FEHB, FSA, and FEDVIP
Question: What is the Federal Employees Dental and Vision Insurance Program (FEDVIP)?
Answer: President George W. Bush signed The Federal Employee Dental and Vision Benefits Enhancement Act of 2004 into law on December 23, 2004. The Act authorizes OPM to establish arrangements under which supplemental dental and vision benefits will be made available to Federal and U.S. Postal Service employees, retirees, and their eligible family members, and the law gives OPM broad contracting authority to leverage the purchasing power of federal enrollees to provide comprehensive benefits with competitive premiums.
How do I change my name and/or address in my plan's system?
Answer: You must contact BENEFEDS in order to change your name and/or address: wwww.benefeds.com or 1-877-888-3337, TTY 1-977-889-5680.
How can I get a plan brochure?
Answer: You may contact your plan directly or view and/or download your plan's brochure via the following website: http://www.opm.gov/insure/dentalvision/08openseason.asp.
How can I contact a plan directly?
Answer: You may obtain your plan's contact information via the following website: http://www.opm.gov/insure/dentalvision/plancontact.asp
Question: Who are the dental carriers?
Answer: The dental carriers are:
- Aetna Life Insurance Company;
- Government Employees Health Association, Inc. (GEHA);
- MetLife Inc.;
- United Concordia Companies, Inc.;
- Group Health, Inc.;
- CompBenefits; and
- Triple-S, Inc.
Question: Who are the vision carriers?
Answer: The vision carriers are:
- FEP BlueVision;
- Spectera, Inc.; and
- Vision Service Plan (VSP).
Question: How do the FEDVIP plans differ from the dental and vision benefits FEHB plans provide as part of their benefits package?
Answer: FEHB and FEDVIP are separate programs. While some FEHB plans offer dental or vision benefits as part of their benefit package, only those carriers under contract to OPM are FEDVIP plans. FEDVIP plans offer comprehensive dental and vision benefits.
FEDVIP is not part of the FEHB program, and it is different from any supplementary dental and vision product your FEHB plan may offer.
Question: Which FEDVIP plans are available nationwide?
Answer: All vision plans are available nationwide. The following dental plans are available nationwide:
- Aetna Life Insurance Company;
- Government Employees Health Association, Inc. (GEHA);
- MetLife Inc.; and
- United Concordia Companies, Inc.
Question: Which FEDVIP plans are available in specific regions?
Answer: The following dental plans are available in specific regions:
- CompBenefits is available in Alabama, Arkansas, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, parts of Maryland, Missouri, Mississippi, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
- Group Health, Inc. is available in all of New York, Northern New Jersey (counties of Bergen, Essex, Hudson, Middlesex, Monmouth, Morris, Passaic, Somerset, Sussex, and Union), Connecticut (counties of Fairfield, Litchfield, New Haven), Pennsylvania (counties of Pike and Monroe).
- Triple-S, Inc. is available in Puerto Rico.
Question: Do any of the plans offer both dental and vision coverage?
Answer: Unfortunately, none of the plans offer both.
Question: Which FEDVIP plans can I enroll in if I live overseas?
Answer: You can enroll in any of the nationwide dental and/or vision plans. These plans provide benefits for services received outside of the United States.
Question: I'm enrolled in a dental plan that's not part of FEHB, but it's listed in my FEHB plan's brochure under Non-FEHB benefits available to Plan members. Is this plan part of the FEDVIP program?
Answer: No, FEDVIP plans are separate from any Non-FEHB dental plan offered through your FEHB plan.
Question: Are the FEDVIP carriers on a contract with OPM even though the government does not contribute to the premiums?
Answer: Yes, the FEDVIP carriers have a signed contract with OPM.
Question: How do I get a replacement ID card?
Answer: Contact the plan directly to make a request.
Question: Who is eligible to enroll in FEDVIP?
Answer: Federal and U.S. Postal Service employees eligible for FEHB coverage (whether or not enrolled) and annuitants/survivor annuitants/compensationers (regardless of FEHB eligibility) are eligible to enroll.
