On December 23, 2004, President George W. Bush signed the Federal Employee Dental and Vision Benefits Enhancement Act of 2004 (Public Law 108-496). The law directed the Office of Personnel Management (OPM) to establish supplemental dental and vision benefit programs to be made available to Federal employees, annuitants, and their eligible family members. In response to the legislation, OPM established the Federal Employees Dental and Vision Insurance Program (FEDVIP). OPM has contracted with dental and vision insurers to offer an array of choices to Federal employees and annuitants. Section 715 of the National Defense Authorization Act for Fiscal Year 2017 (FY 2017 NDAA), Public Law 114-38, expanded FEDVIP eligibility to certain TRICARE-eligible individuals.

This brochure describes the benefits of the High PPO and the Standard Advantage EPO options under Humana Dental Company contract OPM02-FEDVIP-02AP-10 with OPM, as authorized by the FEDVIP law. The address for our administrative office is:

Humana Dental
PO 14287
Lexington, KY 40512 
877-692-2468
http://feds.humana.com

This brochure is the official statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclusions of this brochure.  It is your responsibility to be informed about your benefits. You and your family members do not have a right to benefits that were available before January 1, 2022 unless those benefits are also shown in this brochure.

If you are enrolled in this plan, you are entitled to the benefits described in this brochure.  If you are enrolled in Self Plus One coverage, you and your designated family member are entitled to these benefits.  If you are enrolled in Self and Family coverage, each of your eligible family members is also entitled to these benefits, if they are also listed on the coverage.

OPM negotiates benefits and rates with each carrier annually. Rates are shown at the end of this brochure.

Humana Dental is responsible for the selection of in-network providers in your area. Contact us at 877-692-2468 for the names of participating providers or to request a provider directory. You may also request or view the most current directory via our website http://feds.humana.com. Continued participation of any specific provider cannot be guaranteed. Thus, you should choose your plan based on the benefits provided and not for a specific provider’s participation. When you phone for an appointment, please remember to verify that the provider is currently in-network.  If your provider is not currently participating in the provider network, you may nominate him or her to join. Contact us at 877-692-2468 to nominate a provider who is currently not participating with the Humana Dental High PPO or Standard Advantage EPO Plan. You cannot change plans, outside of Open Season, because of changes to the provider network.

Provider networks may be more extensive in some areas than others.  We cannot guarantee the availability of every specialty in all areas. If you require the services of a specialist and one is not available in your area, please contact us for assistance.

The Humana Dental High PPO and Standard Advantage EPO and all other FEDVIP plans are not a part of the Federal Employees Health Benefits (FEHB) Program.

We want you to know that protecting the confidentiality of your individually identifiable health information is of the utmost importance to us. To review full details about our privacy practices, our legal duties, and your rights, please visit our website, http://feds.humana.com and click on the “Privacy Practices” link at the bottom of the page. If you do not have access to the internet or would like further information, please contact us by calling 800-459-6604.

Discrimination is Against the Law

Humana Dental Company complies with all applicable Federal civil rights laws, to include both Title VII of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act. Pursuant to Section 1557, Humana Dental Company does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex. 

ENGLISH: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-877-692-2468 (TTY: 711).

Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-692-2468 (TTY: 711).

Changes to the plan:

Changes to the plan include:

• D8670, Periodic orthodontic treatment visit. The current frequency is listed as 1 treatment per lifetime.  We are changing to no frequency, no charge.

