Aetna

800-537-9384

0%

40%

60%

70%

$0

$1,500 lifetime max per person (orthodontic services only)

www.aetnafeds.com

$1,500 lifetime max per person (orthodontic services only)

GEHA Standard

877-434-2336

0%

45%

65%

70%

$0

GEHA High

www.gehadental.com

0%

20%

50%

70%

$1,500 lifetime max per person (orthodontic services only)

MetLife Standard

888-865-6854
www.federaldental.metlife.com

0%

45%

65%

50%

$0

$1,200 standard option annual non-orthodontic maximum per person

MetLife High

0%

30%

50%

50%

$3,000 high option non-orthodontic maximum per person
$1,500 lifetime maximum per person for orthodontics

United Concordia

877-394-8224
www.uccifedvip.com

0%

20%

50%

50%

$75 self/$150 self & family/
self plus one
Class B and Class C

$1,200 per year per person
$1,500 lifetime maximum per person (orthodontic services only)

CompBenefits
(Open to residents of the
Southeastern, Midwestern,
and Mid-Atlantic states

877-692-2468
www.fed.dentaladvantage.compbenefits.com

0%

40%

54%

70%

$0

No maximum
Unlimited lifetime orthodontic coverage

GHI
(Open to NY and Northern NJ
residents and parts of CT and PA)

212-501-4444
www.ghi.com

0%

0%

0%

0%

$50 self/$150 self & family/
self plus one
Class B and Class C

$1,250 per year per person
$2,000 lifetime max per person
(orthodontic services only)
Note: GHI has a 12-month waiting
period for orthodontia services

Triple S
(Open to Puerto Rico
residents)

787-774-6060
787-749-4777
800-981-3241
TTY 787-774-6060
www.ssspr.com

0%

30%

60%/30%

50%

$0

No maximum
$1,500 lifetime max per person
(orthodontic services only)

High (In and Out-of- Network benefits)

1

$12.15

$24.31

$36.46

$26.33

$52.67

$79.00

2

$13.36

$26.72

$40.09

$28.95

$57.89

$86.86

3

$14.20

$28.42

$42.62

$30.77

$61.58

$92.34

4

$15.66

$31.31

$46.98

$33.93

$67.84

$101.79

5

$16.99

$33.97

$50.96

$36.81

$73.60

$110.41

Standard (Out-of-Network benefits vary)

1

$9.36

$18.73

$28.09

$20.28

$40.58

$60.86

2

$10.26

$20.51

$30.77

$22.23

$44.44

$66.67

3

$11.61

$23.21

$34.82

$25.16

$50.29

$75.44

4

$12.51

$25.02

$37.53

$27.11

$54.21

$81.32

5

$13.86

$27.72

$41.58

$30.03

$60.06

$90.09

High (In and Out-of- Network benefits)

1

$12.74

$25.49

$38.23

$27.60

$55.23

$82.83

2

$13.98

$27.96

$41.94

$30.29

$60.58

$90.87

3

$15.83

$31.66

$47.48

$34.30

$68.60

$102.87

4

$17.07

$34.13

$51.20

$36.99

$73.95

$110.93

5

$18.92

$37.85

$56.77

$40.99

$82.01

$123.00

Standard (Out-of-Network benefits vary)

1

$7.29

$14.58

$21.88

$15.80

$31.59

$47.41

2

$7.87

$15.74

$23.61

$17.05

$34.10

$51.16

3

$8.69

$17.39

$26.08

$18.83

$37.68

$56.51

4

$9.64

$19.27

$28.91

$20.89

$41.75

$62.64

5

$10.57

$21.14

$31.71

$22.90

$45.80

$68.71

High (In and Out-of- Network benefits)

1

$11.97

$23.94

$35.91

$25.94

$51.87

$77.81

2

$13.38

$26.76

$40.15

$28.99

$57.98

$86.99

3

$14.55

$29.10

$43.65

$31.53

$63.05

$94.58

4

$15.73

$31.45

$47.18

$34.08

$68.14

$102.22

5

$17.59

$35.19

$52.78

$38.11

$76.25

$114.36

High (In-Network benefits only except for emergency services)

1

$11.58

$23.14

$34.72

$25.09

$50.14

$75.23

2

$13.25

$26.50

$29.75

$28.71

$57.42

$26.13

3

$14.38

$28.73

$43.11

$31.16

$62.25

$93.41

4

$15.49

$30.98

$46.47

$33.56

$67.12

$100.69

5

$17.18

$34.34

$51.50

$37.22

$74.40

$111.58

High

1

$9.99

$19.98

$29.97

$21.65

$43.29

$64.94

2

$10.25

$20.49

$30.74

$22.21

$44.40

$66.60

3

$10.81

$21.63

$32.44

$23.42

$46.87

$70.29

4

$14.04

$28.08

$42.11

$30.42

$60.84

$91.24

5

$14.79

$29.58

$44.37

$32.05

$64.09

$96.14

High

1

$16.44

$32.88

$49.31

$35.62

$71.24

$106.84

High

1

$4.14

$8.28

$10.93

$8.97

$17.94

$23.68

Aetna

$18.14

$36.29

$54.43

$39.30

$78.63

$117.93

GEHA Standard

$9.36

$18.73

$28.09

$20.28

$40.58

$60.86

GEHA High

$12.74

$25.49

$38.23

$27.60

$55.23

$82.83

MetLife Standard

$10.57

$21.14

$31.71

$22.90

$45.80

$68.71

MetLife High

$17.59

$35.19

$52.78

$38.11

$76.25

$114.36

United Concordia

$17.18

$34.34

$51.50

$37.22

$74.40

$111.58

888-550-2583

Standard Option

$3.97

$7.94

$11.92

$8.60

$17.20

$25.83

fepblue.org

High Option

$5.01

$10.01

$15.02

$10.86

$21.69

$32.54

866-375-3263

Standard Option

$2.63

$5.13

$7.64

$5.70

$11.12

$16.55

spectera.com/myfedvision

High Option

$3.41

$6.65

$9.91

$7.39

$14.41

$21.47

800-807-0764

Standard Option

$3.82

$7.65

$11.47

$8.28

$16.58

$24.85

choosevsp.com

High Option

$5.40

$10.81

$16.21

$11.70

$23.42

$35.12

Every 24 months

Every 12 months

Every 12 months

$0

Breakage warranty; Laser vision correction discount; low vision coverage.

Every 12 months

Every 12 months

Every 12 months

$0

$130 plus 20% off remaining cost frame allowance for standard and high options.

Every 12 months

Every 12 months

Every 12 months

$10 exam/$25 material

Low vision; prosthetic eye; vision therapy; Laser vision correction discount.

Every 12 months

Every 12 months

Every 12 months

$10 exam/$10 material

$130 frame allowance for standard and high options.

Every 12 months

Every 12 months

Every 12 months

$10 exam/$20 material

Prescription eyewear, choose glasses or contacts; Laser vision correction discount.

Every 12 months

Every 12 months

Every 12 months

$10 exam and glasses

$120 frame allowance under standard option. $150 frame allowance under high option.