• 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; or
• cancel the enrollment during Open Season.
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.
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).
Continuation of Coverage
If you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account
(HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA),
you should consider how coverage under a FEDVIP plan will affect your annual expenses,
and thus the amount that you should allot to an FSAFEDS account. 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 $2,600.
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.
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 claims on behalf of the Dominion Dental Services,
Inc. plan to the FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited
Expense Health Care Flexible Spending Account (LEX HCFSA) to claim reimbursement.
FSAFEDS/High
Deductible Health Plans
and FEDVIP
9
2018
Enroll at www.BENEFEDS.com
Section 3 How You Obtain Care
We will send you an identification (ID) card when you enroll. You should carry your ID
card with you at all times. You should present your ID card whenever you receive
services from an assigned plan provider.
If you do not receive your ID card within 30 days after the effective date of your
enrollment or if you need replacement cards, you may request one through our website at
FederalDentalPlans.com or call us at 855-836-6337.
Identification Cards/
Enrollment
Confirmation
You must choose a primary care dentist before you utilize the plan. Prior to your effective
date, you will receive a notification prompting you to select a dentist. You can find a
current list of dentists online at FederalDentalPlans.com. You can also call us at
855-836-6337 to request that a list be mailed to you. After your effective date, simply call
the dental office you selected and make an appointment. Except for out-of-area
emergency care, you must receive treatment at the dental office you selected.
Where You Get Covered
Care
A complete list of participating dentists are available on our online provider search at
FederalDentalPlans.com. The list is refreshed every night.
Plan Providers
You must receive services from your selected participating general dentist. If specialty
services are necessary, a referral will be provided by your participating general dentist. An
orthodontist can be selected for orthodontia services without a referral.
In-Network
There are no out-of-network benefits available except for emergency care.
Out-of-Network
If you have an emergency outside of the service area, visit any licensed dentist for care.
We will reimburse you for emergency services up to $100 per member per year.
Emergency Services
When you visit a provider who participates with both, your FEHB plan and your FEDVIP
plan, the FEHB plan will pay benefits first. The FEDVIP plan alowance will be the
prevailing charge, in these cases. You are responsible for the difference between the
FEHB and FEDVIP benefit payments and the FEDVIP plan allowance. We are
responsible for facilitating the process with the primary FEHB first payor. You can assist
with this process and also ensure that you are receiving the maximum allowable benefit
under each program by presenting both your FEDVIP and FEHB ID cards at the time of
your dental appointment. The dentist should include both ID numbers when submitting the
claim to the plans.
It is important to bring your FEDVIP and FEHB identification cards to every dental
appointment because most FEHB plans offer some level of dental benefits separate from
your FEDVIP coverage. Presenting both identification cards can ensure that you receive
the maximum allowable benefit under each Program.
First Payor
We will coordinate benefit payments with the payment of benefits under other group
health benefits coverage you may have and the payment of dental costs under no-fault
insurance that pays benefits without regard to fault.
We may request that you verify/identify your health insurance plan(s) annually or at time
of service.
Coordination of Benefits
To enroll in this plan, you must live in our service area. This is where our providers
practice. Our service area is: District of Columbia, Delaware, Maryland, Pennsylvania
and parts of Virginia and parts of New Jersey.
Service Area
10
2018
Enroll at www.BENEFEDS.com