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Chapter 2, Section 4: Federal Employees Dental and Vision Insurance Program

The Federal Employees Dental and Vision Insurance Program provides vision and dental benefit benefits for employees, annuitants and certain family members apart from the limited coverage in those areas provided in the Federal Employees Health Benefits program.

The Federal Employees Dental and Vision Insurance Program provides vision and dental benefit benefits for employees, annuitants and certain family members apart from the limited coverage in those areas provided in the Federal Employees Health Benefits program. FEDVIP, which was authorized by Public Law 108-496 and became effective in 2007, is voluntary for eligible persons. Enrollees pay the full cost; there is no government contribution toward the premiums. Benefits are provided by insurers under contract to the Office of Personnel Management, which oversees the program.

Individuals eligible to enroll in both the FEDVIP and FEHB programs can choose to enroll in FEHB only, FEDVIP only, both, or neither. They can also choose different enrollment types for each program--enrolling, for example, in self and family coverage under FEHB, but self-only coverage under FEDVIP.

Other key features of FEDVIP are:

  • Premiums are deducted from enrollees' pay or annuity when possible.
  • Employees (but not retirees) pay the premiums from pretax payroll dollars and may not opt out of this "premium conversion" arrangement.
  • Employees may use money in health care flexible spending accounts to pay co-payments and deductibles (but not premiums) of either vision or dental care.
  • There are no pre-existing condition limitations on care, although there are waiting periods for orthodontic benefits under the dental benefits plans, and a dental plan carrier may refuse to cover treatments related to teeth missing as of the date of enrollment.
  • Where a FEDVIP carrier is also an FEHB carrier, those enrolled in the carrier's FEHB plan need not choose its dental or vision plan.
  • Employees enrolled in FEDVIP who subsequently retire on an immediate annuity or for disability under CSRS, FERS, or another retirement system for employees of the government may continue FEDVIP enrollment into retirement with no requirement that the retiree have been enrolled for the prior five years, as applies in the FEHB and Federal Employees' Group Life Insurance programs.
  • Eligible persons may enroll or change coverage for the following calendar year during an annual autumn open season running concurrent with that for FEHB. If they make no changes, the previous choice continues.

A link to each FEDVIP plan's Web site, a provider search function and other information is available at www.opm.gov/insure. The FEDVIP general information number is (877) 888-3337, TTY (877) 889-5680. Enrollment and related information is at https://www.benefeds.com. The mailing address is BENEFEDS, P.O. Box 797 Greenland, NH 03840-0797.

Coordination of Benefits-- Some FEHB plans cover some dental and vision services. If a FEDVIP enrollee's FEHB plan does provide any benefits for dental and vision services, the FEHB plan will be the first payor of any benefits. FEDVIP plans are responsible for coordinating benefits with the primary payor.

FEDVIP plans also coordinate benefit payments with the payment of benefits under other group health benefits coverage that enrollees may have and the payment of dental or vision costs under no-fault insurance. They also coordinate benefits with other group dental or vision insurance, if that information is provided by enrollees.

FEDVIP plans may request that enrollees verify or identify their health insurance plan(s) annually or at the time of service. Enrollees who change FEHB plans during an open season after enrolling should communicate that change to BENEFEDS. Providing FEHB information may reduce enrollees' out-of-pocket costs.


Disputed Claims-- Each plan has its own process and time frame for reviewing disputed claims, which are explained in its brochure. If an enrollee has completed the plan's claims dispute process and still disagrees with the plan's decision, he or she may request that an independent third party, mutually agreed to by the plan and OPM, review the decision. The decision of the independent third party is final and binding. OPM does not review disputed FEDVIP claims.

Eligibility

Employees-- Executive Branch and U.S. Postal Service employees are eligible to enroll in FEDVIP if they are eligible to enroll in the FEHB program. It does not matter if they are enrolled in FEHB or not--eligibility is the key. OPM makes the final determination about whether categories of excluded positions apply to a specific employee or group of
employees.

Annuitants-- Federal annuitants are eligible to enroll in FEDVIP if they retired on an immediate annuity under the Civil Service Retirement System (CSRS), the Federal Employees Retirement System (FERS) or another retirement system for employees of the government, including those who retire for disability.

Employees separating with eligibility only for a deferred annuity cannot continue FEDVIP enrollment and are not eligible to enroll once their annuity benefits begin.

Employees enrolled in FEDVIP who retire on a FERS Minimum Retirement Age +10 annuity and elect to postpone receipt of their annuity lose FEDVIP coverage upon separation from service. Such individuals can again enroll in FEDVIP within 60 days of when they start receiving their annuity. They do not have to enroll in the same plan, option or same enrollment type they had when they separated.

