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. Some TRICARE beneficiaries may not be eligible to enroll in both. Visit www.opm.gov/dental or www.opm.gov/vision for more information.

If you sign up for a dental and/or vision plan during the 2021 Open Season, your coverage will begin on January 1, 2022.  Premium deductions will start with the first full pay period beginning on/after January 1, 2022. You may use your benefits as soon as your enrollment is confirmed.

Employees automatically pay premiums through payroll deductions using pre-tax dollars.  Annuitants automatically pay premiums through annuity deductions using post-tax dollars.  TRICARE enrollees automatically pay premiums through payroll deduction or automatic bank withdrawal (ABW) using post-tax dollars.

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 8, 2021 through midnight EST December 13, 2021. 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.

There are no waiting periods associated with the BCBS FEP Dental plan.

You are eligible to enroll if you:

• retired on an immediate annuity under the Civil Service Retirement System (CSRS), the Federal Employees Retirement System (FERS) or another retirement system for employees of the Federal Government;
• retired for disability under CSRS, FERS, or another retirement system for employees of the Federal Government.

Your FEDVIP enrollment will continue into retirement if you retire on an immediate annuity or for disability under CSRS, FERS or another retirement system for employees of the Government, regardless of the length of time you had FEDVIP coverage as an employee.  There is no requirement to have coverage for 5 years of service prior to retirement in order to continue coverage into retirement, as there is with the FEHB Program.

Your FEDVIP coverage will end if you retire on a Minimum Retirement Age (MRA) + 10 retirement and postpone receipt of your annuity.  You may enroll in FEDVIP again when you begin to receive your annuity.

An individual who is eligible for FEDVIP dental coverage based on the individual's eligibility to previously be covered under the TRICARE Retiree Dental Program or an individual eligible for FEDVIP vision coverage based on the individual's enrollment in a specified TRICARE health plan.

Retired members of the uniformed services and National Guard/Reserve components, including “gray-area” retirees under age 60 and their families are eligible for FEDVIP dental coverage.  These individuals, if enrolled in a TRICARE health plan, are also eligible for FEDVIP vision coverage.  In addition, uniformed services active duty family members who are enrolled in a TRICARE health plan are eligible for FEDVIP vision coverage. 

Except with respect to TRICARE-eligible individuals, family members include your spouse and unmarried dependent children under age 22. This includes legally adopted children and recognized natural children who meet certain dependency requirements. This also includes stepchildren and foster children who live with you in a regular parent- child relationship. Under certain circumstances, you may also continue coverage for a disabled child 22 years of age or older who is incapable of self-support. FEDVIP rules and FEHB rules for family member eligibility are NOT the same. For more information on family member eligibility visit the website at www.opm.gov/healthcare-insurance/ dental-vision/ or contact your employing agency or retirement system.

With respect to TRICARE-eligible individuals, family members include your spouse, unremarried widow, unremarried widower, unmarried child, an unremarried former spouse who meets the U.S Department of Defense's 20-20-20 or 20-20-15 eligibility requirements, and certain unmarried persons placed in your legal custody by a court.

Children include legally adopted children, stepchildren, and pre-adoptive children. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity.

The following persons 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.  Note:  Former spouses of TRICARE-eligible individuals may enroll in a FEDVIP dental plan.
• FEHB Temporary Continuation of Coverage (TCC) enrollees
• Anyone receiving an insurable interest annuity who is not also an eligible family member
• Active duty uniformed service members.  Note:  If you are an active duty uniformed service member, your dental and vision coverage will be provided by TRICARE.  Your family members will still be eligible to enroll in the TRICARE Dental Plan (TDP). 

You must use BENEFEDS to enroll or change enrollment in a FEDVIP plan.  BENEFEDS is a secure enrollment website (www.BENEFEDS.com) sponsored by OPM.  If you do not have access to a computer, call 1-877-888-FEDS (1-877-888-3337), TTY number 1-877-889-5680 to enroll or change your enrollment.

