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. FEDVIP 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.
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. Eligible persons may enroll or change coverage for the following calendar year during an annual open season from the Monday of the second full workweek in November through the Monday of the second full workweek in December. If they make no changes, the previous choice continues.
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. (Note: Those in phased retirement status remain eligible for premium conversion because they do not separate from service; see Phased Retirement in Chapter 3, Section 1.)
• 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 retire on an immediate annuity or for disability under a federal retirement system may continue FEDVIP enrollment into retirement with no requirement to have been enrolled for the prior five years, as applies in the FEHB and Federal Employees’ Group Life Insurance programs. Further, unlike in those programs, retirees may newly enroll in FEDVIP during the annual open season.
A link to each FEDVIP plan’s site, a provider search function and other information is at www.opm.gov/healthcare-insurance/dental-vision/plan-information. The FEDVIP general information number is (877) 888-3337, TTY (877) 889-5680. Enrollment and related information is at 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 payer of any benefits. FEDVIP plans are responsible for coordinating benefits with the primary payer.
FEDVIP plans also coordinate benefit payments with other group health, dental or vision benefits coverage that enrollees may have, and with the payment of dental or vision costs under no-fault insurance.
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 policies for reviewing disputed claims, which are explained in its brochure. An enrollee who has completed the plan’s claims dispute process and still disagrees with the plan’s decision 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.
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 regardless of whether they actually are enrolled in that program, except that those who are eligible for FEHB only through enrollment in temporary continuation of coverage are ineligible under FEDVIP. See FEHB Eligibility and Enrollment Rules in Section 1 of this chapter.
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 retirement 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—If you are a survivor of a deceased federal/Postal Service employee or annuitant, you may enroll or continue an existing enrollment only if you are receiving a survivor annuity (unless you are otherwise eligible, such as through your own federal employment).
Compensationers—Injury compensationers are eligible to enroll in FEDVIP or continue 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 duty can enroll or continue the deceased’s enrollment.
Family Members—Under FEDVIP, eligible family members (see www.opm.gov/
• a spouse, including a common law spouse in states where such marriages are recognized (note: eligibility does not apply to domestic partnerships, civil unions or other arrangements not formally recognized as a marriage);
• unmarried dependent children under age 22, including adopted children and recognized children born out of wedlock who meet certain dependency requirements, 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.
Note: Children of a same-sex domestic partner were eligible for coverage under certain conditions during 2014-2015; that coverage generally ended effective in 2016 due to a 2015 U.S. Supreme Court ruling requiring all states to conduct and recognize same-sex marriages. A temporary extension of eligibility for children of a same-sex domestic partnership when the enrollee was stationed overseas expired September 30, 2018.
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. FEHB temporary continuation of coverage enrollees also are ineligible, as are insurable interest annuity recipients unless they qualify otherwise.
You self-certify the eligibility of dependents to be covered under self plus one or self and family coverage. FEDVIP plans may ask you to provide documentation that confirms a family member’s eligibility (such as a marriage certificate or adoption papers) when you initially enroll or when you add a family member to an existing enrollment. If your 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 program as a foster child or as a child incapable of self-support because of a mental or physical disability, provide the FEDVIP plan with a copy of that determination. If such a determination has not been made, you must request that determination from your agency or retirement system and then submit a copy to the FEDVIP plan.
Note: P.L. 114-328 of 2016 eliminated the Tricare Retiree Dental Plan effective with calendar year 2019 and made most military retirees and their family members eligible for FEDVIP, as well as members of the Retired Reserve, non-active Medal of Honor recipients, and survivors. Most family members of active duty personnel are eligible for vision coverage only, and also must be enrolled in a Tricare health plan.
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.
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, as a previously ineligible employee who transferred to a covered position, or as a survivor annuitant (if not already covered under FEDVIP);
• within 60 days of when you return to service following a break in service of at least 30 days;
• from 31 days before you or an eligible family member lose other dental/vision coverage to 60 days after a qualifying life event that allows you to enroll (see below);
• from 31 days before you get married to 60 days after; or
• within 60 days after returning to federal employment after being on leave without pay if you did not have federal dental or vision coverage prior to going on leave without pay, or your coverage was terminated or canceled during your period of leave without pay.
