FEDVIP – Dental and Vision Insurance

The Federal Dental and Vision Insurance Program (FEDVIP) is a voluntary benefit and the vision and dental coverages are separate policies. Eligible persons may choose one, both or neither.

FEDVIP Eligibility and Enrollment

Most federal employees who are eligible for Federal Employees Health Benefits program coverage are eligible for FEDVIP; the main exception is that temporary employees and employees working on seasonal or intermittent schedules are not eligible for FEDVIP, even if they are eligible for FEHB.

FEDVIP conducts enrollment open seasons each autumn running concurrent with the FEHB open season. An eligible individual may enroll in a FEDVIP benefits plan for self-only, self and family, or self plus one (the “one” must be someone who would be eligible for coverage under FEHB as a family member), as described below.

Enrollments or changes in enrollments take place at www.benefeds.com, through a toll-free phone line, (877) 888-3337, TTY (877) 889-5680, or, in exceptional cases, through forms available from the employing agency.

Enrollment cannot be made through FEHB enrollment forms or through automated agency self-service systems; many of those systems have links to Benefeds, however.

Re-enrollment is automatic each year unless an enrollee chooses to make a change during open season or a plan terminates its participation in FEDVIP.

Note: Newly hired employees get one opportunity to enroll in a dental plan and one opportunity to enroll in a vision plan during the 60 calendar days after hiring. Once they enroll in a plan, the 60 day window for that type of plan ends, even if 60 days haven’t yet elapsed. Once they have enrolled in either plan, they cannot change or cancel that particular enrollment until the next open season, unless they experience a life event that allows such a change or cancellation.

Coverage changes are allowed due to certain life events as explained below.

Covered Family Members

Eligible 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.

For both self plus one and self and family enrollments, when an eligible family member on an existing enrollment loses eligibility (for example, reaches age 22 or remarries) and there is at least one other eligible family member remaining on the enrollment, the enrollee must remove the ineligible family member through Benefeds. Failure to remove ineligible family members does not make them eligible.

Former spouses of employees and annuitants are ineligible, as are FEHB Temporary Continuation of Coverage enrollees and anyone receiving an insurable interest annuity who is not otherwise eligible as a family member.

A stepchild remains eligible after a divorce, end of a domestic partnership, or the death of the spouse or partner if the child continues to live with the enrollee in a parent-child relationship.

Retirees

Federal annuitants are eligible to enroll in FEDVIP if they retired on an immediate annuity, including for disability, under the Civil Service Retirement System, the Federal Employees Retirement System or another retirement system for employees of the government. Federal and postal employees enrolled in FEDVIP who subsequently retire on an immediate annuity or for disability may continue FEDVIP enrollment into retirement. There is no five-year rule for continuing coverage into retirement as there is with the FEHB program.

Employees retired on a deferred annuity (not eligible for an immediate annuity when they separate from federal service) are not eligible to enroll in FEDVIP and cannot continue a FEDVIP enrollment into retirement.

Employees enrolled in FEDVIP who retire on a FERS Minimum Retirement Age +10 annuity and elect to postpone receipt of their annuity lose FEDVIP coverage upon separation from service. They can again enroll in FEDVIP within 60 days of when they start receiving their annuity. They do not have to enroll in the same plan, option or same enrollment type they had when they separated.

Survivors

A member of a family who receives an immediate annuity as the survivor of an employee or of a retired employee is eligible to enroll in FEDVIP. The survivor does not have to have been covered under the deceased person’s FEDVIP enrollment. If an employee or annuitant enrolled in FEDVIP dies while enrolled in self plus one or self and family, the enrollment will continue for their eligible family members who become survivor annuitants.

Injury Compensationers and Survivors

Compensationers are eligible to enroll in FEDVIP or continue FEDVIP enrollment into compensation status. A family member receiving monthly compensation from the Office of Workers’ Compensation Programs as the surviving beneficiary of an employee who dies as a result of illness or injury sustained while in performance of his/her duty can enroll in FEDVIP or continue the deceased’s FEDVIP enrollment.

Types of FEDVIP Enrollment

A self only enrollment covers only the enrolled employee or annuitant. An eligible individual may enroll in self only even though he/she has a family, but the family members are not covered.

A self plus one enrollment covers the enrolled employee or annuitant plus one eligible family member. Eligible individuals may enroll in self plus one even though they have more than one eligible family member, but the additional family members are not covered. The enrollee must specify during the enrollment process which one eligible family member he/she wishes to cover under a self plus one enrollment. The enrollee may change the covered family member to another eligible family member during an open season or because of a qualifying life event (see accompanying table).

