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Federal Employees Dental and Vision Insurance Program

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					                   Federal Employees Dental and Vision Insurance Program

The Federal Employees Dental and Vision Insurance        Dental plans provide a comprehensive range of services.
Program (FEDVIP) is a supplemental dental and            Dental services are divided by the four categories as
vision program authorized by the Federal Employee        follows:
Dental and Vision Benefits Enhancement Act of 2004.
                                                             •   Class A (Basic) services, which include oral
OPM contracts with 10 insurance carriers to provide              examinations, prophylaxis, diagnostic evaluations,
comprehensive coverage under the Program.                        sealants and x-rays.
                                                             •   Class B (Intermediate) services, which include
Seven dental plans:                                              restorative procedures such as fillings, prefabricated
        • Aetna Life Insurance Company                           stainless steel crowns, periodontal scaling, tooth
        • CompBenefits                                           extractions, and denture adjustments.
        • Government Employees Health                        •   Class C (Major) services, which include endodontic
            Association, Inc. (GEHA)                             services such as root canals, periodontal services
        • Group Health, Inc. (GHI)                               such as gingivectomy, major restorative services
        • MetLife Inc.                                           such as crowns, oral surgery, bridges and
        • Triple-S, Inc.                                         prosthodontic services such as complete dentures.
        • United Concordia Companies, Inc.                   •   Class D (Orthodontic) services with up to a 24-
Three vision plans:                                              month waiting period.
        • FEP BlueVision (Blue Cross Blue Shield)
        • UnitedHealthcare Vision Plan (formerly         Who is eligible to enroll in FEDVIP?
            Spectera, Inc.)
        • Vision Service Plan (VSP)                      Federal and U.S. Postal Service (USPS) employees are
                                                         eligible to enroll in FEDVIP if they are eligible for the
Three types of enrollment are available under            Federal Employees Health Benefits (FEHB) Program. And,
FEDVIP:                                                  annuitants (regardless of FEHB status).

    •   Self Only: A Self Only enrollment covers         Key FEDVIP Facts
        only the enrolled employee or annuitant.
    •   Self Plus One: A Self Plus One enrollment        •   The FEDVIP program is separate and different from the
        covers the enrolled employee or annuitant            FEHB program.
        plus one eligible family member.                 •   Coordination of benefits (COB) with the FEHB plan, if
    •   Self and Family: A Self and Family                   enrolled in a FEHB plan, is a requirement under the
        enrollment covers the enrolled employee or           FEDVIP law. The FEDVIP plan is secondary to the
        annuitant and all eligible family members.           FEHB plan.
                                                         •   Premiums for the nationwide dental plans and one
Covered Services                                             regional dental plan are based on home ZIP codes. This
                                                             is called a rating region. Vision plans do not have rating
Vision plans will provide comprehensive eye                  regions.
examinations and coverage for lenses, frames and         •   There is no 31-day extension of coverage, Temporary
contact lenses (in lieu of eye glasses). There are no        Continuation of Coverage (TCC), spouse equity
deductibles or waiting periods. Other benefits such as       coverage, or right to convert to an individual policy
discounts on lasik surgery may also be available.            (conversion policy).
Dental Plans
   In areas where dental plans do not have adequate provider access, the plans must provide
   payment based on the standard healthcare prevailing fees or pay benefits based on their plan
   allowance.

   Nationwide Plans – All nationwide plans include international coverage.
      Aetna
      Plan Type – Preferred Provider Organization (PPO)

          Aetna has a long standing relationship with the Federal Government, serving as the
          Government wide medical indemnity carrier when the FEHB Program was first
          established. It is currently one of the larger HMO plans participating in the Federal
          Employees Health Benefits Program (FEHB). It currently provides some dental
          services to all of its Federal members as part of its medical plan.

               •   Aetna will provide a single high option dental plan.
               •   In addition to the in-network benefits shown in the attached chart, Aetna’s
                   dental plan will offer out-of-network benefits based on the American Dental
                   Association fee schedule, using the same payment percentages as for in-
                   network benefits, even in areas where access is adequate.
               •   As noted in the chart, the Aetna plan has no deductibles.
               •   Orthodontia will be covered after a two year waiting period for dependents up
                   to age 19. There is a $1,500 per person lifetime maximum on covered
                   orthodontia services.
               •   Aetna’s non-orthodontia annual maximum per individual, will increase to
                   $3,000 in-network or $2,000 out-of-network.
             •     Aetna members will receive a free add-on discount vision plan.
      GEHA
      Plan Type – Preferred Provider Organization (PPO)

          Government Employees Health Association Inc. (GEHA) is the third largest national
          health plan in the FEHB Program. It has been in the FEHB Program since the
          program was first established. Regarding dental coverage, for nearly 10 years,
          GEHA has offered a nationwide dental insurance plan, Dental Connection Plus.
          GEHA’s Dental Connection Plus plan currently provides coverage to over 57,000
          Federal employees.

               •   GEHA will provide two dental options, High and Standard.
               •   The copayment under the Standard Option plan for preventive services will be
                   eliminated.
               •   Orthodontia will be covered after a two year waiting period for dependents up
                   to age 19. There is a $1,500 per person lifetime maximum on covered
                   orthodontia services.
               •   GEHA’s High Option non-orthodontia annual maximum will increase to
                   $3,500.
       •   Members enrolled in GEHA’s dental plan options will receive the same
           association benefits as other GEHA plan members, including hearing and
           vision discounts, at no additional cost.
       •   In addition to the in-network benefits shown in the attached chart, GEHA’s
           dental plan will offer out-of-network benefits based on the American Dental
           Association fee schedule, using the same payment percentages as for in-
           network benefits, even in areas where access is adequate.