The following procedure codes will change their limit description for the Standard Advantage EPO option for 2022:

Class C Major services - Changing limit description:

• D3355 - Pulpal regeneration - initial visit (1 per tooth per lifetime)
• D3356 - Pulpal regeneration - interim medication replacement (1 per tooth per lifetime)
• D3357 - Pulpal regeneration - completion of treatment (1 per tooth per lifetime)
• D5110 - Complete denture maxillary (1 per 5 years)
• D5120 - Complete denture mandibular (1 per 5 years)
• D5130 - Immediate denture maxillary (1 per 5 years)
• D5140 - Immediate denture – mandibular (1 per 5 years)
• D5211 - Maxillary partial denture - resin base (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5212 - Mandibular partial denture - resin base (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5213 - Maxillary partial denture - cast metal (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5214 - Mandibular partial denture - cast metal (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5221 - Immediate maxillary partial denture – resin base (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5222 - Immediate mandibular partial denture – resin base (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5223 - Immediate maxillary partial denture - cast metal framework with resin denture base (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5224 - Immediate mandibular partial denture - cast metal framework with resin denture base (including retentive/clasping materials, rests and teeth) (1 per 5 years)
• D5225 - Maxillary partial denture - flexible base (including any retentive/clasping materials, rests, and teeth) (1 per 5 years)
• D5226 - Mandibular partial denture - flexible base (including retentive/clasping materials, rests, and teeth) (1 per 5 years)

 We have added the following Dental codes to the Standard Advantage EPO and High PPO option for 2022:

Class C Major services:

• D5227 - immediate maxillary partial denture - flexible base (including any clasps, rests and teeth)
• D5228 - immediate mandibular partial denture - flexible base (including any clasps, rests and teeth)
• D5725 - rebase hybrid prosthesis
• D5765 - soft liner for complete or partial removable denture – indirect

We have removed the following Dental codes to both the Standard Advantage EPO and High PPO option for 2022:

Class D Orthodontic services:

• D8060 - interceptive orthodontic treatment of the transitional dentition
• D8690 - orthodontic treatment (alternative billing to a contract fee)
• D8050 - interceptive orthodontic treatment of the primary dentition

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• The calendar year deductible is $50/individual and $100/family if you use in-network provider. The calendar year deductible is $50/individual and $150/family if you use an out-of-network provider. The deductible applies to all services excluding preventive and orthodontia services.
• The annual maximum benefit under this plan is $5,000 per covered person for in and out-of-network services combined. Preventive services are waived and will not accumulate towards the annual maximum benefit. There is also an extended annual maximum benefit which provides coverage where you pay 70% coinsurance for covered preventive, basic, and major services after the annual maximum benefit is reached. Orthodontic services are excluded from the extended annual maximum benefit. 

There is no waiting period.

Routine cleanings and oral examinations are limited to (3) per calendar year.
Periodontal maintenance is limited to (4) per year.

You Pay:

High PPO Option

• In-Network: $0 for covered Class A Basic services subject to applicable deductibles and maximums.
• Out-of-Network: 10% of the plan allowance for covered Class A Basic services subject to applicable deductible and maximums. Additionally, you will be responsible for the difference between the plan allowance and billed charges.

Note: Out-of-Network dentists can bill you the charges above the plan allowance covered by your Humana Dental plan. To ensure you do not receive additional charges, visit an in-network dentist.

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• The calendar year deductible is $50/individual $100/family if you use an in-network provider. The calendar year deductible is $50/individual $150/family if you use an out-of-network provider. The deductible applies to all services excluding preventive and orthodontia services.
• The annual maximum benefit under this plan is $5,000 per covered person for in and out-of-network services combined.   Preventive services are waived and will not accumulate towards the annual maximum benefit. There is also an extended annual maximum benefit which provides coverage where you pay 70% coinsurance for covered preventive, basic, and major services after the annual maximum benefit is reached. Orthodontic services are excluded from the extended annual maximum benefit.

There is no waiting period.

You Pay:

High PPO Option

• In-Network: 20% of the plan allowance for covered Class B Intermediate services subject to applicable deductibles and maximums.
• Out-of-Network: 40% of the plan allowance for covered Class B Intermediate services subject to applicable deductibles and maximums. Additionally, you will be responsible for the difference between the plan allowance and billed charges.