Question: Who is NOT eligible to enroll in FEDVIP?
Answer: The following people are not eligible to enroll in FEDVIP, regardless of FEHB eligibility or receipt of an annuity or portion of an annuity.
- deferred annuitants,
- former spouses of employees or annuitants,
- FEHB temporary continuation of coverage (TCC) enrollees,
- temporary employees who are:
- serving under an appointment limited to one year or less and have not completed at least one year of current continuous employment, excluding any break in service of 5 days or less; or
- expected to work less than 6 months in each year.
- intermittent employees (who do not have a prearranged regular tour of duty)
- seasonal or occasional employment for one calendar year that amounted to less than 6 months of work does not meet the one year of current continuous employment requirement.
- anyone receiving an insurable interest who is not an eligible family member
Question: If I'm not enrolled in FEHB can I still enroll in FEDVIP?
Answer: Yes, if you are an employee who is eligible for FEHB. You don't have to be enrolled. Annuitants, survivor annuitants and compensationers do not have to be eligible for FEHB to enroll in FEDVIP.
Question: Who is considered an eligible family member?
Answer: Family member eligibility under FEDVIP is the same as for FEHB. Eligible family members are your:
- unmarried dependent child(ren) under age 22 (including an adopted child, stepchild, foster child, and recognized natural child), and
- child age 22 or over who is incapable of self-support because of a mental or physical disability that existed before the child reached age 22.
Question: Does "incapable of self-support" include college students who are not supporting themselves?
Answer: No, in order to be covered under your FEDVIP plan, the child age 22 or over must be incapable of self-support because of a mental or physical disability that existed before the child reached age 22.
Question: My mother lives with me. Can I cover her under my enrollment?
Answer: Unfortunately, parents are not eligible family members.
Question: Are former spouses receiving an apportionment of an annuity or survivor annuity eligible to enroll?
Answer: They would not be eligible.
Question: When can I enroll?
Answer: Eligible individuals will be able to enroll during the upcoming open season, November 12 through December 10, 2007, and during subsequent annual open seasons, or after a qualifying life event that permits enrollment outside of open season. New employees will have 60 days to enroll.
Question: How can I enroll?
Answer: You will be able to enroll through BENEFEDS at www.BENEFEDS.com during open season. Those without access to a computer will be able to enroll by phone at 1-877-888-FEDS (3337), TTY 1-877-889-5680.
Question: Can employees enroll their eligible children without entering a social security number for them, but just their name and date of birth?
Question: Why do we have to use BENEFEDS.com to enroll?
Answer: Streamlining the enrollment process and premium administration into one system offer advantages to employees, agencies, payroll providers, annuity systems and the FEDVIP plans. Enrollees will only need to provide their personal information once and that information will be stored securely for future FEDVIP enrollment actions. BENEFEDS will be the one interface with payroll and annuity systems with standard file layouts. This eliminates the duplicative costs for FEDVIP plans to set up individual interfaces with all payroll and annuity systems.
Question: If I need to enroll using the phone, will I get to talk to a live person or do I have to push all those buttons to enroll?
Answer: A live person will enroll you over the phone. Recorded information will be available to address issues you may have before or after enrollment.
Question: What enrollment types are available?
Answer: An eligible individual may choose one of the following enrollment options:
- Self Only, which covers only the enrolled employee or annuitant;
- Self Plus One, which covers the enrolled employee or annuitant plus one eligible family member specified by the enrollee; or
- Self and Family, which covers the enrolled employee or annuitant and all eligible family members.
Question: Does this mean FEHB will now be offering a Self Plus One category?
Answer: No, FEHB will continue to offer two enrollment options: Self Only and Self and Family.
Question: Do I need to choose the same enrollment type for FEDVIP as I have for FEHB? For example if I'm enrolled in Self and Family for FEHB, can I enroll in Self Only for FEDVIP?
Answer: Your FEDVIP enrollment type does not have to be the same as your FEHB enrollment type.