Survivor Annuitants-- A member of a family who receives an immediate annuity as the survivor of an employee or of a retired employee is eligible to enroll in FEDVIP. The survivor need not have been covered under the deceased person's FEDVIP enrollment. If an employee or annuitant enrolled in FEDVIP dies while enrolled in self plus one or self and family, the enrollment will continue for their eligible family members who become survivor annuitants.

Compensationers-- Injury compensationers are eligible to enroll in FEDVIP or continue FEDVIP enrollment into compensation status. A family member receiving monthly compensation from the Office of Workers' Compensation Programs as the surviving beneficiary of an employee who dies as a result of illness or injury sustained while in performance of his/her duty can enroll in FEDVIP or continue the deceased's FEDVIP enrollment.

Family Members-- Under FEDVIP, eligible family members are:

  • a spouse, including a common law spouse where such marriages are recognized;
  • unmarried dependent children under age 22 (including adopted children and recognized children born out of wedlock who meet certain dependency requirements and stepchildren and foster children who live with the enrollee in a regular parent-child relationship); and
  • children age 22 or over who are incapable of self-support because of a mental or physical disability that existed before reaching age 22.

Former spouses are not eligible, even if they are receiving an apportionment of an annuity or a survivor annuity, nor are parents and other relatives who are not eligible under FEHB, even if they live with and are dependent upon the enrollee. See www.opm.gov/insure/dental/eligibility or www.opm.gov/insure/vision/eligibility. Note: Until 2011, FEDVIP followed FEHB rules for family member eligibility. However, P.L. 111-148 changed several FEHB policies for children's coverage (see FEHB Eligibility and Enrollment Rules in Section 1 of this chapter) while not affecting eligibility policies under FEDVIP.

Enrollees self-certify the eligibility of dependents to be covered under self plus one or self and family coverage. FEDVIP plans may ask an enrollee to provide documentation that confirms a family member's eligibility (such as a marriage certificate or adoption papers), either when an individual initially enrolls or when an enrollee adds a family member to an existing enrollment. If the employing agency or retirement system has already made a determination regarding a child's eligibility under the FEHB program or the Federal Employees' Group Life Insurance (FEGLI) program as a foster child or a child who is incapable of self support because of a mental or physical disability, the enrollee should provide the FEDVIP plan with a copy of that determination. If such a determination has not been made, the enrollee must request that determination from his or her agency or retirement system and then submit a copy to the plan that will make the final determination of eligibility.

FEHB Temporary Continuation-- Those who are eligible for FEHB only through enrollment in temporary continuation of coverage are ineligible under FEDVIP.

End of Coverage-- Your coverage ends when you:

  • no longer meet the definition of an eligible employee or annuitant;
  • begin a period of non-pay status or pay that is insufficient to have your FEDVIP premiums withheld and you do not make direct premium payments to BENEFEDS;
  • are making direct premium payments to BENEFEDS and you stop making the payments; or
  • cancel the enrollment (see Canceling Enrollment under Enrollment, below).

Coverage for a family member ends when:

  • you as the enrollee lose or cancel coverage; or
  • the family member no longer meets the definition of an eligible family member.

Under FEDVIP, there is no 31-day extension of coverage, temporary continuation of coverage, spouse equity coverage, or right to convert to an individual policy as in FEHB.

Enrollment

Eligible individuals can enroll in dental care, vision care or both:

  • during the annual open season that runs concurrent with the annual FEHB open season in mid-November through mid-December;
  • within 60 days after first becoming eligible as a new employee or as a previously ineligible employee who transferred to a covered position;
  • within 60 days after first becoming eligible as a survivor annuitant (if not already covered under FEDVIP);
  • within 60 days after returning to service following a break in service of at least 31 days; or
  • within 60 days after a qualifying life event that allows enrollment (see table).

Newly hired eligible employees and newly eligible employees have one opportunity to enroll for vision coverage and one opportunity to enroll for dental coverage in the 60-day period. Once they enroll in either type of plan, the opportunity for that type of enrollment ends, even if the period hasn't elapsed. They cannot change or cancel that enrollment until the next open season, unless they experience a qualifying life event that allows such a change or cancellation.

Enrollment typically is done online through BENEFEDS at www.benefeds.com or by phone at (877) 888-3337 (TTY (877) 889-5680). In limited circumstances a paper form election is allowed. Enrollment is not allowed through the FEHB election form (SF 2809) or through agency self-service pay and benefits systems, although some of those systems provide links to BENEFEDS.