If you are currently enrolled in FEDVIP and do not want to change plans, your enrollment will continue automatically. Please Note:  Your plans’ premiums may change for 2022.

Note: You cannot enroll or change enrollment in a FEDVIP plan using the Health Benefits Election Form (SF 2809) or through an agency self-service system, such as Employee Express, PostalEase, EBIS, MyPay, or Employee Personal Page.  However, those sites may provide a link to BENEFEDS.

Self Only: A Self Only enrollment covers only you as the enrolled employee or annuitant.  You may choose a Self Only enrollment even though you have a family; however, your family members will not be covered under FEDVIP.

Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plus one eligible family member whom you specify.  You may choose a Self Plus One enrollment even though you have additional eligible family members, but the additional family members will not be covered under FEDVIP.

Self and Family: A Self and Family enrollment covers you as the enrolled employee or annuitant and all of your eligible family members.  You must list all eligible family members when enrolling.

Open Season

If you are an eligible employee, annuitant, or TRICARE-eligible individual, you may enroll in a dental and/or vision plan during the November 8, through midnight EST December 13, 2021, Open Season.  Coverage is effective January 1, 2022.

During future annual Open Seasons, you may enroll in a plan, or change or cancel your dental and/or vision coverage.  The effective date of these Open Season enrollments and changes will be set by OPM.  If you want to continue your current enrollment, do nothing.  Your enrollment carries over from year to year, unless you change it.

New hire/Newly eligible

You may enroll within 60 days after you become eligible as:

• a new employee;
• a previously ineligible employee who transferred to a covered position;
• a survivor annuitant if not already covered under FEDVIP; or
• an employee returning to service following a break in service of at least 31 days.
• a TRICARE-eligible individual

Qualifying Life Event

A qualifying life event (QLE) is an event that allows you to enroll, or if you are already enrolled, allows you to change your enrollment outside of an Open Season. 

The following chart lists the QLEs and the enrollment actions you may take.

Qualifying Life Event: Marriage
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes

Qualifying Life Event: Acquiring an eligible family member (non-spouse)
From Not Enrolled to Enrolled: No
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Losing a covered family member
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: Yes
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Losing other dental/vision coverage (eligible or covered person)
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Moving out of regional plan's service area
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes

Qualifying Life Event: Going on active military duty, non- pay status (enrollee or spouse)
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: Yes
Change from One Plan to Another: No

Qualifying Life Event: Returning to pay status from active military duty (enrollee or spouse)
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Returning to pay status from Leave without pay
From Not Enrolled to Enrolled: Yes (if enrollment cancelled during LWOP)
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes (if enrollment cancelled during LWOP)

Qualifying Life Event: Annuity/ compensation restored
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Transferring to an eligible position*
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: Yes
Change from One Plan to Another: No

*Position must be in a Federal agency that provides dental and/or vision coverage with 50 percent or more employer-paid premium.

The timeframe for requesting a QLE change is from 31 days before to 60 days after the event. There are two exceptions:

• There is no time limit for a change based on moving from a regional plan’s service area and
• You can not request a new enrollment based on a QLE before the QLE occurs, except for enrollment because of loss of dental or vision insurance. You must make the change no later than 60 days after the event.

Generally, enrollments and enrollment changes made based on a QLE are effective on the first day of the pay period following the one in which BENEFEDS receives and confirms the enrollment or change. BENEFEDS will send you confirmation of your new coverage effective date.

Once you enroll in a plan, your 60-day window for that type of plan ends, even if 60 calendar days have not yet elapsed. That means once you have enrolled in either plan, you can not change or cancel that particular enrollment until the next Open Season, unless you experience a QLE that allows such a change or cancellation.

Canceling an Enrollment

You may cancel your enrollment only during the annual Open Season. An eligible family member’s coverage also ends upon the effective date of the cancellation.

Your cancellation is effective at the end of the day before the date OPM sets as the Open Season effective date.