Question: When will coverage be effective?
Answer: Coverage for those who enroll during this year's open season (November 12 through December 10, 2007) will be effective on January 1, 2008, unless they self-certified that they are eligible for this Program and they are not. In that case their enrollment will be voided as discussed in the Enrollment Terms and Conditions they agreed to in the enrollment process. Enrollees may be asked for documentation to confirm eligibility.
Question: Can I have dental insurance only or vision insurance only or do I have to choose both dental and vision?
Answer: You may select one or both or neither.
Question: Do I have to enroll in FEDVIP?
Answer: No, this is a voluntary dental and vision program available to eligible Federal and USPS employees, retirees, and their eligible family members who want comprehensive dental and vision benefits.
Question: If my FEHB plan is also one of the new FEDVIP plans, do I have to choose that FEDVIP plan to enroll in?
Answer: No, you can choose any FEDVIP plan regardless of your FEHB enrollment.
Question: Does my FEDVIP coverage automatically continue from year to year as my FEHB coverage does?
Answer: Yes, your coverage continues unchanged, unless you make a change during open season or as a result of a Qualifying Life Event that permits a change outside of open season.
Question: Can I cancel my enrollment?
Answer: You may cancel your enrollment during the annual open season. You may also cancel if you are called to active military duty.
Question: Do Judiciary branch employees also use BENEFEDS to enroll?
Question: If some FEDVIP plans are not going to send out benefit cards how does an employee show coverage to the dentist or vision care provider?
Answer: The FEDVIP plans will inform you of how you will show proof of coverage. The FEDVIP plans will provide this information in their plan brochures.
Question: How much are premiums?
Answer: You can find the premiums and your rating area at http://www.opm.gov/insure/DentalVision/index.asp. (See below for an explanation of rating areas.)
Question: Are there different premiums for USPS employees?
Answer: No, USPS employees pay the same premiums as Federal employees and annuitants.
Question: What is a rating area?
Answer: A rating area is a group of zip codes that corresponds to a particular rate charged by a dental plan. Each FEDVIP dental plan can have up to five rating areas, and those areas vary from plan to plan. Your residence zip code may be in rating area 1 for one plan but in rating area 2 for another plan. The dental rating area chart is available at http://www.opm.gov/insure/dentalvision/08/DentalRatingArea.pdf [109 KB].
Question: Do vision plans have more than one rating area?
Answer: No, vision plans charge a nationwide rate.
Question: How much are the premiums if I live overseas?
Answer: There is only one rating area if you live overseas. You can find international premiums at: http://www.opm.gov/insure/dentalvision/08/internationaldentalrates.pdf [11 KB].
Question: Are premiums paid on a pre-tax basis?
Answer: Premiums are paid on a pre-tax basis (premium conversion) if you are an active employee and your salary is sufficient to make the premium withholding. Pre-tax premiums are not available to annuitants, survivor annuitants or compensationers.
Question: Can I opt out of premium conversion?
Answer: No, unlike FEHB, employees may not opt out of premium conversion for FEDVIP. If employees do not wish to have premium conversion for FEDVIP, they should not enroll.
Question: Will there be a government contribution toward premiums?
Answer: No, by law there is no government contribution to the premiums.
Question: Do part-time employees pay the same premium as full-time employees?
Question: I missed paying some premiums during 2007. I'm not canceling my coverage. Once the 2008 plan year begins, will I still have to pay the 2007 back due premiums?
Answer: Yes, your premium deduction amount will reflect your 2008 premium amount as well as adjustments for 2007 premiums still due.
Question: If I cancel my FEDVIP plan during open season, will I still be responsible for missed premiums from 2007?
Answer: Yes, you must pay your 2007 premiums in full.
Question: If I drop my coverage during open season, when will premiums stop coming out of my pay/annuity?
Answer: Assuming you have no back-due premiums, your premium deductions will stop with the first pay period or annuity cycle beginning on or after January 1, 2008.