Options-- An eligible individual may choose one of the following enrollment options:

Self-Only. A self-only enrollment covers only the enrolled employee or annuitant. An eligible individual may enroll in self-only even though he or she has a family, but the family members are not covered.

Self Plus One. A self plus one enrollment covers the enrolled employee or annuitant plus one person who is eligible as a family member (see above). Eligible individuals may enroll in self plus one even though they have more than one eligible family member, but the additional family members are not covered. The enrollee must specify during the enrollment process which one eligible family member he or she wishes to cover under a self plus one enrollment. The enrollee may change the covered family member to another eligible family member during an open season or because of a qualifying life event.

Self and Family. A self and family enrollment covers the enrolled employee or annuitant and all persons who are eligible as family members (see above). Enrollees should list all eligible family members when they enroll in order to ensure timely claim payments. All of the enrollee's eligible family members are automatically covered, even if the enrollee fails to list all of them when enrolling, but claim payments may be delayed for family members who were omitted. An eligible individual may enroll in self and family coverage before he or she has any eligible family members. The family member (such as a newly adopted child or a new spouse) is automatically covered by the self and family enrollment from the date he or she becomes a family member. However, enrollees should still add new family members to existing self and family enrollments to ensure timely payment of claims.

For both self plus one and self and family enrollments, when an eligible family member on an existing enrollment loses eligibility (for example, a child reaches age 22) and there is at least one other eligible family member remaining on the enrollment, the enrollee should remove the ineligible family member. Failure to remove ineligible family members does not make them eligible.

The type of enrollment need not be the same as the type chosen in the FEHB, if applicable. Those enrolled in both vision and dental plans can choose different enrollment types for each. In addition, they can choose a different dependent for each if enrolled as self plus one in each.

"Dual enrollment" is when an individual is covered under more than one FEDVIP dental enrollment or more than one FEDVIP vision enrollment, for example when two eligible persons, each having children covered under self and family coverage, are married. Generally, dual enrollment is prohibited except when elimination of the dual enrollment would cause an enrollee or an eligible family member to lose coverage. Guidance on situations that are considered to be dual enrollment that must be rectified and the steps to be taken are in Benefits Administration Letter 10-202 at www.opm.gov/retire/pubs/bals/bal10.asp.

Allowable FEDVIP Enrollment Changes Outside of Open Season*

Qualifying Life Events that may permit a change in enrollment From not enrolled to enrolled Increase from self-only to self plus one or to self and family, or from self plus one to self and family Decrease from self and family to self plus one or to self-only, or from self plus one to self-only Cancel Change from one plan to another
Acquiring an eligible family member
No
Yes
No
No
No
Losing a covered family member
No
No
Yes
No
No
Losing other den-tal/vision coverage
Yes
Yes
No
No
No
Moving out of regional plan’s service area
No
No
No
No
Yes
Return to pay status from active military duty
Yes
No
No
No
No
Annuity or compensation restored
Yes
No
No
No
No
Leaving pay status due to deployment to active military duty (enrollee or spouse)
No
No
No
Yes
No
Transferring to an eligible position with a federal agency that pro vides dental and/ or vision coverage with 50 percent or more employer- paid premiums
No
No
No
Yes
No

* See the text under Enrollment for policies allowing cancellation in certain special circumstances.

Canceling Enrollment-- Enrollment can be canceled only during an open season, except that:

  • If BENEFEDS and/or a FEDVIP plan discover an unauthorized dual enrollment, one of the enrollments must be canceled. This is done prospectively from the date the dual enrollment was discovered. (Note: The premiums paid for the cancelled enrollment will not be refunded to the enrollee, but the enrollee is not required to refund any benefits paid under the cancelled enrollment).
  • An individual taking an enrollment action based on experiencing a qualifying life event (QLE) may cancel that action within the time limit allowed for the QLE.
  • If an employee changes his or her enrollment in anticipation of a permitted QLE, and that event does not occur, the change can be cancelled.
  • You may cancel enrollment if you transfer to an eligible position with a federal agency that provides dental and/or vision coverage with 50 percent or more employer-paid premiums.
  • You may cancel enrollment upon your deployment or your spouse's deployment to active military duty.

These cancellations will become effective at the end of the pay period that you submit your request. An eligible family member's coverage also ends upon the effective date of a cancellation.

Re-Enrollment-- Re-enrollment is automatic each year unless an enrollee makes a change in an open season or a plan terminates its participation in FEDVIP.