Coverage ends for active and retired Federal, U.S. Postal employees, and TRICARE-eligible individuals when you:

• no longer meet the definition of an eligible employee, annuitant, or TRICARE-eligible individual;
• as a Retired Reservist you begin active duty;
• as sponsor or primary enrollee leaves active duty
• begin a period of non-pay status or pay that is insufficient to have your FEDVIP premiums withheld and you do not make direct premium payments to BENEFEDS;
• are making direct premium payments to BENEFEDS and you stop making the payments;
• cancel the enrollment during Open Season;
• a Retired Reservist begins active duty; or
• the sponsor or primary enrollee leaves active duty.

Coverage for a family member ends when:

• you as the enrollee lose coverage; or
• the family member no longer meets the definition of an eligible family member.

NOTE: Coverage ends for a covered individual when BCBS FEP Dental does not receive premium payment for that covered individual.

Under FEDVIP, there is no 31-day extension of coverage. The following are also NOT available under the FEDVIP plans:

• Temporary Continuation of Coverage (TCC);
• spouse equity coverage; or
• right to convert to an individual policy (conversion policy).

If you are enrolled in an FSAFEDS HCFSA, you can take advantage of the Paperless Reimbursement option, which allows you to be reimbursed from your HCFSA without submitting an FSAFEDS claim. When BCBS FEP Dental receives a Federal Employees Dental Program claim for payment, we forward information about your out-of-pocket expenses (such as copayment and deductible amounts) to FSAFEDS for processing. FSAFEDS then reimburses you for your eligible out-of-pocket costs without the need for a claim form or receipt.

Using your FSA pre-tax dollars for your dental needs is a great way to get more out of your benefit dollar.  BCBS FEP Dental will submit your eligible FSAFEDS out-of-pocket expenses electronically via Paperless Reimbursement (PR).  To enroll in PR, visit www.FSAFEDS.com and click on My Account Summary, then Paperless Reimbursement.  Please note that insurance premiums are not eligible expenses for either type of FSA. 

If you have an HCFSA or LEX HCFSA FSAFEDS account and you haven’t exhausted your funds by December 31st of the plan year, FSAFEDS can automatically carry over up to $500 of unspent funds into another health care or limited expense account for the subsequent year. To be eligible for carryover, you must be employed by an agency that participates in FSAFEDS and actively making allotments from your pay through December 31.  You must also actively reenroll in a health care or limited expense account during the NEXT Open Season to be carryover eligible. Your reenrollment must be for at least the minimum of $100.  If you do not reenroll, or if you are not employed by an agency that participates in FSAFEDS and actively making allotments from your pay through December 31st, your funds will not be carried over.

Because of the tax benefits an FSA provides, the IRS requires that you forfeit any money for which you did not incur an eligible expense and file a claim in the time period permitted. This is known as the “Use-It-Or-Lose-It” rule. Carefully consider the amount you will elect. 

For a health care or limited expense account, each participant must contribute a minimum of $100 to a maximum of $2,700.

Current FSAFEDS participants must re-enroll to participate next year.  See www.fsafeds.com or call 1-877-FSAFEDS (372-3337) or TTY: 1-866-353-8058.  Note: FSAFEDS is not open to retired employees, or to TRICARE eligible individuals.

If you enroll or are enrolled in a high deductible health plan with a health savings account (HSA) or health reimbursement arrangement (HRA), you can use your HSA or HRA to pay for qualified dental/vision costs not covered by your FEHB and FEDVIP plans. You will be required to submit your claim to the FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA). 

When you enroll for the first time, you will receive a welcome letter along with an identification card ("ID Card") which will serve as confirmation of your enrollment.  Each employee will receive 1 set of 2 BCBS FEP Dental ID cards.  The ID cards will have the employee's name only on the ID cards.  It is important to bring your FEDVIP and FEHB (if applicable) ID cards to every dental appointment because most FEHB plans offer some level of dental benefits separate from your FEDVIP coverage. Presenting both ID cards can ensure prompt payment of the maximum allowable benefits under each Program.

