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What’s inside
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04 COMPARE PLAN BENEFITS
12 DEFINITIONS
13 HELPFUL RESOURCES
15 ENDNOTES
16 WHAT’S NEW IN 2020
06 FIND YOUR RATE CODE
07 FIND YOUR PREMIUM
08 INCLUDED BENEFITS & SAVINGS
11 COVERAGE FOR MAJOR DENTAL NEEDS
Plans
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What’s inside
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GEHA offers two 2020 FEDVIP dental plan options: High Option and Standard Option. Both plans include comprehensive dental services, along with no deductibles and no waiting periods* for most services.
Compare plan benefits
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2020 plan yearHigh Option Standard Option
PLAN PAYS THE FOLLOWING PERCENTAGE OF THE
PLAN ALLOWANCEIn-network Out-of-network† In-network Out-of-network†
Basic – Class A3
Exams, cleanings1 and X-rays - Waiting period - Calendar year deductible
100%
NoneNone
100%
NoneNone
100%
NoneNone
100%
NoneNone
Intermediate – Class B3
Fillings, extractions and periodontal maintenance - Waiting period - Calendar year deductible
80%
NoneNone
80%
NoneNone
55%
NoneNone
55%
NoneNone
Major – Class C3
Root canals, crowns, bridges, dentures, periodontal surgery and implants2
- Waiting period - Calendar year deductible
50%
NoneNone
50%
NoneNone
35%
NoneNone
35%
NoneNone
Orthodontics – Class D4
- Waiting period - Calendar year deductible
70%NoneNone
70%NoneNone
70%12 monthsNone
70%12 monthsNone
Calendar year maximum Unlimited per person $2,500 per person
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All classes of service are included in both High Option and Standard Option as part of the plan. This is a brief description of services covered under the GEHA Connection Dental Federal plan. Do NOT rely on this chart alone. All benefits are subject to the definitions, limitations and exclusions set forth in the dental brochure. Limitations and exclusions: This plan has certain limits on dental coverage to keep plan rates affordable for you and your dependents. A complete list of plan limitations and exclusions may be found in the GEHA Connection Dental Federal Plan Brochure available online at gehadental.com/PlanBrochure
* There is no waiting period for Class A, Class B or Class C services. There is a 12-month waiting period for Class D orthodontic services on the Standard Option plan only.
† If your out-of-network dentist charges more than GEHA’s agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance.
1,2,3,4 See full definitions and endnotes on pages 12 and 15.
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It pays to stay in-network
GEHA dental plan members get access to more than 379,000 in-network locations nationwide and enjoy worldwide coverage.
If you have a FEHB medical plan with dental coverage, your medical plan will be considered the primary payer for some preventive, restorative and other services before any benefits are paid by any FEDVIP dental plan. This includes GEHA’s FEDVIP plan.
For FEHB medical plans
If your out-of-network dentist charges more than GEHA’s agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance.
Out-of-network services
GEHA does not cover orthodontic services previously started with another carrier, except for High Option members with orthodontics started under TRICARE.
Prior orthodontic services
To get the greatest value from your GEHA plan, you are encouraged to use in-network providers. All in-network preventive care is covered at 100% with any GEHA dental plan. For other services, network providers will not bill you more than the plan’s allowable charges — the agreed-upon fees for covered services. To find a provider, or to see if your provider is in-network, visit geha.com/Search
How to enrollTo sign up for a plan online, visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal. You can also call BENEFEDS toll-free at 877.888.3337 TTY: 877.889.5680
Find a provider at geha.com/Search
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StateFirst 3 digits of
ZIP codeRate code
AK Entire state 5
AL Entire state 1
AR Entire state 1
AZ Entire state 2
CA 939-941, 943-952, 954Rest of the state
54
CO Entire state 4
CT 064-069Rest of the state
54
DC Entire state 4
DE Entire state 3
FL 330-334Rest of the state
32
GA 300-303, 305, 311, 399Rest of the state
32
HI Entire state 3
IA Entire state 1
ID Entire state 2
IL 600-608Rest of the state
31
IN460-462, 470, 472463, 464Rest of the state
231
KS Entire state 2
KY 410Rest of the state
21
LA Entire state 2
StateFirst 3 digits of
ZIP codeRate code
MA Entire state 4
MD205-212, 214, 217219Rest of the state
432
ME Rest of the state 3
MI 480-485Rest of the state
32
MN 550-555, 563Rest of the state
32
MO Entire state 2
MS Entire state 1
MT Entire state 2
NC Entire state 2
ND Entire state 1
NE Entire state 1
NH Entire state 4
NJ 080-084Rest of the state
35
NM Entire state 3
NV Entire state 3
NY005, 100-119, 124-126063Rest of the state
542
OH 430-432, 440-443, 450-455, 459
Rest of the state21
OK Entire state 2
OR Entire state 3
StateFirst 3 digits of
ZIP codeRate code
PA
173-174183189-196Rest of the state
4531
RI Entire state 4
SC Entire state 2
SD Entire state 1
TN Entire state 2
TX Entire state 2
UT Entire state 1
VA 201, 205, 220-227Rest of the state
42
VT Entire state 2
WA980-985986Rest of the state
534
WI 540Rest of the state
32
WV 254Rest of the state
42
WY 834Rest of the state
21
PR Entire territory 1
GU Entire territory 1
VI Entire territory 1
FO International + all other areas not listed 1
Locate your state and the first three digits of your ZIP code in the chart below to get your rate code — a number between 1 and 5.
