Visit a Dentist— ANY Dentist

You chose a dental plan that can help you save1 and get the care you need.

No matter who your dentist may be, with the MetLife Preferred Dentist Program, the power to choose and save is yours.

Here are the facts:

  • You can go to any licensed dentist, in or out of the network.
  • Reimbursement for your out-of-network dental care is based on the 90th percentile of “reasonable and customary” charges1. We look at what dentists in your area actually charge for services, and we calculate reimbursement based on the 90th percentile of those charges.
  • The way we determine allowable charges for the 90th R&C means your eligible benefit amount for out-of-network care is high relative to average dental charges in the community. This helps you pay less out of pocket.
  • Sometimes when you visit an out-of-network dentist you may have to pay part of the bill. This is called balance billing. But with a 90th percentile R&C plan, in most cases you won’t be balance billed above your typical out-of-pocket costs – your deductible, coinsurance amount and your plan maximum.

Take charge of your dental care

Talk to your dentist

Before you get any major dental work, you should talk to your dentist about getting a pretreatment estimate2. That’s when your dentist sends the plan for your care to MetLife.

For most procedures, you and your dentists will receive the estimate – online or by fax – during your visit. The statement shows amounts for what your plan covers. Then  you and your dentist can talk about your care and costs before your treatment. It’s a great way to be prepared and plan ahead.

Get your plan information – fast!

Managing your dental benefits has never  been easier. You’ve got MyBenefits – your secure member website. Just log on at www.metlife.com/mybenefits. With the 24/7 website you can3:

  • Review your plan information, including what’s covered and coinsurance
  • Track your deductible and plan maximums
  • Find a dentist or view your claim history
  • Read up on the oral health information you need to make informed decisions about your care

Take a look at the charts below. They will give you a better idea of how your plan works when you visit a participating (in-network) or a non-participating (out-of-network) dentist.

The 90th bar

This chart shows how often plan members across the nation usually go to a participating or non-participating dentist. It also shows just how rare it is for you to pay more than your typical out-of-pocket costs.

Savings example

This hypothetical example shows that whether you get a cleaning from a participating or non-participating dentist, you can still save money4.

Visit any licensed dentist. The choice is all yours!

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

Learn more about your dental plan.

1R&C fee refers to the Reasonable and Customary (R&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 the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife.

2Actual benefit determinations are made when services are rendered and are subject to the following as applicable on the date of service: patient eligibility; plan and frequency limitations; maximums and deductibles; and other coverages.

3With the exception of scheduled or unscheduled systems maintenance or interruptions, the MyBenefits website is typically available 24 hours a day, 7 days a week.

4Please note: This is a hypothetical example that reviews an adult teeth cleaning (D1110) in the Chicago area, zip 60601.  It assumes that the annual deductible has been met.

5This example excludes non-participating dentists who charge more than what 90% of what other dentists in the area charge. Please note that if you receive care from a dentist that falls into this category, your out-of-pocket costs may be higher.

6Negotiated Fee refers to the fees that in-network dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums.

gray map of counties in missouri and kansas

Blue Cross Abandons Affordable Care Act Insurance Exchange in Missouri

UPDATE 6/13/2017: 

St. Louis-based Insurance company, Centene Corp., has announced plans to enter the Missouri, Kansas, and Nevada Affordable Care Act insurance exchanges in 2018. In April of this year, Centene CEO Michael Neidorff was quoted as saying “As to exchanges, we see nothing at this point to prevent us from proceeding with our 2018 marketplace participation.

According to Kansas City Business Journal, “As of March 31st, Centene served about 1.2 million exchange members, up about 500,00 from the previous year.” Centene Corp. is also expected to expand its six current markets in Washington, Indiana, Ohio, Georgia, Florida, and Texas signaling the potential for even more growth in 2018.

In a statement, Neidorff said, “Centene recognizes there is uncertainty of new healthcare legislation, but we are well positioned to continue providing accessible, high quality and culturally sensitive healthcare services to our members” according to an article on Reuters.

 

Citing major and “unsustainable” financial losses, insurance giant Blue Cross Blue Shield have announced plans to abandon individual plans offered through the Affordable Care Act Insurance Exchange for 2018 in both Missouri and Kansas.