Note: Out-of-Network dentists can bill you for charges above the plan allowance covered by your Humana Dental plan. To ensure you do not receive additional charges, visit an in-network dentist.

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• The calendar year deductible is $50/individual and $100/family if you use an in-network provider. The calendar year deductible is $50/individual and $150/family if you use an out-of-network provider. The deductible applies to all services excluding preventive and orthodontia services.
• The annual maximum benefit under this plan is $5,000 per covered person for in and out-of-network services combined. Preventive services are waived and will not accumulate towards the annual maximum benefit. There is also an extended annual maximum benefit which provides coverage where you pay 70% coinsurance for covered preventive, basic, and major services after the annual maximum benefit is reached. Orthodontic services are excluded from the extended annual maximum benefit.
• There is no waiting periods.

You Pay:

High PPO Option

• In-Network: 50% of the plan allowance for covered Class C Major services subject to applicable deductibles and maximums.
• Out-of-Network: 60% of the plan allowance for covered Class C Major services subject to applicable deductibles and maximums. Additionally, you will be responsible for the difference between the plan allowance and billed charges.

Note: Out-of-Network dentists can bill you for charges above the plan allowance covered by your Humana Dental plan. To ensure you do not receive additional charges, visit an in-network dentist.

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care or treatment of a covered condition and meet generally accepted dental protocols.
• There is no deductible for orthodontic services.
• There is no waiting period.
• The lifetime maximum for orthodontic services is $2,500 per covered person.

You Pay:

High PPO Option

• In-Network: 50% of the plan allowance for covered Class D Orthodontic services subject to applicable maximums.
• Out-of-Network: 50% of the plan allowance for covered Class D Orthodontic services subject to applicable maximums. Additionally, you will be responsible for the difference between the plan allowance and billed charges.

Note: Out-of-Network dentists can bill you for charges above the plan allowance covered by your Humana Dental plan. To ensure you do not receive additional charges, visit an in-network dentist.

Important things you should keep in mind about these benefits: 

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols. 
• The calendar year deductible is $50/individual and $100/family if you use an in-network provider. The calendar year deductible is $50/individual and $150/family if you use an out-of-network provider. The deductible applies to all services excluding preventive and orthodontia services.  
• The annual maximum benefit under this plan is $5,000 per covered person for in and out-of-network services combined.   Preventive services are waived and will not accumulate towards the annual maximum benefit. There is also an extended annual maximum benefit which provides coverage where you pay 70% coinsurance for covered preventive, basic, and major services after the annual maximum benefit is reached. Orthodontic services are excluded from the extended annual maximum benefit. 
• There is no waiting period.

You Pay:

High PPO Option

•  In-Network: 20% of the plan allowance for covered General Services subject to applicable deductibles and maximums.
•  Out-of-Network: 40% of the plan allowance for covered General Services subject to applicable deductibles and maximums. Additionally, you will be responsible for the difference between the plan allowance and billed charges.

Note: Out-of-Network dentists can bill you for charges above the plan allowance covered by your Humana Dental plan. To ensure you do not receive additional charges, visit an in-network dentist.

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• There is no calendar year deductible.
• There is no waiting period for basic services.
• The annual benefit maximum is unlimited.

You Pay:

Standard Advantage EPO Option

• In-Network: The co-pay amount shown in the Benefit Schedule.
• Out-of-Network: In full for all charges. There are no out-of-network benefits available except for emergency services when the services of an in-network provider are not available.

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• There is no calendar year deductible.
• There is no waiting period for intermediate services.
• The annual benefit maximum is unlimited.

You Pay:

Standard Advantage EPO Option

• In-Network: The co-pay amount shown in the Schedule of Benefits.
• Out-of-Network: In full for all charges. There are no out-of-network benefits available except for emergency services when the services of an in-network provider are not available.

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• There is no calendar year deductible.
• There is no waiting period for major services.
• The annual benefit maximum is unlimited.