If you require a replacement ID card, you may order a replacement ID card via           www.bcbsfepdental.com or you may call 1-855-504-2583.  An ID card is neither a guarantee of benefits nor does your provider need it to render dental services.  Your dentist may call 1-855-504-2583 to confirm your enrollment and the benefits available to you.

Our website, www.bcbsfepdental.com, has a sophisticated provider search tool that allows you to select dentists according to a flexible set of criteria including location, proximity and specialty.  Our online provider search directory is updated weekly and is available on a 24/7 basis.  You may also contact us at 1-855-504-2583 for the names of participating providers or to request a provider directory.

When you make your appointment, please advise the dentist office that you are enrolled in the BCBS FEP Dental plan and wish to use your in-network benefits.  This will also serve to confirm that the dentist is a BCBS FEP Dental provider.  Note:  BCBS FEP Dental providers may work out of several locations, be sure to check that any location that is not listed on our online provider search tool is participating to ensure you receive in-network benefits.

Also, be sure to give the provider your FEHB information (if applicable).

You do not have to select a  primary care dentist to receive benefits.  You are free to choose the dentist you want for your dental care.  However, your dentist choice can make a difference in the benefits you receive and the amount you pay.  You may have additional out-of-pocket costs if your dentist is not an in-network provider.

When you use a BCBS FEP Dental network provider, benefits are provided at the in-network level.  You are responsible only for covered charges up to our Maximum Allowed Amount per procedure.  You are not responsible for the difference between our Maximum Allowed Amount and the billed charges.  BCBS FEP Dental’s network consists of independently credentialed and contracted providers.  To find a dentist in your area go to www.bcbsfepdental.com. You may also contact customer service at 1-855-504-2583.

Note:  The BCBS FEP Dental provider network may be different from the FEP medical network.  Be sure to locate an in-network provider on the web site provided above.

Only providers listed with their corresponding locations are in-network. Not all dentists at a location may be in-network and the same provider at a different location may not be in-network. It is your responsibility to ensure that the listed provider is active and in-network at the time and location at which you receive services. 

You may obtain care from any licensed dentist.  If the dentist you use is not part of our network, benefits will be determined based on the  out-of-network benefit level.  Because these providers are out of our network, payment will be based on the lesser of the provider’s actual charge or the maximum allowed amounts established by BCBS FEP Dental for services rendered by out-of-network providers.   You are responsible for the difference between our payment and the amount billed.  If a member chooses to go out of network, payment will be made directly to the member.

Precertification is not mandatory. Although precertification estimates are not required BCBS FEP Dental strongly recommends and highly encourages  pre-treatment estimates be submitted for all major and extensive services prior to treatment.  Major Services are subject to licensed dental professional  review,  applies to such services but not limited extensive oral surgery, periodontal services, major restorative (crowns, bridges, inlays/onlays), endodontic, removable prosthodontic, implant placement and related treatment, and orthodontic services. Extensive and clinically involved  treatment plans will require additional supporting documentation such as chart notes, x-rays, photos, and may alternate to a least costly professionally acceptable procedure.

We will provide a non-binding, explanation of benefits to both you and your dentist that will indicate if procedures are covered and an estimate of what we will pay for those specific services. The estimated Maximum Allowable Amount is based on your current eligibility and contract benefits in effect at the time of the completed service. Submission of other claims or changes in eligibility or the contract may alter final payment. A pretreatment estimate is not a guarantee of benefits.