Step 1: Locate ZIP code to find rate codeF
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Biweekly cost Rate code 1* Rate code 2* Rate code 3* Rate code 4* Rate code 5*
Self Only $10.06 $11.04 $12.55 $13.54 $15.02
Self Plus One $20.12 $22.08 $25.05 $27.06 $30.02
Self and Family $30.17 $33.11 $37.58 $40.58 $45.04
Retirees monthly
Self Only $21.80 $23.92 $27.19 $29.34 $32.54
Self Plus One $43.59 $47.84 $54.28 $58.63 $65.04
Self and Family $65.37 $71.74 $81.42 $87.92 $97.59
Biweekly cost Rate code 1* Rate code 2* Rate code 3* Rate code 4* Rate code 5*
Self Only $17.27 $19.00 $21.56 $23.28 $25.83
Self Plus One $34.56 $37.97 $43.13 $46.55 $51.70
Self and Family $51.84 $57.00 $64.68 $69.85 $77.59
Retirees monthly
Self Only $37.42 $41.17 $46.71 $50.44 $55.97
Self Plus One $74.88 $82.27 $93.45 $100.86 $112.02
Self and Family $112.32 $123.50 $140.14 $151.34 $168.11
Step 2: Use your rate code to find your 2020 premium
* Rates based on member’s primary state of residence.
HIGH OPTION
STANDARD OPTION
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High Option Standard Option
Vision coverage & discounts$5 copay for routine eye exams at qualified EyeMed™ providers. For out-of-network exams, EyeMed reimburses you up to $45 per covered member per year. No limit on the number of discount glasses or contact lenses purchased each year. EyeMed providers include LensCrafters, Pearle Vision, Target, JCPenney Optical and independent eye doctors.gehadental.com/Vision
Hearing aid savingsGet discounts through TruHearing™ on hearing aids. Most members save 30% to 60% off their hearing aids, averaging more than $2,100 in savings per pair.gehadental.com/Hearing
Electric toothbrush5
GEHA members can save more than 70% off a premium electric toothbrush by cariPRO™. gehadental.com/Toothbrush
Teeth whiteningReceive a 20% discount on the lowest published price on all Smile Brilliant home teeth whitening products. This includes custom-fitted trays, whitening gel and desensitizing gel.smilebrilliant.com/GEHA
Medical alert systemGEHA members and extended family are eligible for discounted services from Life Alert®, the industry leader in responsive emergency care. Members receive free activation, plus a 10% monthly discount.gehadental.com/LifeAlert
Included benefits & savings
These benefits are neither offered nor guaranteed under contract with the FEDVIP program, but are made available to all enrollees who become members of GEHA and their eligible family members.
5 See full definitions and endnotes on pages 12 and 15.
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With no waiting periods on most services, GEHA’s plans let you start treatments right away, even when your needs go beyond annual cleanings.*
Coverage for major dental needs
You pay $0 deductible
Coverage Orthodontics Dental implantsNight guards(occlusal guards)
In-network
You pay your regular coinsurance and/or any amount that exceeds the lifetime benefit maximum.
You pay your regular coinsurance and/or any amount that exceeds the annual benefit maximum.
You pay your regular coinsurance and/or any amount that exceeds the annual benefit maximum.
Out-of-networkYou pay any charges that exceed the plan allowance, plus any regular coinsurance.
You pay any charges that exceed the plan allowance, plus any regular coinsurance.
You pay any charges that exceed the plan allowance, plus any regular coinsurance.
Standard Option maximum benefit $2,500 lifetime max, per covered member
$2,500 annual, per covered member Once per calendar year
High Option maximum benefit $3,500 lifetime max, per covered member
$2,500 annual, per covered member Once per calendar year
Age limit None None Members age 13 or older
Standard Option waiting period 12 months None None
High Option waiting period None None None
Not covered
Cosmetic treatment, orthodontic work in progress (except for High Option members with orthodontics started under TRICARE).
Any service associated with implants not specifically listed in the plan brochure.
Guards used to treat temporomandibular joint dysfunction (TMJ).
*There is no waiting period for Class A, Class B or Class C services. There is a 12-month waiting period for Class D orthodontic services on the Standard Option plan only.