A self and family enrollment covers the enrolled employee or annuitant and all eligible family members. Enrollees should list all eligible family members when they enroll. All of the enrollee’s eligible family members are automatically covered, even if the enrollee fails to list all of them when enrolling on Benefeds, but claim payments may be delayed for family members who were omitted.

Within FEDVIP, dental insurance plans and vision insurance plans operate independently of one another. That means that eligible employees and annuitants can enroll for dental insurance only, vision insurance only, neither, or both. If they’re enrolled in both, they can choose different enrollment types for each. In addition, employees/annuitants who enroll in both a dental plan and vision plan and choose self plus one coverage for each plan can opt to cover a different dependent in each plan.

Generally, dual enrollment—when an individual is covered under more than one FEDVIP dental enrollment or more than one FEDVIP vision enrollment—is prohibited except when elimination of the dual enrollment would cause a covered person to lose coverage.

Enrollment Procedures

Eligible individuals can enroll:

  • during the annual open season;
  • within 60 days after first becoming eligible as a new employee, a previously ineligible employee who transferred to a covered position, or a survivor annuitant, if not already covered under FEDVIP;
  • within 60 days after returning to service following a break in service due to deployment for active military duty; or
  • within 60 days after a qualifying life event that allows enrollment, including marriage, loss of other dental or vision coverage by yourself or an eligible family member, restoration of an annuity or injury compensation, and return from leave without pay if you did not have coverage before that period or your coverage was canceled during that period.

Certain life events also allow for changing plans, such as on marriage or when moving out of the coverage area of a regional plan, or for changing type of enrollment consistent with the life event, such as going from self plus one to self and family on the birth of a child, or vice-versa if a child ages out of eligibility.

Enrollment changes due to qualifying life events generally must be made between 31 days before the event to 60 days after the event, and those who miss the deadline generally must wait until the next open season. These periods may be extended in limited circumstances.

Applicants self-certify their eligibility for FEDVIP, and those who elect self plus one or self and family coverage in FEDVIP self-certify the eligibility of their dependent(s). Employees who do not know whether they or their family members are eligible for coverage should check with their employing agency for guidance.

FEDVIP plans may ask an enrollee to provide documentation that confirms a family member’s eligibility (such as a marriage certificate or adoption papers, or a determination of eligibility for a family member under FEHB or the Federal Employees’ Group Life Insurance program), either when an individual initially enrolls or when an enrollee adds a family member to an existing enrollment.

Canceling Coverage

Enrollees generally can cancel their enrollment only during the annual open season, except that if an employee changes his/her enrollment in anticipation of a permitted qualifying life event, and that event does not occur, the change can be canceled. Enrollment also can be canceled when either the employee or the employee’s spouse is called to active military duty.

An eligible family member’s coverage also ends upon the effective date of a cancellation.

Benefits and Premiums

Benefits are offered through carriers chosen by the Office of Personnel Management; some of them part of or affiliated with FEHB carriers. It is not necessary to choose a vision or dental plan offered by an FEHB carrier in which the employee is enrolled.

Carriers under the program are secondary payers and are responsible for coordination of benefits with FEHB plans, which provide primary benefits. FEDVIP plans also coordinate benefit payments with the payment of benefits under other group health benefits coverage enrollees may have and the payment of dental or vision costs under no-fault insurance.

There are no pre-existing condition limitations. Enrollees are immediately eligible to receive all benefits with the exception of orthodontia. At a minimum, enrollees are eligible to receive the full level of orthodontia benefits after 24 months of continuous enrollment in a participating plan.

All of the plans have provider networks. Plans vary according to whether or to what extent they will pay benefits for services provided by a non-network provider.

Regional plans have limited service areas and may require that enrollees receive care from providers who contract with them in order to receive benefits, except for emergencies. If an enrollee or a covered family member moves outside of a regional plan’s service area, the enrollee can change to another plan.

Active employees must pay premiums with pre-tax money, although annuitants may not. Employees with health care flexible spending accounts may submit dental/vision co-payments/deductibles as eligible expenses against their FSA account. However, the premiums are not reimbursable under an FSA. Enrollees pay the full cost of coverage, with no government contribution toward the premiums.

For dental plans, premiums are determined in part based on where the enrollee lives—a rating area. Each dental plan may have up to six rating areas, including an international rate. However, the zip codes included in each rating area differ from plan to plan.

Vision plans do not have separate rating areas as they each charge a nationwide rate.

Specific coverage and premium information is at www.opm.gov/healthcare-insurance/dental-vision.

Disputed Claims

Each plan has its own process and timeframe for reviewing disputed claims, which are explained in its brochure. If an enrollee has completed the plan’s claims dispute process and still disagrees with the plan’s decision, he or she may request that an independent third party, mutually agreed to by the plan and OPM, review the decision. The decision of the independent third party is final and binding. OPM does not review disputed FEDVIP claims.

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