Federal Employees Dental and Vision Insurance Program (FEDVIP)

RI 70-01 For Federal Civilian Employees

What does this Program offer?

The Federal Employees Dental and Vision Insurance Program provides comprehensive dental and vision insurance at competitive group rates. There are seven dental plans and three vision plans from which to choose. FEDVIP features nationwide, international, and regional plans.

A dental or vision insurance plan is much like a health insurance plan; you may be required to meet a deductible and provide a copay or coinsurance payments for your dental or vision services. With any plan choice, you should look at all the information and find a plan that will best fit your needs. You should also review your FEHB plan brochure to determine what dental and/or vision coverage the FEHB plan provides.

If you are currently enrolled in FEDVIP and do not want to change plans or enrollment type, you do not need to do anything. Your enrollment will continue automatically. Please Note: your premiums and benefits may change for 2008.

Key FEDVIP Facts

• FEDVIP is part of the annual Federal Benefits Open Season.
• FEDVIP is separate and different from the FEHB Program.
• FEDVIP coverage continues each year. You do not need to reenroll each year. If you do not want to change plans or enrollment type, do nothing.
• Coordination of benefits (COB) with the FEHB plan, if enrolled in a FEHB plan, is a requirement under the FEDVIP law. The FEDVIP plan is always secondary to the FEHB plan.
• You can use your Flexible Spending Account (FSA) with FEDVIP. You can submit your FEDVIP copayments and deductibles as eligible expenses against your FSA account.
• Cancellation of coverage can only be made during Open Season or upon deployment to active military duty.
• All nationwide FEDVIP plans provide international coverage.
• There are separate and/or different provider networks for each plan.
• Utilizing an in-network provider will reduce out-of-pocket costs.
• There are no pre-existing condition limitations.
• There is no opportunity to convert to a private plan when your FEDVIP coverage ends. There is no 31-day extension of coverage, Temporary Continuation of Coverage (TCC), Spouse Equity coverage, or right to convert to an individual policy (conversion policy).

What enrollment types are available?

• Self Only, which covers only the enrolled employee or retiree;
• Self Plus One, which covers the enrolled employee or retiree plus one eligible family member specified by the enrollee; and
• Self and Family, which covers the enrolled employee or retiree and all eligible family members.

Appendix I lists the available dental and vision insurance plans along with basic benefit information.

How much does it cost?

You pay the entire premium. There is no government contribution to the premium. If you are an active employee, your premiums are taken from your salary on a pre-tax basis if your salary is sufficient to make the premium withholding. When you retire, premiums will be withheld from your monthly annuity check if your annuity is sufficient.

Premiums for the nationwide dental plans and one regional dental plan are based on where you live. This is called your rating region. Your home ZIP code is used to find your rating region. Rating regions vary by carrier. The vision plans do not have rating regions. Enrolling in a FEDVIP plan will not reduce your FEHB premium.

See Appendices J and K to find 1) the rating region assigned to the area where you live by the different dental plans and 2) the related premium you will pay. You may also go to our website at www.opm.gov/insure/dentalvision for premium and rating region information.

Am I eligible to enroll?

Federal employees eligible for FEHB coverage (whether or not actually enrolled) and retirees (regardless of FEHB status) are eligible to enroll in a dental and/or vision plan. Former spouses and deferred annuitants are NOT eligible to enroll. Anyone receiving an insurable interest annuity who is not also an eligible family member is NOT eligible to enroll.

When can I enroll?

If you are a new employee eligible for FEDVIP, or an employee who has become newly eligible to enroll, you may enroll within 60 days of first becoming eligible. An eligible employee or retiree may also enroll during the annual Federal Benefits Open Season, which runs from the Monday of the second full work week in November through the Monday of the second full work week in December. An eligible employee or retiree may enroll, change enrollment type, or change plans or options during Open Season or outside of Open Season if they experience a qualifying life event (QLE) such as a change in family or other insurance coverage status. Please see Appendix H for more information about QLEs that permit employees and retirees to enroll or make changes in FEDVIP.

Premiums are deducted beginning the first full pay period on or after January 1. For new or newly eligible employees who elect to enroll, coverage is effective the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment. An Open Season enrollment or change is effective January 1.

How do I enroll?

You may enroll on the Internet at www.BENEFEDS.com. BENEFEDS is a secure enrollment website sponsored by OPM. For those without access to a computer, please call 1-877-888-FEDS (1-877-888-3337) (TTY number, 1-877-889-5680).

You cannot enroll in a FEDVIP plan using the Health Benefits Election Form (SF 2809) or through an agency selfservice system, such as Employee Express, MyPay or Employee Personal Page. However, those sites may provide a link to BENEFEDS.

What should I consider in making my decision to participate in this Program?

There are things to consider when deciding to enroll in FEDVIP or selecting a FEDVIP plan. By considering these questions thoroughly, you will be able to determine if FEDVIP is a good option for you.

1. Does my FEHB plan provide dental or vision coverage?

2. How does the FEDVIP plan coordinate benefits with the FEHB plan and how is the coordination of benefits calculated?

3. How affordable is the plan?

   • How much will it cost me on a biweekly or monthly basis?
   • Must I pay a deductible?.
   • If I use a FEDVIP provider outside of the network, how much will I pay to get care?
   • How frequently can I visit the dentist and how much do I have to pay at each visit?
   • Will the plan provide benefits if I am also covered by another dental or vision plan?

4. Do I have access to any provider?

   • Does the plan give me the freedom to choose my own dentist or am I restricted to a panel of dentists selected by the plan?
   • Are there enough of the kinds of dentists I want to see?
   • Where will I go for care? Are these places near where I work or live?
   • Do I need to get permission before I see a dental specialist?
   • Will the plan allow referrals to specialists? Will my dentist and I be able to choose the specialist?

5. Does the plan provide coverage for specialty services?

   • Are dentures, orthodontics, implants or replacement of missing teeth covered?
   • What are the plan's limitations or exclusions?
   • Are there annual limits on the types of services included?

How do I find my premium rate?

If you live outside the United States:
Go to Appendix K for your dental and vision premium rates.

If you live inside the United States:
Go to Appendix K for your vision premium rate. To find your biweekly or monthly dental premium, you must first find your rating area on the chart in Appendix J. The plans have not changed their rating regions for the upcoming plan year.

Please Note: If you are currently enrolled and have moved or your postal service has assigned you a new ZIP code, your rating region may have changed.

1. To find your dental rating area:
   1. Go to the chart in Appendix J.
   2. Find your state and your corresponding Zip code (1st 3 digits).
   3. Look under the Plan name and you will find your rating area.
2. To find your biweekly or monthly dental premium, match your rating area with your desired FEDVIP plan on the chart in Appendix K.

Making an informed choice

• Before selecting a plan that best suits your needs, ask your carrier or access the OPM website for a copy of the plan brochure.
• If you have questions about coverage, exclusions, limitations or payment of benefits, ask the plan before making your plan selection.
• Find out which plan your provider participates in and why. Keep in mind that if your provider leaves the plan, this is not a qualifying life event allowing a change.

How do I get more information about this Program?

Visit FEDVIP online at www.opm.gov/insure/dentalvision for information including:

• How to enroll
• FEDVIP plan websites, brochures, and provider searches
• Dental premium rates
• Vision premium rates

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