Question: Is there any information you can give me now on the specific benefits that will be offered?
Answer: All plan brochures are available for downloading from the FEDVIP website: www.opm.gov/insure/dentalvision/08openseason.asp.
Question: What services do vision plans include?
Answer: Vision plans will feature comprehensive eye examinations and coverage for lenses, frames and contact lenses. Other benefits such as discounts on LASIK surgery may also be available.
Question: What services do dental plans include?
Answer: Dental plans will provide a comprehensive range of services, including the following:
- Class A (Basic) services, which include oral examinations, prophylaxis, diagnostic evaluations, sealants and x-rays.
- Class B (Intermediate) services, which include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions, and denture adjustments.
- Class C (Major) services, which include endodontic services such as root canals, periodontal services such as gingivectomy, major restorative services such as crowns, oral surgery, bridges and prosthodontic services such as complete dentures.
- Class D (Orthodontic) services with up to a 24-month waiting period.
Question: Are there any pre-existing condition limitations?
Answer: No, there are no pre-existing condition limitations. There may be specific plan exclusions or limitations.
Question: Will there be a waiting period before I can use the services?
Answer: For dental benefits, there is a waiting period for orthodontia services of up to 24 months. You must be enrolled in the same dental plan/option over the duration of the waiting period to receive orthodontia services. There are no waiting periods for any other dental services or any vision services.
Question: My child has or needs braces. If the braces are applied before I enroll in a FEDVIP plan, would my new carrier cover any of the remaining cost since my child's treatment will continue for 2 to 3 years?
Answer: No, FEDVIP dental plans will not cover the cost of any orthodontic appliances that were placed before enrollment in the plan and satisfaction of any waiting period.
Federal Employee Health Benefits (FEHB) Program, Flexible Spending Accounts (FSA) and Federal Employee Dental and Vision Insurance Program (FEDVIP)
Question: If I am currently enrolled in an FEHB plan, will I be required to enroll in a dental or vision plan offered by my FEHB carrier?
Answer: No, your FEHB plan is separate from the dental and vision insurance program. You may enroll in any dental or vision plan (assuming you live in the service area, if it is a regional plan).
Question: I am currently enrolled in a supplemental dental or vision plan and that carrier is also offering a FEDVIP plan. Can I get credit toward the orthodontic waiting period for the amount of time I've spent in the supplemental plan?
Answer: No, the FEDVIP plan is completely separate from the supplemental plan. You will not be able to transfer the amount of time you spent in the supplemental plan to the FEDVIP Plan.
Question: I have private coverage with one of the companies that now participates in FEDVIP. Can I get credit for the amount of time I've spent in that plan (it's the same company) toward the orthodontic waiting period?
Answer: No, FEDVIP is completely separate from your private plan. You will not be able to transfer the amount of time you spent in your private plan to your FEDVIP Plan.
Question: If an employee's spouse has (non-Federal) dental coverage for the family and the Federal employee signs up for dental self and family - which insurance is primary and which is secondary?
Answer: Each situation varies; however, the two plans will coordinate benefits to lower your out-of-pocket costs.
Question: My FEHB plan covers some dental and vision services. If I enroll in a FEDVIP plan will that replace my FEHB coverage?
Answer: No, any coverage provided under your FEHB plan remains as your primary coverage. FEDVIP coverage would pay secondary to that coverage. FEDVIP is not intended to replace any existing coverage.
Question: If I enroll in a FEDVIP plan, will my FEHB plan reduce my premiums because I will no longer use my FEHB plan's vision or dental benefits?
Answer: No, your FEHB plan will still be the primary payor for your vision and dental care up to the limits of its coverage.
Question: What are the advantages of enrolling in a FEDVIP plan when I already have dental and vision coverage with my FEHB plan?
Answer: FEDVIP plans provide comprehensive coverage that your FEHB plan may not provide. But only you can decide whether it is to your advantage to enroll in a FEDVIP plan.
