Federal Employees Dental and Vision Insurance Program

Chapter 2: Section 4

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.

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/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 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, 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. 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—If you are a survivor of a deceased federal/U.S. 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 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 (see www.opm.gov/healthcare-insurance/dental-vision/eligibility) are:

• a spouse, including a “legally married” same-sex spouse, meaning one married in a jurisdiction (including in a foreign country) that recognizes such marriages, regardless of current place of residence, and 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 (children of legally married same-sex couples are treated the same as those of opposite-sex married couples).

If you are in a same-sex domestic partnership that meets certain qualifications (see Domestic Partners in Chapter 8, Section 4) and live in a jurisdiction that does not recognize same-sex marriage, your partner’s children are eligible as well; however, your partner is not eligible. If you want to cover a child of a same-sex domestic partner, you must certify that you would marry the partner were that option available in your state of residence. Rules at 5 CFR 894 govern situations such as moves among jurisdictions with differing policies on the subject. In some circumstances, children eligible for coverage under these conditions may not be eligible to have their share of premiums paid on a pretax basis (see Premium Conversion, below) and the associated portion of the premium will have to be paid with after-tax money.

If you divorce or terminate a qualifying domestic partnership, or if your spouse or qualifying partner dies, stepchildren remain eligible if they continue to live with you in regular parent-child relationships.

Stepchildren remain eligible after divorce from the spouse, termination of the domestic partnership or the death of the spouse or domestic partner if they continue to live with the enrollee in a regular parent-child relationship.

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.

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), either 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, you should 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 plan that will make the final determination of eligibility.

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, 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 loses 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 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 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 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 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 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 further 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, 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).
• An 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—Re-enrollment is automatic each year unless you make 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 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.

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 the annual open season.

You may newly enroll outside an open season if:

• 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;
• you get married; 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.

You may change from one dental and/or vision plan to another plan or from one option to another option in the same plan outside an open season if:

• you get married; or
• you return to federal employment after being on leave without pay and 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 addition, if you are enrolled in a dental or vision plan with a geographically restricted service area, and you or a covered eligible family member move out of the service area, you may change to a different dental or vision plan that serves that area. You may make this change at any time before or after the move, once you or a covered eligible family member has a new address. You may increase your type of enrollment (going from self-only to self plus one or self and family, or from self plus one to self and family) outside an open season consistent with marriage, acquiring an eligible child, or loss of other dental or vision coverage by an eligible family member.

You may decrease your type of enrollment consistent with the loss of one or more eligible family members due to divorce, death, loss of eligibility of a previously enrolled child, or the deployment of your spouse to active military duty. You may decrease from self and family to self plus one if after the event you have only one remaining eligible family member, or to self-only from self plus one or self and family if there are no remaining eligible family members.

For either an increase or a decrease in a type of enrollment, you may not change from one dental or vision plan or from one option to another within a plan unless the event qualifies for that type of change as described above.

The time for requesting a QLE-related change typically runs for the 60 days after the event except that an increase or decrease in the type of enrollment may be made as soon as 31 days before the event, and there is no limit related to a move outside the area of a geographically restricted plan as described above. A change due to a QLE is effective the first day of the pay period following the pay period in which you make the change.

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).

 

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 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 (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:

Aetna Vision
(855) 347-6899
www.aetnafeds.com

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

UnitedHealthcare Vision
(866) 249-1999

www.myuhcvision.com/fedvip

Vision Service Plan
(800) 807-0764

www.choosevsp.com

Dental Benefits

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 and other plan information are at www.opm.gov/healthcare-insurance/dental-vision/plan-information.

To contact dental plans:

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

Delta Dental
(855) 410-3255
www.deltadentalfeds.org

Dominion Dental
(855) 836-6337
www.dominiondental.com

EmblemHealth
(212) 501-4444
www.emblemhealth.com

FEP BlueDental
(855) 504-2583
www.fepblue.org

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

Humana Dental Company
(877) 692-2468
http://feds.humana.com/dental

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

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

United Concordia
(877) 394-8224

www.uccifedvip.com

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