According to the press release, “Like many other health insurers across the country, we have been faced with challenges in this market. Through 2016, we have lost more than $100 million. This is unsustainable for our company. We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of this market is a barrier to our continued participation.”

This decision comes on the heels of Aetna’s recent decision to completely pull out of the insurance exchange program after a citing a $450 million loss financial loss in 2016 and an additional projected $200 million loss this year.

While Blue Cross has roughly 1 million members in the affected area, they are estimating that approximately 67,000 will lose coverage. The new decision will not impact members who purchased their plans prior to October 1st, 2013, those who purchased Medicare Advantage, Medicare Supplement, short-term or student health plan from Blue KC, or members who have Blue Cross coverage through their employer.

Nonetheless, the move by Blue Cross comes as a major blow to families and individuals in the area, not to mention the Affordable Care Act itself. Out of the 32 counties the decision impacts, 25 will be left without any options available on the exchange as the situation stands today. Insurance providers have until June 21st to inform the government where or if they will sell plans on the insurance exchanges for 2018.

map of missouri counties effected by blue cross decision to leave insurance exchangeThe State of the ACA Insurance Exchange in Missouri

According to Fox4kc.com “This year, 97 out of Missouri’s 114 counties and the City of St. Louis have only one insurer offering plans on the exchanges. Earlier this year, Humana announced that it is also withdrawing from the exchanges. As things stand today, that leaves 25 counties with no insurer option and 77 counties with only one insurer option next year.

This comes on top of a new report from the Department of Health and Human Services showing that under Obamacare insurance premiums in Missouri’s individual market have increased by an astonishing 145% in just four years.”

Missouri isn’t the only state where insurance providers have been struggling. Healthcare Economist at Washington University in St. Louis, Tim McBride, believes the decision made by Blue Cross Blue Shield of Kansas City “is part of a larger trend with insurers pulling out of marketplaces in Virginia and Iowa as well.”

If you find yourself one of the 67,000 people in the Missouri and Kansas area that this decision impacts—we can help. For over 30 years, we have assisted thousands of employers and individuals secure the coverage they need for themselves and their families. Our benefits counselors are on hand M-F 8:30 am to 5:00 pm and are specially trained in helping attorneys with their insurance needs and may be able to help in the event of a loss of coverage for 2018.

Stay tuned to The Missouri Bar Private Insurance Exchange for more updates, or contact us today at www.mobar.memberbenefits.com/contact/ to see what options may be available to you.

To view the full press release from Blue Cross Blue Shield visit www.bluekc.com.

Final Market Stabilization Rule

Did you know that approximately 500,000 fewer Americans enrolled in a plan during the open enrollment in 2017 than in 2016? The Centers for Medicare & Medicaid Services has issued the final market stabilization rule. The goal is to increase choices, lower premiums and encourage stability in health insurance markets for 2018.

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What is LifeLock?

Identity theft hit a record high in 2016, 15.4 million Americans fell victim – up 16 percent from 2015. *

 

LifeLock is the leader in identity theft protection services. Unlike a bank, a credit card company or a credit bureau, their focus is on protecting your identity – to help keep you safer in an always connected world.

DETECT & ALERT
Lifelock’s proprietary technology scans millions of transactions every second for threats to your identity.†

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Meet Chas Trinder – One of Your Benefits Counselors

Meet Chas Trinder – One of Your Benefits Counselors

You may know Chas by his charming British accent, but we know Chas as a caring, customer-centric individual. He has a passion for helping clients with their health insurance needs, while also helping them stay with-in their budget.

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Meet Lynn Meares – One of Your Benefits Counselors

Meet Lynn Meares – One of Your Benefits Counselors

Lynn’s knowledge of the insurance business is apparent the minute you get on the phone with her. With more than 15 years of experience, Lynn’s passion and drive shine through. In fact, she says the best part of her job is “the opportunity to get to know clients from all of the associations we work with and provide them with the information needed to make the best decision for their family health insurance needs.”

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5 Things to Consider When Buying Dental Insurance

Whether you’re currently without dental insurance or are simply shopping around for a new policy, the fact remains that the process of searching for your ideal policy can be quite tedious and time-consuming. After all, dental insurance is a lot different than a traditional health insurance plan in the sense that it’s less open-ended and provides coverage for very specific preventative care.

As you shop for a dental health plan, here are a few of the most important considerations to keep in mind.

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