Dominion Dental Services FederalDentalPlans com

•  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 during Open Season. 

Coverage for a family member ends when: 

•  you as the enrollee lose 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.  The following are also 

NOT available under the FEDVIP plans:

•  Temporary Continuation of Coverage (TCC); 

•  spouse equity coverage; or 

•  right to convert to an individual policy (conversion policy). 

Continuation of Coverage

If you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account 

(HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA), 

you should consider how coverage under a FEDVIP plan will affect your annual expenses, 

and thus the amount that you should allot to an FSAFEDS account.  Please note that 

insurance premiums are not eligible expenses for either type of FSA. 

If you have an HCFSA or LEX HCFSA FSAFEDS account and you haven’t exhausted 

your funds by December 31st of the plan year, FSAFEDS can automatically carry over up 

to $500 of unspent funds into another health care or limited expense account for the 

subsequent year. To be eligible for carryover, you must be employed by an agency that 

participates in FSAFEDS and actively making allotments from your pay through 

December 31.  You must also actively reenroll in a health care or limited expense account 

during the NEXT Open Season to be carryover eligible. Your reenrollment must be for at 

least the minimum of $100.  If you do not reenroll, or if you are not employed by an 

agency that participates in FSAFEDS and actively making allotments from your pay 

through December 31st, your funds will not be carried over. 

Because of the tax benefits an FSA provides, the IRS requires that you forfeit any money 

for which you did not incur an eligible expense and file a claim in the time period 

permitted.  This is known as the “Use-it-or-Lose-it” rule.  Carefully consider the amount 

you will elect.   

For a health care or limited expense account, each participant must contribute a minimum 

of $100 to a maximum of $2,600. 

Current FSAFEDS participants must re-enroll to participate next year.  See www.fsafeds.

com or call 1-877-FSAFEDS (372-3337) or TTY: 1-866-353-8058. 

If you enroll or are enrolled in a high deductible health plan with a health savings account 

(HSA) or health reimbursement arrangement (HRA), you can use your HSA or HRA to 

pay for qualified dental/vision costs not covered by your FEHB and FEDVIP plans. 

You will be required to submit your claims on behalf of the Dominion Dental Services, 

Inc. plan to the FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited 

Expense Health Care Flexible Spending Account (LEX HCFSA) to claim reimbursement. 

FSAFEDS/High 

Deductible Health Plans 

and FEDVIP

9 

2018  

Enroll at www.BENEFEDS.com 

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Section 3 How You Obtain Care 

We will send you an identification (ID) card when you enroll.  You should carry your ID 

card with you at all times.  You should present your ID card whenever you receive 

services from an assigned plan provider. 

If you do not receive your ID card within 30 days after the effective date of your 

enrollment or if you need replacement cards, you may request one through our website at 

FederalDentalPlans.com or call us at 855-836-6337. 

Identification Cards/

Enrollment 

Confirmation 

You must choose a primary care dentist before you utilize the plan.  Prior to your effective 

date, you will receive a notification prompting you to select a dentist.  You can find a 

current list of dentists online at FederalDentalPlans.com. You can also call us at 

855-836-6337 to request that a list be mailed to you.  After your effective date, simply call 

the dental office you selected and make an appointment.  Except for out-of-area 

emergency care, you must receive treatment at the dental office you selected. 

Where You Get Covered 

Care 

A complete list of participating dentists are available on our online provider search at 

FederalDentalPlans.com.  The list is refreshed every night. 

Plan Providers 

You must receive services from your selected participating general dentist.  If specialty 

services are necessary, a referral will be provided by your participating general dentist. An 

orthodontist can be selected for orthodontia services without a referral. 

In-Network

There are no out-of-network benefits available except for emergency care. 

Out-of-Network 

If you have an emergency outside of the service area, visit any licensed dentist for care. 

We will reimburse you for emergency services up to $100 per member per year. 

Emergency Services

When you visit a provider who participates with both, your FEHB plan and your FEDVIP 

plan, the FEHB plan will pay benefits first.  The FEDVIP plan alowance will be the 

prevailing charge, in these cases.  You are responsible for the difference between the 

FEHB and FEDVIP benefit payments and the FEDVIP plan allowance.  We are 

responsible for facilitating the process with the primary FEHB first payor. You can assist 

with this process and also ensure that you are receiving the maximum allowable benefit 

under each program by presenting both your FEDVIP and FEHB ID cards at the time of 

your dental appointment. The dentist should include both ID numbers when submitting the 

claim to the plans. 

It is important to bring your FEDVIP and FEHB identification cards to every dental 

appointment because most FEHB plans offer some level of dental benefits separate from 

your FEDVIP coverage. Presenting both identification cards can ensure that you receive 

the maximum allowable benefit under each Program. 

First Payor

We will coordinate benefit payments with the payment of benefits under other group 

health benefits coverage you may have and the payment of dental costs under no-fault 

insurance that pays benefits without regard to fault.  

We may request that you verify/identify your health insurance plan(s) annually or at time 

of service.   

Coordination of Benefits 

To enroll in this plan, you must live in our service area.  This is where our providers 

practice.  Our service area is: District of Columbia, Delaware, Maryland, Pennsylvania 

and parts of Virginia and parts of New Jersey. 

Service Area 

10 

2018  

Enroll at www.BENEFEDS.com 

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