FEDVIP is the Federal Employees Dental and Vision Insurance Program administered by the U.S. Office of Personnel Management. It is a program where supplemental dental and vision benefits are available to eligible Federal and U.S. Postal Service employees, annuitants, and their eligible family members. Aetna is one of the approved carriers to offer Federal Employees a supplemental dental plan under this program.
2. Do I have to use network dentists to get covered benefits?
No. You can visit any licensed dentist, anywhere. Aetna does have a dental network with over 109,000 dental locations. Your out-of-pocket costs may be lower if you use a dentist in Aetna's dental PPO network and you are not responsible for charges above our network negotiated fees. You can find Aetna network dentists by using our DocFind® online directory.
Annual Benefit Maximum $3,000 in-network/$2,000 out of network per member (includes Basic, Intermediate and Major services).
Visit any licensed dentist, anywhere – without a referral.
No Deductible
Preventive/Basic Services 100% covered*
e.g. Cleanings, X-rays, Sealants, Space Maintainer and Fluoride
Intermediate Services 60% covered*
e.g. Fillings, Theraputic Pulpotomy, Uncomplicated Extractions, Periodontal Scaling, Denture Adjustment and Repair
Major Services 40% covered*
e.g. Inlays, Onlays, Crowns, Root Canal, Full & Partial Dentures, Pontics, General Anesthesia/Intravenous Sedation
Orthodontic Services** 30% covered*
Orthodontic Lifetime Maximum $1,500/member
*Aetna will pay the percentages listed above as follows:
In network - percentage of our negotiated fee with the participating provider. Member not responsible for amounts above the negotiated fee.
Out of network - percentage of the provider's prevailing charge (usual & customary - 75th percentile). Member may be responsible for amounts above that level.
See "How we pay Out-of-network claims" under the Member tab on our Home page.
**Orthodontia is covered for children up to, but not including, 19 years of age. A member will be eligible to receive Orthodontic benefits after they have been continuously enrolled in the Aetna Denal PPO Plan for 24 months.
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4. How much does the new Aetna Dental PPO plan cost?
Please see our rate calculator to determine the region where you live and the premium for your region.
5. How do I pay the premium for the new Aetna Dental PPO Plan and is it pre-tax?
First you must enroll in the Aetna Dental plan PPO through the www.benefeds.com website. Once you enroll in the new dental plan, premiums are withheld from your paycheck. Premiums are paid on a pre-tax basis (premium conversion) if you are an active employee and your salary is sufficient to make the premium withholding. Pre-tax premiums are not available to annuitants, survivor annuitants or compensationers.
Yes. There is an annual maximum of $3,000 in-network/$2,000 out-of-network per member. The maximum applies to preventative, intermediate and major services. However, you still have access to network discounts when you use a participating dentist even after your dental benefits are exhausted. There is also an orthodontia lifetime maximum of $1,500 per child once they have been continuously covered by the Aetna Dental PPO Plan for 24 months.
Only on Orthodontia coverage. Orthodontia coverage is available for children up to 19 years of age. A member will be eligible to receive Orthodontic benefits after they have been continuously covered by the Aetna Dental PPO plan for 24 months.
No. Orthodontia is covered for children up to age 19 after a 24 month waiting period. Although we do not offer adult orthodontia, members in our Aetna PPO Dental plan can access the Aetna negotiated rate on orthodontia from participating dental providers.
Implants and related services are not covered except for the crown that goes over the implant. The tooth being replaced must be extracted while covered under the FEDVIP plan. Implant crowns are covered under the major category at 40%.
12. Do I get any other perks with the Aetna Dental PPO plan?
Yes. Enrolling in the Aetna Dental PPO plan also gives you access to our Aetna VisionSM Discount program that includes discounts on frames, lenses and Lasik surgery at participating locations. You also get great discounts on gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more!
14. How can I keep track of my benefits used and claim history?
Once you are an Aetna member, you'll be able to access your personalized, secure member portal on Aetna Navigator®. You can check the status of a claim and view your claim history, view an Explanation of Benefits, replace your membership card- and lots more.
Enroll at www.benefeds.com during open season, November 9 through December 14, 2009, or after a qualifying life event that permits enrollment outside of open season. New employees will have 60 days to enroll.
Enroll at www.benefeds.com during open season, November 9 through December 14, 2009. See rate calculator to determine the region where you live and the premium for your rating region.
17. Do I submit dental claims to my medical or dental carrier when I have some dental coverage in my medical plan?
If you have dental coverage through your FEHB medical plan and coverage under FEDVIP, your FEHB plan will be the first payor of any benefit payments. Please ask your dentist to submit his charges to your FEHB medical plan first. We are responsible for coordinating benefits with the primary payor.
We will also 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.
Federal employees and annuitants in the United States and overseas are eligible to enroll in our Aetna Dental PPO under FEDVIP. If you receive covered dental services while overseas, you will need to submit your claims to Aetna. Upon receipt of the claim, Aetna will translate the claim, if necessary, and process it. We use the rate of exchange in effect at the time we process the claim. Claims are paid in U.S. currency. See Section 6 of our federal brochure for more information.
This material is for informational purposes only. See your FEDVIP brochure for a complete description of benefits, exclusions, limitations and conditions of coverage.