Belated Enrollments or Changes-- The time limit for enrolling or changing an enrollment may be extended for up to six months after the individual first becomes eligible, or has a qualifying life event, or after the end of open season, if the individual provides evidence to BENEFEDS that he or she was unable to enroll or change enrollment timely for reasons beyond his or her control. If BENEFEDS allows a belated enrollment or change in enrollment, the individual must enroll or change enrollment within 30 days after BENEFEDS notifies the enrollee. BENEFEDS will allow belated enrollments and changes only in exceptional circumstances, and its decisions cannot be appealed.

Effective Date-- The effective date of open season enrollments is the start of the succeeding calendar year. Generally, enrollments and changes to enrollments that occur outside of open season become effective the first day of the pay period or annuity cycle following the one in which BENEFEDS receives the enrollment or change. For belated enrollments or belated changes in enrollments, the effective date will be retroactive to the date the enrollment or change in enrollment would have been effective if made timely.

Qualifying Life Events-- A qualifying life event (QLE) is an event that may allow eligible individuals to enroll, or allow those already enrolled to change their enrollment, outside of an open season. The number and type of permitted QLEs are more limited than in the FEHB program. In addition, the rules for QLEs in FEDVIP apply to annuitants as well as employees. See the accompanying table.

The enrollment action taken must be consistent with the QLE. For example, an enrollee can change from self only to self plus one when the QLE is "acquiring an eligible family member." However, the enrollee cannot decrease from self plus one to self only since that action is not consistent with adding a family member.

The time frame for requesting a QLE change is from 31 days before to 60 days after the event, except that:

  • there is no time limit for a change based on losing a covered family member or moving from a regional plan's service area; and
  • an individual cannot request a new enrollment based on a QLE before the QLE occurs, except for enrollment because of the loss of other dental or vision insurance--apart from that exception, the individual must make the change no later than 60 days after the event.

If an employee changes his or her enrollment in anticipation of a permitted QLE, and that event does not occur, the change can be cancelled.

Vision Benefits

Premiums vary according to whether the enrollee chooses the high or standard option, and whether the enrollee chooses self-only, self plus one or self and family coverage. Premium rates are at www.opm.gov/insure/vision/rates.

There are three vision plans, each of them national and each with standard and high options: FEP BlueVision, UnitedHealthcare Vision, and Vision Service Plan (VSP). Each offers comprehensive vision services, including annual examinations, lenses and frames, discounts on laser vision correction, and coverage for elective or medically necessary contact lenses. See plan brochures for specific coverage terms.

To contact vision plans:

FEP BlueVision
(888) 550-2583
www.fepblue.org/benefitplans

UnitedHealthcare Vision
(866) 249-1999
www.myuhcvision.com/fedvip

Vision Service Plan
(800) 807-0764
www.choosevsp.com

Dental Benefits

There are seven dental carriers. Four of them are national carriers: Aetna, GEHA, MetLife, and United Concordia. Of those, GEHA and MetLife offer high and standard options. There are three regional carriers: Triple-S Salud (Puerto Rico), GHI (state of New York and parts of Connecticut, New Jersey, and Pennsylvania), and Humana Dental Company (Alabama, Arizona, Arkansas, California, Colorado, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Missouri, Mississippi, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, and parts of Maryland).

Dental coverage includes (see plan brochures for specific coverage terms):

  • Basic services, such as oral examinations, prophylaxis, diagnostic evaluations, sealants, and X-rays.
  • Intermediate services, such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions, and denture adjustments.
  • Major services, such as root canals, gingivectomy, crowns, oral surgery, bridges, and complete dentures.
  • Orthodontic services, subject to a waiting period of up to 24 months of continuous enrollment in the same plan before eligibility for benefits begins.

Standard reimbursement rates are for in-network services. Costs to enrollees for using out of network providers are higher.

Premiums vary according to whether the enrollee chooses the high or standard option (where applicable), whether the enrollee chooses self-only, self plus one or self and family coverage, and according to geographic rating areas established by the plans. Triple-S Salud and GHI have only one rating area; the others have five each.

Rating areas and premiums are at www.opm.gov/insure/dental/rates.

To contact dental plans:

Aetna
(877) 459-6604
www.aetnafeds.com

GEHA
(877) 434-2336
www.gehadental.com

MetLife
(888) 865-6854
www.federaldental.metlife.com

United Concordia
(877) 394-8224
www.uccifedvip.com

Triple-S Salud
(787) 774-6060
www.ssspr.com

GHI
(800) 444-2333
www.ghi.com

Humana Dental Company
(877) 692-2468
www.feds.humana.com

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