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 their first 60 days. 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 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 one or more family members eligible to be 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. 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 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, consistent with that 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 in anticipation of gaining an eligible family member, as described under Qualifying Life Events, below. The family member (such as a newly adopted child or a new spouse) is automatically covered by a self and family enrollment from the date he or she becomes eligible as a family member. However, enrollees should still add new family members to existing self and family enrollments to ensure timely payment of claims.
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 further can choose different enrollment types for each. In addition, they can choose a different eligible family member for each if enrolled as self plus one in each.
For both self plus one and self and family enrollments, when an eligible family member on an existing enrollment loses eligibility (for example, a non-disabled 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.
“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, marry each other. 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/retirement-services/publications-forms/benefits-administration-letters.
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 canceled enrollment will not be refunded to you, but you are not required to refund any benefits paid under the canceled enrollment.)
• If you take an enrollment action based on experiencing a qualifying life event (QLE), you may cancel that action within the time limit allowed for the QLE.
• If you change enrollment in anticipation of a permitted QLE and that event does not occur, you can cancel the change.
• 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—An existing enrollment renews automatically each year in the open season unless you make a change or your plan’s participation ends.
Belated Enrollments or Changes—The time limit for enrolling or changing an enrollment may be extended for up to six months after you first becomes eligible, or have a qualifying life event, or after the end of open season, if you provide evidence to BENEFEDS that you were unable to enroll or change enrollment timely for reasons beyond your control. If BENEFEDS allows a belated enrollment or change in enrollment, you must enroll or change enrollment within 30 days after BENEFEDS notifies you. BENEFEDS will allow belated enrollments and changes only in exceptional circumstances, and its decisions cannot be appealed.
Changes Outside Open Season—Outside the annual open season, new enrollments and changes in existing enrollments are allowed consistent with certain qualifying life events. If you do not act within the pertinent time, you must wait until the next open season.
You may newly enroll up to 60 days after:
• you marry;
• you or an eligible family member lose other dental/vision coverage;
• your annuity or injury compensation is restored after having been terminated;
• you return to pay status after being on leave without pay due to deployment to active military duty; or
• you return to federal employment after being on leave without pay if you did not have federal dental or vision coverage prior to going on leave without pay, or your coverage was terminated or canceled during your period of leave without pay.
In the case of marriage or loss of other coverage, you also can enroll up to 31 days before the event.
If you already are enrolled, within 31 days before to 60 days after you may:
• increase enrollment type (such as from self-only to self plus one) and/or change plan/plan options within a plan upon marriage;
• increase enrollment type upon acquiring an eligible family member or when an eligible family member loses other vision/dental coverage;
• decrease enrollment type on the loss of, or loss of eligibility of, a covered family member;
• change plans/plan options on returning to federal employment after being on leave without pay if you did not have FEDVIP coverage prior to going on leave without pay, or your coverage was terminated or canceled during your period of leave without pay.
You also may change plans/plan options at any time after moving out of a regional plan’s service area.
Retirees and injury compensationers may make enrollment changes under the same circumstances as active employees (although not all of the conditions that apply to active employees, such as going on leave, apply to retirees).
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.
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, a plan comparison tool and other plan information are at www.opm.gov/healthcare-insurance/dental-vision/plan-information.
There are four vision plans, each of them national and each with standard and high options: Aetna Vision, FEP BlueVision, UnitedHealthcare Vision, and Vision Service Plan. 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:
Aetna Vision Preferred
Vision Service Plan
There are 10 dental carriers. Six are national—Aetna, Delta Dental, FEP BlueDental, GEHA, MetLife and United Concordia—and four are regional—Dominion Dental (District of Columbia, Delaware, Maryland, Pennsylvania and parts of New Jersey and Virginia); EmblemHealth (state of New York and parts of Connecticut, New Jersey and Pennsylvania); 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); and Triple-S Salud (Puerto Rico).
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. Premium rates, a plan comparison tool and other plan information are at www.opm.gov/healthcare-
To contact dental plans:
Humana Dental Company