The final determination of eligibility is determined when the claim process.  Please note that you are not required to submit pretreatment estimates to your FEHB carrier.  They may be submitted directly to BCBS FEP Dental at:

BCBS FEP Dental
P.O. Box 75
Minneapolis, MN 55440-0075

In some cases, you and your dental practitioner have a choice of treatment options and if more than one service can be used to treat your dental condition, we may decide to only authorize alternate treatment for a less costly covered service if the service selected is an appropriate method of treatment.  This benefit application is done in an effort to keep your dental premiums affordable and assure you have coverage for the most common types of dental treatment.  The dental plan limits benefits to the maximum allowable charge for the least costly covered service that accomplishes a result that meets accepted standards of professional dental care as determined by us.  We will limit benefits payable to the benefit that would have been payable if the least costly covered service had been provided. This is called the alternate benefit. 

If you and your dentist choose the more expensive treatment instead of the alternate benefit, you are responsible for the additional charges beyond the allowance for the alternate service, even if an in-network provider provides services.  This means that any difference between the alternate benefit and the charge actually incurred is your responsibility, including any applicable coinsurance.

BCBS FEP Dental recommends receiving a pre-certification/pre-determination prior to receiving services so you and your dental provider are aware of the coverage terms and benefits. For example, if the dental consultants determine an arch can be restored with a standard prosthesis or restoration, no benefits will be allowed for the individual implant or implant procedures. An implant is a covered procedure of the plan only if determined to be dentally necessary and least expensive appropriate treatment. We will review the clinical documentation submitted by your treating dentist. If the Dental Advisor determines the implant is not dentally necessary or a less expensive appropriate treatment is available no benefits will be allowed for the individual implant or implant procedures, and the allowance for the less expensive treatment may be approved.  For example, full mouth reconstruction is not a covered benefit.

BCBS FEP Dental’s claim review is conducted by licensed dental professionals who review the clinical documentation submitted by your treating dentist. 

These licensed dental professionals will review necessary clinical notes and diagnostic images checking for dental necessity for procedures including but not limited to onlays, crowns, build ups, bridges, implants , periodontal treatment, extractions and anesthesia. The licensed dental professionals may extend an alternate benefit equivalent to that of another professionally acceptable form of treatment in accordance with the terms of the BCBS FEP Dental Plan.

The member has the right to appeal any unfavorable clinical decision provided that new additional supporting documentation has been received. The member’s dental provider can appeal on the member’s behalf.

If you have dental coverage through your FEHB plan and coverage under BCBS FEP Dental, your FEHB plan will be the first payor of any benefit payments.  When services are rendered by a provider who participates with both your FEHB and your BCBS FEP Dental plan, the BCBS FEP Dental Maximum Allowed Amount will be the prevailing charge, in these cases.  We are responsible for facilitating the process if the primary FEHB payor is Blue Cross Blue Shield Service Benefit Plan.  You are responsible for the difference between the FEHB and BCBS FEP Dental benefit payments and the BCBS FEP Dental Maximum Allowed Amount.

If you are covered under the Blue Cross Blue Shield Service Benefit Plan Basic Option and BCBS FEP Dental, you are not responsible for a $30 co-pay.  If your provider collects the co-pay upfront, they are required to reimburse the co-pay in full once the claim has processed under BCBS FEP Dental.

It is important to bring your FEDVIP and FEHB (if applicable) identification cards to every dental appointment because most FEHB plans offer some level of dental benefits separate from your BCBS FEP Dental coverage.  Presenting both identification cards can ensure that you receive prompt payment for the maximum allowable benefit under each Program.  Please see the following examples.

Example 1: High Option coverage (In-Network provider).  This example assumes all deductibles have been met and annual maximums have not been reached.

BCBS FEP Dental member with FEHB coverage – FEHB is always primary 
Services are provided by an In-Network Provider
1-surface filling: $108.00
Maximum Allowable Amount: $60.00
FEHB payment (estimated): $16.00
BCBS FEP Dental benefits payable in the absence of FEHB coverage: $42.00 ($60.00 at 70%)
Payment by BCBS FEP Dental: $42.00
Member’s responsibility: $2.00 ($60-$16-$42=$2.00)

Example 2: High Option coverage (Out-of-Network provider).  This example assumes all deductibles have been met and annual maximums have not been reached.

