Emergency Services ..........................................................................................................................................................12
Plan Allowance .................................................................................................................................................................12
Section 5 Dental Services and Supplies Class A Basic ...............................................................................................................13
Class B Intermediate ...................................................................................................................................................................15
Class C Major ..............................................................................................................................................................................18
Class D Orthodontic ....................................................................................................................................................................23
General Services .........................................................................................................................................................................24
Section 6 International Services and Supplies ............................................................................................................................26
Section 7 General Exclusions – Things We Do Not Cover .........................................................................................................27
Section 8 Claims Filing and Disputed Claims Processes ............................................................................................................30
How to File a Claim for Covered Services .......................................................................................................................30
Deadline for Filing Your Claim .........................................................................................................................................30
Disputed Claims Process ...................................................................................................................................................30
Section 9 Definitions of Terms We Use in This Brochure ..........................................................................................................31
Stop Health Care Fraud! .............................................................................................................................................................32
Summary of Benefits ..................................................................................................................................................................33
Rate Information .........................................................................................................................................................................34
2
2018
Enroll at www.BENEFEDS.com
How We Have Changed For 2018
We have made the following modifications for 2018:
Class A Services: Added the following procedure code:
•
D1575 Distal shoe space maintainer – fixed - unilateral
•
D9995 Teledentistry – synchronous; real-time encounter (when available)
•
D9996 Teledentistry – asynchronous; information store and forwarded to dentist for subsequent review (when available)
Class B Services: Added the following procedure code:
•
D4346 Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation
Class C Services: Added the following procedure codes:
•
D6081 Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of
the implant surfaces, without flap entry and closure
3
2018
Enroll at www.BENEFEDS.com
FEDVIP Program Highlights
You can select from several nationwide, and in some areas, regional dental Preferred
Provider Organization (PPO) or Health Maintenance Organization (HMO) plans, and high
and standard coverage options. You can also select from several nationwide vision plans.
You may enroll in a dental plan or a vision plan, or both. Visit www.opm.gov/healthcare-
insurance/dental-vision/ for more information.
A Choice of Plans and
Options
You enroll online at www.BENEFEDS.com. Please see Section 2, Enrollment, for more
information.
Enroll Through
BENEFEDS
If you or one of your family members is enrolled in or covered by one FEDVIP plan, that
person cannot be enrolled in or covered as a family member by another FEDVIP plan
offering the same type of coverage; i.e., you (or covered family members) cannot be
covered by two FEDVIP dental plans or two FEDVIP vision plans.
Dual Enrollment
If you sign up for a dental and/or vision plan during the 2017 Open Season, your coverage
will begin on January 1, 2018. Premium deductions will start with the first full pay period
beginning on/after January 1, 2018. You may use your benefits as soon as your
enrollment is confirmed.
Coverage Effective Date
Employees automatically pay premiums through payroll deductions using pre-tax dollars.
Annuitants automatically pay premiums through annuity deductions using post-tax
dollars.
Pre-Tax Salary Deduction
for Employees
Each year, an Open Season will be held, during which you may enroll or change your
dental and/or vision plan enrollment. This year, Open Season runs from November 13,
2017 through midnight EST December 11, 2017. You do not need to re-enroll each Open
Season unless you wish to change plans or plan options; your coverage will continue from
the previous year. In addition to the annual Open Season, there are certain events that
allow you to make specific types of enrollment changes throughout the year. Please see
Section 2, Enrollment for more information.
Annual Enrollment
Opportunity
Your enrollment or your eligibility to enroll may continue after retirement. You do not
need to be enrolled in FEDVIP for any length of time to continue enrollment into
retirement. Your family members may also be able to continue enrollment after your
death. Please see Section 1, Eligibility, for more information.
Continued Group
Coverage After
Retirement
There is no waiting period associated with this plan.
Waiting Period
4
2018
Enroll at www.BENEFEDS.com