All classes of service are included in both High Option and Standard Option as part of the plan. This is a brief description of services covered under the GEHA Connection Dental Federal plan. Do NOT rely on this chart alone. All benefits are subject to the definitions, limitations and exclusions set forth in the dental brochure. Limitations and exclusions: This plan has certain limits on dental coverage to keep plan rates affordable for you and your dependents. A complete list of plan limitations and exclusions may be found in the GEHA Connection Dental Federal Plan Brochure available online at gehadental.com/PlanBrochure
Learn more at gehadental.com | Questions? Call 877.590.4342 | Enroll online at benefeds.com
Definitions
Term Definition
BENEFEDS BENEFEDS is the government-authorized and U.S. Office of Personnel Management (OPM)-sponsored enrollment portal that eligible participants use to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP).
Calendar year maximum The annual benefit maximum that you can receive per person each calendar year.
Class A services Basic services that include oral examinations, cleanings, diagnostic services, sealants and radiographic images.
Class B services Intermediate services that include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions and denture adjustments.
Class C services Major services that include endodontic services such as root canals, periodontal services such as gingivectomy, major restorative services such as crowns, oral surgery, bridges, implants and prosthodontic services such as complete dentures.
Class D services Orthodontic services.
Coinsurance Coinsurance is the stated percentage of covered expenses you must pay.
Cosmetic procedure A cosmetic procedure is any procedure or portion of a procedure performed primarily to improve physical appearance or is performed for psychological purposes.
In-network provider Any licensed dentist, dental hygienist or denturist who is a part of GEHA’s provider network.
Plan allowance The amount we allow for a specific procedure. When you use an in-network provider, your out-of-pocket cost is limited to the difference between the plan allowance and our payment. The plan allowance may vary by geographic location and/or an in-network provider’s contracted fee schedule. When you use an out-of-network provider, you are responsible for the difference between our payment and the billed amount.
Premium The total amount paid to an insurance company for coverage, typically paid biweekly or monthly.
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Helpful tools Description Learn more
Find your dentist Find a provider or see if your provider is in-network. geha.com/Search
Compare GEHA FEDVIP plans Find information about our High Option and Standard Option plans. gehadental.com/Plans877.590.4342
Procedure Pricing tool Easily verify if a service is covered and estimate how much you’ll pay. gehadental.com/Pricing
Sign up Enroll in the GEHA FEDVIP dental plan of your choice. benefeds.com877.888.3337TTY: 877.889.5680
Plan resources Description Learn more
Customer Care Contact GEHA with questions about your plan benefits or coverage. 877.590.4342
Overseas coverage Get information about dental coverage when you‘re outside of the United States. gehadental.com/OutsideUSA
Enrollment help Tips for new enrollees or members who are changing plans. gehadental.com/Enroll
The National Active and Retired Federal Employees Association
Dedicated to helping federal employees and retirees manage their benefits. narfe.org
U.S. Office of Personnel Management
Official information for federal employees eligible for FEDVIP and FEHB plans. opm.gov
If you have questions after reviewing this benefits guide, the tools, phone numbers and websites below are great places to find helpful answers. If you’re stuck or overwhelmed, please call 877.590.4342 and talk to one of our Customer Care advisers. They are here to help you.
Helpful resources
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1 Plans cover two cleanings per calendar year at no cost to you with an in-network provider.
2 Implants are limited to $2,500 per covered person per year, included in the regular calendar year maximum.
3 The High Option calendar year maximum for Class A, B and C covered services is unlimited per person. The Standard Option calendar year maximum for Class A, B and C covered services is $2,500 per covered person.
4 Class D orthodontic benefits are limited to a lifetime maximum of $3,500 for High Option and $2,500 for Standard Option, per covered person.
The cariPRO™ premium electric toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont™ bristles are also available at an exclusive, members-only price.
Endnotes
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WHAT’S NEW
X Unlimited annual maximum benefit. The High Option annual benefit maximum increased to unlimited per person for combined Class A, Class B and Class C covered services.2,4
X Bitewing X-rays. To align with industry standards, these X-rays are covered once per calendar year for adults 23 and older.
X 24 new CDT dental procedure codes. We have added new codes, including D9613 — for the “infiltration of sustained-release therapeutic drug” — which was added to combat the opioid epidemic. This code provides dentists an alternative option for pain management. Dentists can place this medication at the site of a third molar (wisdom tooth) extraction instead of writing an opioid prescription. This code will be allowed for third molar extractions only, for children up to 22, and once per lifetime.
X Reminder: Children qualify for 100% coverage on tooth sealants and fluoride treatments when using an in-network dentist.
For a complete list of plan changes, download the plan brochure at gehadental.com/PlanBrochure
2,4 See full definitions and endnotes on pages 12 and 15.
To learn more, visit gehadental.com
OS-BKT-0819-001
/gehahealth /company/gehahealth
gehapossible.comQuestions? Call 877.590.4342
This is a brief description of the features of GEHA’s FEDVIP plans. Before making a final decision, please read the GEHA federal brochure available at gehadental.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure. © 2019 Government Employees Health Association, Inc. All rights reserved. Please recycle.
How to enrollEnroll in the GEHA FEDVIP dental plan of your choice.
benefeds.com | 877.888.3337 | TTY: 877.889.5680
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