BCBS FEP Dental member with FEHB coverage – FEHB is always primary
Services are provided by an Out-of-Network Provider
1-surface filling: $108.00*
FEHB payment (estimated): $16.00
BCBS FEP Dental benefits payable in the absence of FEHB coverage: $64.80 ($108.00 at 60%)
Payment by BCBS FEP Dental: $64.80
Member’s responsibility: $27.20 ($108-$16-$64.80=$27.20)

*Assumes provider charge is within the Maximum Allowed Amount

If you are covered under a non-FEHB plan, your BCBS FEP Dental benefits will be coordinated using traditional COB provisions for determining payment. Please see the following examples.

We will coordinate benefit payments with the payment of benefits under other group health benefits coverage (non-FEHB) you may have and the payment of dental costs under no-fault insurance that pays benefits without regard to fault.

Example 3: High Option coverage (In-Network provider).  This example assumes all deductibles have been met and annual maximums have not been reached.

BCBS FEP Dental coverage is secondary to non-FEHB coverage
Services are provided by an In-Network Provider
2-surface filling: $121.00
Maximum Allowable Amount: $73.00
FEHB payment (estimated): $60.50
BCBS FEP Dental benefits payable in the absence of FEHB coverage: $51.10 ($73.00 at 70%)
Payment by BCBS FEP Dental: $12.50
Member’s responsibility*: $0.00 ($73-$60.50-$12.50=$0.00)
*Assumes provider does not have a contractual relationship regarding fees with the primary carrier

Example 4: High Option coverage (Out-of-Network provider).  This example assumes all deductibles have been met and annual maximums have not been reached.

BCBS FEP Dental coverage is secondary to non-FEHB coverage
Services are provided by an Out-of-Network Provider
2-surface filling: $121.00
FEHB payment (estimated): $96.80
BCBS FEP Dental benefits payable in the absence of FEHB coverage: $72.60 ($121.00 at 60%)
Payment by BCBS FEP Dental: $24.20
Member’s responsibility*: $0.00 ($121-$96.80-$24.20=$0.00)
*Assumes  provider charge is within the Maximum Allowed Amount

If you live in a limited access area* (defined as driving distance greater than 15 miles urban areas/ greater than 35 miles in rural areas) and you receive covered dental services from an out-of-network provider, we will pay the same plan allowances as if you utilized an in-network provider.   It is important to note that you will be responsible for the difference between the billed amount and our payment.  Applying the Limited Access provision will not result in additional payment under the High Option orthodontic plan.  If you have any questions about limited access areas or you are having problems locating an in-network dentist in your area, please call us at 1-855-504-2583.

*NOTE: Access Standards

Limited Access does not apply to International Members.

Urban and suburban zip codes: at least 90% of FEDVIP eligibles in a network access area (zip code plus 15 driving-miles) must have access to a dental care preferred provider.

Rural zip codes: at least 80% of FEDVIP eligibles in a network access area (zip code plus 35 driving-miles) must have access to a dental care preferred provider.

A deductible is a fixed amount of expenses you must incur for certain covered services and supplies before we will pay for covered services.  There is no family deductible limit.  Covered charges credited to the deductible are also counted towards the Plan maximum and limitations.

Class A
In-Network High Option: $0
In-Network Standard Option: $0
Out-of-Network High Option: $50
Out-of-Network Standard Option: $75

Class B
In-Network High Option: $0
In-Network Standard Option: $0
Out-of-Network High Option: $50
Out-of-Network Standard Option: $75

Class C
In-Network High Option: $0
In-Network Standard Option: $0
Out-of-Network High Option: $50
Out-of-Network Standard Option: $75

Orthodontics
In-Network High Option: $0
In-Network Standard Option: $0
Out-of-Network High Option: $0
Out-of-Network Standard Option: $0

Coinsurance is the percentage of our allowance that you must pay for your care. Coinsurance does not begin until you meet your deductible, if applicable.