Question: Will I be able to use my Flexible Spending Account (FSA) in conjunction with the dental and vision program?
Answer: Yes, you can submit your FEDVIP co-payments/deductibles as eligible expenses against your FSA account. However, FEDVIP insurance premiums are not reimbursable under an FSA.
Question: Can I use paperless reimbursement under FEDVIP?
Answer: Only the VSP (vision plan) is participating in paperless reimbursement. If you enroll with them and enroll in FSAFEDS, you may use this benefit.
Question: Are Federal retirees/annuitants and their eligible family members eligible?
Answer: Yes, retirees/annuitants and their spouses and eligible dependent children are eligible to participate in FEDVIP. Retirees must have retired with an immediate annuity (a FERS Minimum Retirement Age plus 10 annuity, postponed, counts as an immediate annuity). Those in receipt of a deferred annuity are not eligible to enroll in FEDVIP.
Question: Are retirees receiving a deferred annuity eligible?
Question: Do I need to be enrolled in FEDVIP five years before I retire to continue enrollment into retirement?
Answer: No, there is no length of time you must be enrolled in FEDVIP to continue coverage into retirement as there is with FEHB and FEGLI.
Question: I am not enrolled in FEHB. If I stay enrolled in a FEDVIP plan for the next five years, can I then get FEHB coverage in retirement?
Answer: No, your FEDVIP enrollment will not count towards the 5-year enrollment requirement for carrying FEHB coverage into retirement.
Question: If I don't enroll now, and I retire next year, can I enroll during retirement?
Answer: Yes, you can enroll during an open season as an annuitant.
Question: I plan to enroll in a FEDVIP plan during open season, and I understand my benefits will begin on January 1, 2008. I also understand the first deduction from my paycheck for FEDVIP will occur on the first pay period that begins on or after January 1, 2008. I will be retiring after open season but before the first premium deduction comes out of my pay. Should I enroll during open season as an employee or an annuitant?
Answer: Enroll as an employee during open season. BENEFEDS, which handles all FEDVIP enrollment and premium administration functions, will work closely with agency payroll offices and retirement systems to "find" FEDVIP enrollees who retire on an immediate annuity and deduct the FEDVIP premiums from their annuity payments. It may take a few annuity cycles for this to occur. After the first successful deduction from your annuity, BENEFEDS will adjust your deduction to "catch up" for the payments that were missed during the transition. You'll receive a letter from BENEFEDS informing you of the amount of the adjusted deduction.
Question: If you accept a deferred retirement annuity at age 62, would you then be eligible for FEDVIP? What about Minimum Retirement Age (MRA) +10 retirees?
Answer: If you are on a deferred retirement annuity, you are not eligible for FEDVIP. Your FEDVIP coverage will end if you retire on a MRA + 10 retirement and you postpone receipt of your annuity. You can enroll in FEDVIP again when you begin to receive your annuity.
Question: Will employees be responsible for contacting BENEFEDS and letting them know they have retired and FEDVIP premiums need to come out of their annuity payment instead of billing the agency they just retired from?
Answer: No, you are not required to contact BENEFEDS. However, you can speed up the process by contacting BENEFEDS.
Question: Will my deduction continue to be pre-tax after I retire?
Answer: No, retiree pay premiums on post tax basis.
Question: I am an active member of the uniformed services (not a federal employee or federal retiree). Am I eligible for FEDVIP?
Answer: No, you are not eligible.
Question: I've been called up for active duty, can I enroll in FEDVIP?
Answer: You will be eligible to enroll once you return from active duty. You will have 60 days from the date you are restored to a civilian position in which to enroll in FEDVIP.
Question: If I have TRICARE, can I enroll in FEDVIP?
Answer: Yes, TRICARE enrollees are eligible to participate in the FEDVIP program if they meet other eligibility requirements (see the section on eligibility and enrollment, above).
Question: I am currently enrolled in FEDVIP as an employee. If I am called to active duty, can I cancel my coverage?
Answer: Yes, you can cancel through BENEFEDS.