(state and higher education employees | retirees if receiving a monthly pension from TCRS based on their own service or if they participated in a higher education optional retirement plan | local education and local government employees contact agency to see if agency participates)
Eligible employees can choose from two different dental insurance plans. Members pay the full monthly premium. We recommend comparing the networks and benefits.
Important 2022 Dental Benefit Information
- Dental DPPO preferred provider will change to Delta Dental of Tennessee for 2022. Current enrolled DPPO members who stay in this plan will automatically be enrolled in this plan for 2022.
- Dental DHMO prepaid provider will NOT change in 2022.
- DPPO preferred provider premiums will decrease in 2022; DHMO prepaid provider premiums will stay the same in 2022.
All members enrolled in the Delta Dental DPPO preferred provider plan will receive new ID cards for 2022. Newly enrolled members in the Cigna DHMO prepaid provider plan will receive new ID cards.
Members can request additional ID cards by contacting their insurance company or by using the insurance company's mobile app.
Delta Dental of Tennessee Preferred Provider Organization (DPPO) for 2022
Members can use any dentist, but will save money when using an in-network provider. Members pay deductibles and co-insurance for services.
7 a.m. to 5 p.m. CT
Delta Dental DPPO – tennessee.deltadental.com/stateoftn/
More about the Delta Dental DPPO
- You can use any dentist, but you receive maximum benefits when visiting an in-network DPPO provider for the state's dental plan. Review Delta Dental’s DPPO network (coming soon).
- You pay deductibles and co-insurance for some dental care. Deductible does not apply to diagnostic and preventive benefits such as periodic oral evaluation.
- You or your dentist will file claims for covered services. Discuss any estimated expenses with your dentist or specialist. Charges for dental procedures are subject to change.
- Waiting periods apply for some services (e.g., crowns, dentures, implants and complete or partial dentures) from the member’s coverage start date before benefits begin.
- Teledentristy is offered and claims are handled as if the patient received dental services in a dental office. Charges are considered as Type A: Diagnostic and Preventive and are subject to frequency limitations.
- There is a 12-month waiting period from the member’s coverage start date that applies to dentures and implants to replace one or more natural teeth.
- Referrals to specialists are not required.
- Dental treatment in progress at time of member’s effective date with Delta Dental may have pro-rated benefits under the Delta Dental plan. If you are currently enrolled in the State’s MetLife DPPO plan, Delta Dental will work with your dentist to ensure you continue to receive the benefits that are covered. For ortho claims, ask your orthodontist or dental office to submit a claim with the total fee, initial banding date, and total number of months of treatment. This detail will allow us to calculate what we can pay.
- Time enrolled in the MetLife DPPO for the State Group Insurance Program will count toward waiting periods under the Delta Dental DPPO contract.
- See the Certificate of Coverage for coverage details. COMING SOON!
- You pay coinsurance for many covered services and your share is based on the provider negotiated fee, or PNF agreed upon by the provider and Delta Dental of Tennessee. The PNF is the highest dollar amount of reimbursement for specific dental procedures provided by Delta Dental DPPO in-network providers. The in-network dentists have agreed to not charge members or the plan more than the PNF. When a member receives dental services from an out-of-network provider, the out-of-network dentist will be paid by the plan for covered procedures according to the average PNF for in-network providers and respective plan coinsurance. The member then is responsible for all other charges by the out-of-network dentist.
Cigna Dental Health Maintenance Organization (DHMO) - Prepaid Provider for 2021 and 2022
Members are required to use a network general dentist. Members must select a network general dentist and notify Cigna. Members pay copays for services. Review the Patient Charge Schedule under Publications and Dental HMO - Prepaid Provider.
More about the Cigna DHMO
- You must select and use a Cigna network general dentist from the DHMO list for the state’s dental plan and let Cigna know of your choice.
- You must use your selected dentist to receive benefits.
- You may select a network pediatric dentist as the network general dentist for your dependent child under age 13. At age 13, you must switch the child to a network general dentist or pay the full charge from the pediatric dentist.
- There may be some areas in the state where network general dentists are limited or not available. Before enrolling, carefully check the network for your location.
- With the DHMO, you may be able to cancel this coverage if you enroll and later there are no network general dentists within a 25-mile radius of your home address.