Class A
In-Network High Option: 0%
In-Network Standard Option: 0%
Out-of-Network High Option: 10%
Out-of-Network Standard Option: 40%

Class B
In-Network High Option: 30%
In-Network Standard Option: 45%
Out-of-Network High Option: 40%
Out-of-Network Standard Option: 60%

Class C
In-Network High Option: 50%
In-Network Standard Option: 65%
Out-of-Network High Option: 60%
Out-of-Network Standard Option: 80%

Orthodontics
In-Network High Option: 50%
In-Network Standard Option: 50%
Out-of-Network High Option: 50%
Out-of-Network Standard Option: 50%

Once you reach this amount, you are responsible for all additional charges.  The Annual Benefit Maximums within each option are combined between in and out-of-network services.  The total Annual Benefit Maximum will never be greater than the In-Network Maximum Annual Benefit.

Maximum Annual Benefits:

In-Network High Option: Unlimited
In-Network Standard Option: $1,500
Out-of-Network High Option: $3,000
Out-of-Network Standard Option: $750

The Lifetime Maximum is applicable to Orthodontia benefits only.  There are no other lifetime maximums under this Plan.

Lifetime Orthodontic Maximum

In-Network High Option: up to $3,500
In-Network Standard Option: up to $2,500
Out-of-Network High Option: up to $3,500
Out-of-Network Standard Option: up to $1,250

You pay the coinsurance percentage of our network allowance for covered services.  You are not responsible for charges above that allowance.  To avoid any misunderstanding of the amount that you will owe, ask your dentist about his or her participation status in the BCBS FEP Dental network prior to receiving dental care.

Only providers listed with their corresponding locations are in network. Not all dentists at a location may be in network and the same provider at a different location may not be in network. It is your responsibility to ensure that the listed provider is active and in network at the time and location at which you receive services.

If the dentist you use is not part of our network, benefits will be considered at the out-of- network level.  All services provided by an out-of-network dentist will be paid at out-of-network levels, except for limited access benefits.  All benefit payments are based on BCBS FEP Dental’s Maximum Allowable Amounts, which is a schedule of fixed dollar maximums established by BCBS FEP Dental for services by out-of-network providers.  If a member chooses to go out of network, payments will be made directly to the member.

All out-of-network services listed in Section 5 are subject to the maximum allowable amount as defined by BCBS FEP Dental. The member is responsible for all remaining charges that exceed the allowable maximum.

The calendar year refers to the plan year, which is defined as January 1, 2022 to December 31, 2022.

In-progress treatment for dependents of retiring active duty service members who were enrolled in the TRICARE Dental Program (TDP) will be covered for the 2022 plan year; regardless of any current plan exclusion for care initiated prior to the enrollee's effective date.

This requirement includes assumption of payments for covered orthodontia services up to the FEDVIP policy limits, and full payment where applicable up to the terms of FEDVIP policy for covered services completed (but not initiated) in the 2022 plan year such as crowns and implants.

This is not a requirement for carriers to provide in-progress coverage for orthodontia in a plan where an enrollee must meet a waiting period.

FEDVIP carriers will not cover in-progress treatment if you enroll in a FEDVIP plan that has a waiting period, or does not cover the service.  Several FEDVIP dental plans have options that offer orthodontia coverage without a 12-month waiting period, and without age limits. 

We will pay benefits, subject to plan provisions, in an amount equal to the covered percentage for the charges incurred by you. You are responsible for paying the dentist and for submitting your claims to BCBS FEP Dental.  We will reimburse you in US dollars based on the OANDA currency conversion rate.

You may visit any dentist; however, you will only receive in-network benefits if you receive care from a dentist that participates in our international dental program.  Our international dental program includes English-speaking dentists in approximately 100 countries worldwide.  Customer service is available 24/7 to assist in making an appointment.

