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MetLife Dental and EyeMed Vision Option

If you are eligible for Medicare, you and your spouse, if he or she is also Medicare-eligible, can enroll in the MetLife Dental and EyeMed Vision Option if you enroll in either the HOP Medical Plan or the Value Medical Plan. Dental and vision coverage is not available on a standalone basis or with a Medicare Advantage plan.

The dental and vision coverage includes preventive care and offers discounts for certain services when you use an in-network provider. Review the sections that follow for more details on how the benefits work, how to find network providers, and any limitations or restrictions.

Note for current Health Options Program members: If you did not enroll in the MetLife Dental and EyeMed Vision Option when you were first eligible or if you are currently enrolled and drop your coverage, you will not be able to re-enroll in coverage in the future, unless there's an Open Enrollment or if you experience a Qualifying Event.

MetLife Dental Coverage

Highlights:

  • You don’t need to change dentists when you join. You can visit any dentist you want, but choosing one that’s part of the MetLife network (an in-network dentist) saves you money.*
  • If you use an in-network dentist, there’s no annual deductible.
  • When you see an in-network dentist, you pay nothing for preventive care (exams and cleanings) and less than half the cost for all other services as compared to going out of network.
  • Each year, you can receive up to $1,350 in basic and major restorative services. Preventive services do not count toward the maximum annual benefit.
  • If you use an in-network dentist after you receive the maximum annual benefit, you’ll continue to pay discounted rates.

*Savings from enrolling in the MetLife Preferred Dentist Program will depend on various factors, including how often participants visit the dentist and the costs for services rendered.

Find a Dentist

Visit the MetLife website to find a participating dentist near you. To find a dentist, enter your ZIP code at the bottom of the "Dental Benefits" box at the top of the page. You can also do an advanced search and find participating dentists by name, distance and specialty.

Review the Comparison Chart for details on what you'll pay for in-network and out-of-network dental care. Also review the “Covered Services and Limitations” section on page 4 of the MetLife Dental and EyeMed Vision Option brochure (PDF 175KB).

Each time you need dental care, you decide whether to use an in-network dentist or one that is not part of the MetLife network. While you are free to go out of network whenever and as often as you like, using a MetLife dental provider is your lower-cost option.

Here's why:

  • With in-network providers, you never pay a deductible. If you use out-of-network dentists, you must satisfy a $100 deductible before the Plan pays any benefits for basic or major restorative services.
  • Your percentage of the cost is always lower with an in-network provider.
  • MetLife negotiates discounted rates* with in-network dentists. This means they are under contract to accept a specific amount for each service. Out-of-network dentists can charge any amount, but MetLife will pay benefits based only on the amount it has established for in-network providers. This means, if you use an out-of-network dentist, you pay 100% of the difference between what the dentist charges and MetLife’s discounted rate.

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

You are not required to show an ID card to your dentist as proof of coverage. Just tell your dentist’s office that MetLife is your dental carrier when you schedule an appointment. Dentists may submit claims for you, which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed.

Read the MetLife Dental and EyeMed Vision Option brochure (PDF 175KB) for information on pre-treatment estimates, limitations and exclusions. For questions about the MetLife dental coverage, call the HOP Administration Unit at 1-800-773-7725 or MetLife at 1-855-700-7997.

EyeMed Vision Coverage

Highlights:

  • Eye examinations, frames, and prescription lenses or medically necessary contact lenses are covered once every other calendar year.
  • You have the option to see a provider in the EyeMed Insight network or an out-of-network provider; however, you’ll always pay less for in-network services.
  • When you visit a PLUS Provider (e.g., LensCrafters and Target Optical), you are eligible for an additional $50 frame allowance.
  • Out-of-network care will be reimbursed up to the Plan limits after you submit a claim for the full amount of the service.
  • The HealthyEyes wellness program keeps the focus on your eye health with online tools, articles, and videos.

Find a Vision Provider

EyeMed’s Enhanced Provider Search has more than 100,000 Insight network providers nationally. You can filter your search to find ones near you that have the frame brands, hours, and services you want most.

Review the Comparison Chart for details on what you'll pay for in-network and out-of-network vision care.

Each time you need vision care, you decide whether to use an in-network provider or one that is not part of the EyeMed Insight network. While you are free to go out of network whenever and as often as you like, using an EyeMed provider is your lower-cost option.

Here's why:

  • For most in-network services, including eye exams, most lenses and frames, you’ll pay nothing—a $0 copay—when you need care.
  • When you purchase frames from a PLUS Provider (e.g., LensCrafters and Target Optical), you’ll receive an additional $50 toward frame allowance.
  • If you visit an out-of-network provider, you’ll pay the full amount of the service up front and submit a claim for reimbursement, along with an itemized invoice.
  • EyeMed negotiates discounted rates* with in-network providers. This means they are under contract to accept a specific amount for each service. Out-of-network providers can charge any amount, but EyeMed will only pay up to the maximum reimbursement level. This means, if you use an out-of-network provider, you pay 100% of the difference between what the provider charges and EyeMed’s maximum reimbursement level.

* Discounted rates refers to the fees that in-network providers have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing, and benefits maximums. Discounted rates are subject to change.

EyeMed will send you two ID cards when you join, but you don’t have to have it when you visit your eye doctor. If you lose your card or need extras for your family, you can print a replacement or to pull up a digital version anytime, anywhere, download the EyeMed Members app through the Apple App Store or Google Play. Read the MetLife Dental and EyeMed Vision Option brochure (PDF 175KB) for information on limitations and exclusions.

For More Information

Use the links below to get more information on the MetLife Dental and EyeMed Vision Option, including a list of what is and isn't covered:

 

Last modified April 14, 2021