You Pay:

Standard Advantage EPO Option

• In-Network: The co-pay amount shown in the Schedule of Benefits.
• Out-of-Network: In full for all charges. There are no out-of-network benefits available except for emergency services when the services of an in-network provider are not available.

Not covered: Additional Procedures Covered as Major Services

• Gold foil restoration
• Restoration for cosmetic purposes only
• Precision attachments, personalization, precious metal bases, and other specialized techniques
• Replacement of dentures that have been lost, stolen or misplaced
• Removable or fixed prostheses initiated prior to the effective date of coverage or inserted/cemented
  after the coverage ending date

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• There is no calendar year deductible.
• There is no waiting period or age limit for orthodontic services.
• There is no lifetime maximum for orthodontia.
• 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.

You Pay:

Standard Advantage EPO Option

• In-Network: The co-pay amount shown in the Schedule of Benefits.
• Out-of-Network: In full for all charges. There are no out-of-network benefits available except for emergency services when the services of an in-network provider are not available.

Not covered:

• Repair of damaged orthodontic appliances
• Replacement of lost or missing appliance

Important things you should keep in mind about these benefits:

• Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care, or treatment of a covered condition and meet generally accepted dental protocols.
• There is no calendar year deductible.
• The annual benefit maximum is unlimited.

You Pay:

Standard Advantage EPO Option

• In-Network: The co-payment shown in the Benefit Schedule.
• Out-of-Network: In full for all charges. There are no out-of-network benefits available except for emergency services when the services of an in-network provider are not available.

Not covered:

• Nitrous oxide
• Oral sedation

The exclusions in this section apply to all benefits. Although we may list a specific service as a benefit, we will not cover it unless we determine it is necessary for the prevention, diagnosis, care, or treatment of a covered condition.

High PPO option:

This plan does not provide benefits for the following:

• Any expenses incurred while you qualify for any worker’s compensation or occupational disease act or law, whether or not you applied for coverage.
• Services:
  • That are free or that you would not be required to pay for if you did not have this insurance, unless charges are received from and reimbursable to the U.S.government or any of its agencies as required by law;
  • Furnished by, or payable under, any plan or law through any government or any political subdivision (this does not include Medicare or Medicaid); or
  • Furnished by any U.S. government-owned or operated hospital/institution/agency for any service connected with sickness or bodily injury. 
• Any loss caused or contributed by:
  • War or any act of war, whether declared or not;
  • Any act of international armed conflict; or
  • Any conflict involving armed forces of any international authority.
• Any expense arising from the completion of forms.
• Your failure to keep an appointment with the dentist.
• Any service we consider cosmetic unless it is necessary as a result of an accidental injury sustained while you are covered under this policy. We consider the following cosmetic procedures to include, but are not limited to:
  • Facings on crowns or pontics (the portion of a fixed bridge between the abutments)posterior to the second bicuspid;
  • Any service to correct congenital malformation;
  • Any service performed primarily to improve appearance;
  • Characterizations and personalization of prosthetic devices; or
  • Any procedure to change the spacing and/or shape of the teeth.
• Charges for: 
  • Precision or semi-precision attachments;
  • Overdentures and any endodontic treatment associated with overdentures;
  • Other customized attachments;
  • Any service for 3D imaging (cone beam images);
  • Temporary and interim dental services;
  • Additional charges related to material or equipment used in the delivery of dental care.
  • Charges rendered for treatment in a clinical or dental facility sponsored or maintained by the group.
• Any service related to:
  • Restoration or maintenance of occlusion;
  • Splinting teeth, including multiple abutments, or any service to stabilize periodontally weakened teeth;
  • Replacing tooth structures lost as a result of abrasion, attrition, erosion or abfraction; or
  • Bite registration or bite analysis.
• Infection control, including but not limited to sterilization techniques
• Fees for treatment performed by someone other than a dentist except for scaling and teeth cleaning, and the topical application of fluoride that can be performed by a licensed dental hygienist. The treatment must be rendered under the supervision and guidance of the dentist in accordance with generally accepted dental standards.
• Any hospital, surgical or treatment facility, or for services of an anesthesiologist or anesthetist.
• Prescription drugs or pre-medications, other than those specifically listed as covered herein, whether dispensed or prescribed.
• Any service not specifically listed as covered in this brochure.
• Any service that:
  • Is not eligible for benefits based upon clinical review;
  • Does not offer a favorable prognosis;
  • Does not have uniform professional acceptance; or
  • Is deemed to be experimental or investigational in nature.
• Any expense incurred before your effective date or after the date your coverage under this plan terminates.
• Services provided by someone who ordinarily lives in your home or who is a family member.
• Charges exceeding the reimbursement limit for the service.
• Treatment resulting from any intentionally self-inflicted injury or bodily illness.
• Local anesthetics, irrigation, nitrous oxide, bases, pulp caps, study models, treatment plans, occlusal adjustments, or tissue preparation associated with the impression or placement of a restoration when charged as a separate service, unless otherwise noted as covered herein. These services are considered an integral part of the entire dental service.
• Temporary dental services.
• Repair and replacement of orthodontic appliances.
• Replacement of crowns, onlays, buildups, and posts and cores is covered only if the existing crown, onlay, buildup, or post and core was inserted at least five years prior to the replacement and satisfactory evidence is presented that it is not and cannot be made serviceable.
• Any surgical or nonsurgical treatment for any jaw joint problems, including any temporomandibular joint disorder, craniomaxillary, craniomandibular disorder or other conditions of the joint linking the jaw bone and skull; or treatment of the facial muscles used in expression and chewing functions, for symptoms including, but not limited to, headaches.
• The oral surgery benefits under this plan does not include:
  • Any services for orthognathic surgery;
  • Any services for destruction of lesions by any method;
  • Any services for tooth transplantation;
  • Any services for removal of a foreign body from the oral tissue or bone;
  • Any services for reconstruction of surgical, traumatic, or congenital defects of the facial bones;
  • Any separate fees for pre and post-operative care.
• General anesthesia or conscious sedation is not a covered service unless it is based on clinical review of documentation provided and administered by a dentist or health care practitioner in conjunction with covered oral surgical procedures, periodontal and osseous surgical procedures, or periradicular surgical procedures for covered services.
• General anesthesia or conscious sedation administered due, but not limited to, the following reasons are not covered:
  • Pain control unless a documented allergy to local anesthetic is provided.
  • Anxiety;
  • Fear of pain;
  • Pain management;
  • Emotional inability to undergo surgery
• Preventive control programs including, but not limited to, oral hygiene instructions, plaque control, take-home items, prescriptions and dietary planning.
• Replacement of any lost, stolen, damaged, misplaced or duplicate major restoration, prosthesis or appliance.
• Any laboratory tests, saliva samples, anaerobic cultures, sensitivity testing or charges for oral pathology procedures.
• Separate fees for pre- and post-operative care and re-evaluation within 12 months are not considered covered services under the surgical periodontic services in this plan.
• We do not cover services that generally are considered to be medical services except those specifically noted as covered in this plan.

Plan Limitations:

• Bitewing x-rays are limited to 2 films per year under age 10 and up to 4 films per year for ages 10 and older.