- You pay copays for dental treatments. Review the Patient Charge Schedule under Publications and Dental HMO - Prepaid Provider at www.tn.gov/partnersforhealth/publications/publications.html before having procedures performed.
- No deductibles to meet, no claims to file, no waiting periods, no annual dollar maximum.
- Preexisting conditions are covered.
- Referrals to specialists are required.
- Teledentristy offered at no charge.
- The completion of crowns, bridges, dentures, implants or root canal or orthodontic treatment treatment already in progress on a new member’s effective date will not be covered.
- See the Certificate of Coverage under Publications and Dental HMO - Prepaid Provider at www.tn.gov/partnersforhealth/publications/publications.html for complete details.
MetLife Dental Preferred Provider Organization (DPPO) for 2021
Members can use any dentist, but will save money when using an in-network provider. Members pay co-insurance for services.
Monday - Friday, 7-10 CT
MetLife DPPO — MetLife's website
More about the MetLife DPPO
- You can use any Dentist, but you receive maximum benefits when visiting an in-network DPPO provider for the state's dental plan. The list of providers in the DPPO network is found at https://www.metlife.com/stateoftn/.
- Deductible applies for Basic and Major dental care.
- You pay coinsurance for Basic, Major, Orthodontic and out-of-network covered services.
- You or your Dentist will file claims for covered services.
- Some services (e.g., crowns, dentures, implants and complete or partial dentures) require a six-month Waiting Period from the member’s coverage start date before benefits begin.
- Teledentristy is offered and claims are handled as if the patient received dental services in a dental office. Charges are considered as “Type A: Diagnostic and Preventive” and are subject to frequency limitations.
- There is a 12-month Waiting Period from the member’s coverage start date for both the replacement of a missing tooth and Orthodontics.
- Referrals to Specialists are not required.
- Discuss any estimated expenses with your dentist or specialist. Maximum Allowable Charges for dental procedures are subject to change.
- Dental treatment in progress at time of member’s effective date with MetLife may have pro-rated benefits under the MetLife plan. MetLife has transition-of-care guidelines for participants whose dental treatment is in progress during the benefit plan transition to MetLife.
- See the Certificate of Coverage under Publications and Dental PPO for coverage details at https://www.tn.gov/content/dam/tn/finance/fa-benefits/documents/dental_dppo_certificate.pdf. Note: Waiting periods may apply to select procedures.
You pay coinsurance for many covered services and your share is based on the "maximum allowable charge" (MAC) for a given service. MAC is the lesser of the amount charged by the dentist or the maximum payment amount that in-network dentists have agreed to accept in full for the dental service. When you receive dental services from an out-of-network provider, MetLife will reimburse a percentage of the MAC. You are then responsible for paying everything over the percentage of MAC reimbursed up to the charge submitted by the out-of-network dentist. Out-of-network providers typically charge more than the allowable charge, resulting in higher costs for you.
Additional enrollment information
Continuation of dental coverage through COBRA or the retiree dental plan
If you are enrolled in dental coverage as an ACTIVE employee under a state sponsored plan and your employment is terminated (separation of service or retirement), you will be given the opportunity to continue your dental coverage for 18 months under the Consolidated Omnibus Budget Reconciliation Act , or COBRA. A COBRA notification will be mailed to your home address listed in Edison upon the termination of your active coverage. To continue dental through COBRA, you must complete and return the COBRA enrollment form to Benefits Administration within 60 days of the latter of the date active coverage would end or the date on the COBRA notification letter. Please indicate if you are a Tennessee Consolidated Retirement System, or TCRS retiree via a hand written note on the signature page of the COBRA enrollment form. Continuation of dental insurance is NOT automatic at retirement.
If you do not qualify to continue dental insurance through COBRA or simply wish to enroll in the retiree dental plan upon the termination of your active insurance coverage, you should submit an application directly to Benefits Administration. Please note, you must be a TCRS retiree or an optional retirement plan, or ORP retiree from a higher education agency.
Upon expiration of your COBRA coverage, if you enrolled in this option and you are receiving a monthly TCRS pension or a higher education ORP retiree, you will be given an opportunity to enroll in the retiree dental plan.
NOTE: A complete description of the benefits, provisions, conditions, limitations and exclusions for both the Delta Dental and Cigna dental plans will be included in their respective Certificate of Insurance. If any discrepancies exist between the information listed above and the legal plan documents, the legal plan documents will govern. We recommend you review these documents.