8:00 a.m. to 1:00 p.m., Central)

Email: afsa.service@mercer.com

Underwritten by:

Metropolitan Life Insurance Company, New York, NY 10166

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