Standard Advantage EPO option:

This plan does not provide benefits for the following:

• Any dental service or treatment not specifically listed as a covered service;
• Services and treatment not prescribed by or under the direct supervision of a dentist, except in those states where dental hygienists are permitted to practice without supervision by a dentist.  In these states, we will pay for eligible covered services provided by an authorized dental hygienist performing within the scope of his or her license and applicable state law;
• Services and treatment which are experimental or investigational;
• Services and treatment for which the cost is later recovered in a lawsuit or in a compromise or settlement of any claim, except where prohibited by law;
• Services and treatment received from a dental or medical department maintained by or on behalf of an employer, mutual benefit association, labor union, trust, or similar person or group;
• Services and treatment incurred after the termination date of your coverage unless otherwise indicated;
• Services which in the opinion of the in-network dentist or specialist are not necessary treatment to establish and/or maintain your oral health;
• Any service that is not consistent with the normal and/or usual services provided by the in-network dentist or specialist or which in the opinion of the in-network dentist or specialist would endanger your health;
• Services and treatment resulting from your failure to comply with professionally prescribed treatment;
• Telephone consultations;
• Any charges for failure to keep a scheduled appointment;
• Any services that are strictly cosmetic in nature including, but not limited to, charges for personalization or characterization of prosthetic appliances;
• Services related to the diagnosis and treatment of Temporomandibular Joint Dysfunction (TMJD);
• Services or treatment provided as a result of intentionally self-inflicted injury or illness;
• Services or treatment provided as a result of injuries suffered while committing or attempting to commit a felony, engaging in an illegal occupation, or participating in a riot, rebellion or insurrection;
• The cost of hospitalization, pharmaceuticals, drugs or medications;
• Any service or procedure which the in-network dentist or specialist is unable to perform because of your general health or physical limitations;
• Treatment for cysts, neoplasms and malignancies;
• Office infection control charges;
• Charges for copies of your records, charts or x-rays, or any costs associated with forwarding/mailing copies of your records, charts or x-rays;
• State or territorial taxes on dental services performed;
• Adjunctive dental care services are covered by other medical insurance even when provided by a general dentist or oral surgeon;
• Services and treatment of any dentist other than an in-network general dentist or specialist, except out-of-area emergency services up to co-pay amount of $100 per member per year. Emergency services are defined as treatment due to injury, accident or severe pain requiring the services of a dentist which occurs under circumstances where it is neither medically or physically possible for you to be treated by an in-network provider.

Plan Limitations:

• Two (2) teeth cleanings (prophylaxis) are covered 2 per calendar year;
• Replacement of a filling is covered if it is more than two (2) years from the date of original placement;
• Replacement of a bridge, crown or denture is covered if it is more than five (5) years from the date of original placement;
• Implant D6010 surgical implant body is covered one (1) per tooth per lifetime. Original date of placement, prior to Humana coverage is within the lifetime of the member.

The benefits on this page are not part of the FEDVIP contract or premium, and you cannot file a FEDVIP disputed claim about them. Fees you pay for these services do not count toward FEDVIP deductibles or annual maximums. These programs and materials are the responsibility of Humana Dental, and all appeals must follow their guidelines. For additional information contact us at, 877-692-2468 or visit the website at https://feds.humana.com/.

Humana’s Lifestyle Discount Program is designed to help you achieve lifelong well-being with valuable discounts and exclusive deals on popular health and wellness services. As a Humana member, you have access to this valuable program (program eligibility varies based on your service area). This program is subject to change at any time and not available where prohibited by law. For additional information, contact us at 1-800-4-HUMANA or https://feds.humana.com.

Weight loss: Members will receive a 50% discount off every Nutrisystem plan, seven free high-protein shakes, and free shipping on all orders. To get started, sign in to https://Humana.com/LifestyleDiscounts and select the link to Nutrisystem. If you prefer, call Nutrisystem at 1-866-430-8647.

Lasik: With nearly 600 locations nationwide, members may choose any in-network provider and receive these discounts: 15% off standard prices or 5% off promotional prices. Extra member value: Special set prices, free Lasik exam, affordable financing options, multiple technologies, 100% bladeless procedures, free enhancements for life on most procedures. To get started, sign in to https://Humana.com/LifestyleDiscounts and select the link to Lasik. If you prefer, call 1-855-645-2020.