For help in locating an in-network provider, you may call 24 hours a day (outbound calling code for the country you are calling from) plus 353-94-9372257.  If calling from Ireland, press 0-94-9372257.

Customer service (in the U.S.)  1-855-504-2583

Customer service (international) call collect 651-994-2583

You are responsible for paying the dentist and submitting the claims to BCBS FEP Dental for reimbursement.  Mail the completed claim form and receipt to:

BCBS FEP Dental Claims
P.O. Box 75
Minneapolis, MN  55440-0075

There is one international region.  Please see the rate table for the actual premium amount.

To avoid delay in the payment of your dental claims, please have your dental provider submit your claims directly to your FEHB plan (Should you be enrolled), then to BCBS FEP Dental. Pretreatment estimates and preoperative radiographs can be submitted directly to BCBS FEP Dental (exception: If accidental injury occurs, pretreatment estimates should be submitted to your FEHB plan).

If you need to send in a paper claim you may download a claim form from BCBS FEP Dental’s website, www.bcbsfepdental.com.

Mail completed claim form to: 

BCBS FEP Dental Claims
P.O. Box 75
Minneapolis, MN 55440-0075

You must submit your claim within 24 months from the date service was rendered.

Follow this disputed claims process if you disagree with our decision on your claim or request for services.  FEDVIP legislation does not provide a role for OPM to review disputed claims.

Members may appeal any claims decision by submitting a written notice via U.S. Mail or email.

The maximum annual benefit that you can receive per person.

Federal retirees (who retired on an immediate annuity) and survivors (of those who retired on an immediate annuity or died in service) receiving an annuity.  This also includes those receiving compensation from the Department of Labor’s Office of Workers’ Compensation Programs, who are called compensationers.  Annuitants are sometimes called retirees.

From January 1, 2022 through December 31, 2022. Also referred to as the plan year.

Basic services, which include oral examinations, prophylaxis, diagnostic evaluations, sealants, and X-rays. 

Coinsurance is the stated percentage of covered expenses you must pay.

A copayment is a fixed amount of money you pay the provider when you receive the service.

A cosmetic procedure is any procedure or portion of a procedure performed primarily to improve physical appearance or is performed for psychological purposes.

Covered services shall include only those services specifically listed in Section 5 Dental Services and Supplies. A covered service must be incurred and completed while the person receiving the service is a covered person. Covered services are subject to plan provisions for exclusions and limitations and meet acceptable standards of dental practice as determined by us.

The calendar date on which you visit the dentist's office and services are rendered. 

The Federal employee, annuitant, or TRICARE-eligible individual enrolled in this plan.

Dental services that initiated in 2021 that will be completed in 2022.

A covered service is deemed incurred on the date care, treatment or service is received.

The amount we use to determine our payment for services.  If services are provided by an in-network dentist the maximum allowable amount is based on the discounted fee he or she accepts as payment in full for the procedure or procedures.  If services are provided by an out-of- network dentist the maximum allowed amount is based on BCBS FEP Dental’s determination of charges for the procedure or procedures.

Network Allowance means the allowance per procedure that BCBS FEP Dental has negotiated with the provider and they have agreed to accept as payment in full for his/her services.

BCBS FEP Dental

Generally, a sponsor means the individual who is eligible for medical or dental benefits under 10 U.S.C. chapter 55 based on his or her direct affiliation with the uniformed services (including military members of the National Guard and Reserves).

Under circumstances where a sponsor is not an enrollee, a TEI family member may accept responsibility to self-certify as an enrollee and enroll TEI family members

TEI family members include a sponsor’s spouse, unremarried widow, unremarried widower, unmarried child, and certain unmarried persons placed in a sponsor’s legal custody by a court. Children include legally adopted children, stepchildren, and pre- adoptive children. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity.

The amount of time that you must be enrolled in this plan before you can receive Orthodontic services.  Note, there are no waiting periods associated with BCBS FEP Dental.

BCBS FEP Dental