Teeth whitening: Humana teamed up with ProSmileUSATM to offer up to 70% off teeth whitening. ProSmileUSA specializes in Hi-IntensityTM, competitive strength, professional teeth bleaching. To order a teeth whitening kit, sign in to https://Humana.com/LifestyleDiscounts and select the link to ProSmileUSA.

Identity monitoring and protection services: Protect yourself with identity monitoring and protection services provided by CyberScout®. This benefit provides expert support to help detect fraud, monitor credit activity, and resolve any identity-related issues. To get started or to review a complete list of services and savings, sign in to https://Humana.com/LifestyleDiscounts and select CyberScout (https://MyIDManager.com/LifestyleDiscounts).

Alternative medicine: You’ll get on-the-spot discounts of up to 30% when you receive services from the WholeHealth Network providers. Choose from: Chiropractic, Massage therapy, Acupuncture. It’s easy to get your savings from more than 37,000 WholeHealth Network providers. To get started, sign in to https://Humana.com/LifestyleDiscounts. To find a provider in your area, visit the WholeHealth Choices website at https://Humana.wholehealthmd.com. If you prefer, call WholeHealth at 1-866-430-8647.

Hearing aids: Humana provides you access to the TruHearing® program, which may save you 30%–60% on hearing aids. TruHearing provides hearing solutions for virtually every type of hearing loss, care from a local professional in your area, and a worry-free purchase with a 45-day trial and 3-year warranty. To learn more, visit TruHearing.com today or call 1-888-403-3937.

Vision Discount: Humana medical and dental members receive our Vision Discount program at no cost. The program offers access to more than 119,000 vision provider locations (access points) including LensCrafters, Pearle Vision, and Target Optical. To locate a network provider, members can call 1-866-995-9316 or via the following method:

Go to https://Humana.com > Member Resources > Find a Doctor > Vision care

Fraud increases the cost of health care for everyone and increases your Federal Employees Dental and Vision Insurance Program premium.

Protect Yourself From Fraud – Here are some things that you can do to prevent fraud:

• Do not give your plan identification (ID) number over the telephone or to people you do not know, except to your providers, plan, BENEFEDS, or OPM.
• Let only the appropriate providers review your clinical record or recommend services.
• Avoid using providers who say that an item or service is not usually covered, but they know how to bill us to get it paid.
• Carefully review your explanation of benefits (EOBs) statements.
• Do not ask your provider to make false entries on certificates, bills or records in order to get us to pay for an item or service.
• If you suspect that a provider has charged you for services you did not receive, billed you twice for the same service, or misrepresented any information, do the following:
  • Call the provider and ask for an explanation.  There may be an error.
  • If the provider does not resolve the matter, call us at 877-692-2468 and explain the situation.
• Do not maintain as a family member on your policy:
  • Your former spouse after a divorce decree or annulment is final (even if a court order stipulates otherwise); or
  • Your child over age 22 (unless he/she is disabled and incapable of self- support).

If you have any questions about the eligibility of a dependent, please contact BENEFEDS.

Be sure to review Section 1, Eligibility, of this brochure prior to submitting your enrollment or obtaining benefits.

Fraud or intentional misrepresentation of material fact is prohibited under the plan.  You can be prosecuted for fraud and your agency may take action against you if you falsify a claim to obtain FEDVIP benefits or try to obtain services for someone who is not an eligible family member or who is no longer enrolled in the plan, or enroll in the plan when you are no longer eligible.

• Do not rely on this chart alone. This page summarizes specific expenses we cover; please review the individual sections of this brochure, for more detail.
• If you want to enroll or change your enrollment in this plan, please visit www.BENEFEDS.com or call 877-888-FEDS (877-888-3337), TTY number 877-889-5680.

How to find your monthly and bi-weekly rates:

• In the first chart below, look up your state or first three digits of your zip code to determine your rating area.
• In the second chart on the following page match your Rating Area to the enrollment type and plan option.