MetLife
Plan Type – Preferred Provider Organization (PPO)

   MetLife has a long-standing relationship with the Federal Government (over 50
   years) as the administrator of the Federal Employees Group Life Insurance (FEGLI)
   Program. In addition, MetLife is involved with Long Term Care Partners in
   administering the Federal Long Term Care Insurance Program, and the BENEFEDS
   Portal. MetLife is the largest commercial Dental insurance carrier in the U.S serving
   over 21 million people and over 31,000 companies. Forty-three of the Fortune 100
   companies have selected MetLife to administer their dental benefits.

       •   MetLife will provide two dental options, High and Standard.
       •   Orthodontia will be covered after a two year waiting period for dependents up
           to age 19. There is a $1,500 (in-network) per person lifetime maximum on
           covered orthodontia services under Standard Option and a $3,000 per person
           lifetime maximum under High Option.
       •   MetLife provides an out-of-network benefit at a lower percentage rate.
       •   MetLife will have a deductible for preventative, intermediate and major out-
           of-network services.
       •   MetLife will provide a benefit for implants.

United Concordia
Plan Type – Preferred Provider Organization (PPO)

   United Concordia Companies, Inc. is one of the largest dental benefit administrators
   in the United States. It is a subsidiary of Highmark, a Pennsylvania licensee of the
   Blue Cross and Blue Shield Association. United Concordia has administered dental
   benefit programs for Fortune 500, federal and state governments, and other well
   known customers for more than 30 years.

   United Concordia serves the 1.7 million members in the TRICARE Dental Program
   (TDP), the largest fully insured dental program in the world. TDP is available to
   family members of all active duty Uniformed personnel and to Selected Reserve and
   Individual Ready Reserve (IRR) members and their families. In April 2005, the TDP
   contract was awarded to United Concordia by the Department of Defense for a third,
   five-year term, through 2011.

       •   United Concordia will provide a single high option dental plan.
       •   There is no deductible associated with United Concordia’s plan.
       •   Orthodontia will be covered after a two year waiting period for dependents up
           to age 19. There is a $1,500 per person lifetime maximum on covered
           orthodontia services.
       •   Benefit design features additional coverage of implant prosthetics and resin
           crowns.
       •   No out-of-network benefits in areas where access is adequate.


Regional Plans
Triple-S
Plan Type – Preferred Provider Organization (PPO)
Service Area – The Island of Puerto Rico.

   Triple-S is Puerto Rico’s largest health insurance provider and has been a health
   insurance carrier for under the Federal Employees Health Benefits Program (FEHB)
   for more than 40 years. Approximately 93% of Federal employees through the years
   have consistently chosen Triple-S, Inc., as their carrier. Triple-S is affiliated with the
   Blue Cross and Blue Shield Association.

       •   Orthodontia will be covered after a two year waiting period for dependents up
           to age 19. There is a $1,500 per person lifetime maximum on covered
           orthodontia services.
       •   Triple-S does not offer an out-of-network benefit in areas that meet access
           standards.
GHI
Plan Type – Preferred Provider Organization (PPO)
Service Area – All of New York State as well as some Zip Codes in Pennsylvania,
Connecticut and New Jersey.

   GHI has a long standing relationship with the Federal Government, as a New York
   based regional health insurance carrier. With more than a half million covered
   patients enrolled in GHI commercial dental programs, including 30,000 FEHBP
   employees and covered dependents with limited preventive dental care through GHI
   medical plans, GHI has had a significant and long-term New York regional presence
   in the dental marketplace.

       •    There is an out-of-network benefit even in areas that meet access, which pays
            benefits up to a schedule maximum.
       • Orthodontia will be covered after a one year waiting period for dependents up
            to age 19. There is a $2,000 per person lifetime maximum on covered
            orthodontia services.
CompBenefits
Plan Type – Preferred Provider Organization (PPO)
Service Area – All of Alabama, Arkansas, Arizona, California, Colorado, DC, Florida,
Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Missouri, Mississippi, North
Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, and West
Virginia. And most of Maryland.

       •   Under CompBenefits, members will pay fixed copayments for each service,
           regardless of the amount of the charge.
       •   CompBenefits is the only plan without a waiting period for orthodontia.
       •   CompBenefits has the highest per person annual maximum benefit of any
           FEDVIP provider: $10,000.
       •   No out-of-network benefit in areas that meet the access standards.
Vision Plans
 Nationwide Plans – All nationwide plans include international coverage.
    FEP BlueVision
    FEP BlueVision is offering an insured vision plan that is underwritten by the local BCBS
    plans but will be administered by Davis Vision. The Association will contract with Davis
    Vision, a wholly owned subsidiary of Highmark, Inc. (a licensee of BCBSA and a
    Participating Plan for FEP BlueVision) to administer its offering under the program.
    Davis Vision, Inc. is one of the nation’s leading managed vision and eyecare providers
    and presently serves more than 10,000 client groups covering nearly thirty-five million
    beneficiaries.

           •  Flat rate reimbursement in areas without adequate access.
           •  Low vision services are offered and members can receive discounts on laser
              vision correction.
           • Offers an unconditional breakage warranty to repair or replace any plan frame
              or lens(es) for a period of one year from the date of delivery.
           • Coverage for elective contact lenses and medically necessary contract lenses.
           • FEP BlueVision’s High Option provides an out-of network based on a fee
              schedule.
           • There are no out-of-network benefits under FEP BlueVision’s Standard
              Option.
    UnitedHealthcare Vision Plan (formerly Spectera)
    UnitedHealthcare Vision is offering an insured vision plan. UnitedHealthcare Vision has
    been providing vision services for over forty years and currently has over 17 million
    members nationwide.

           •    UnitedHealthcare Vision will pay out-of-network, limited access and
                international benefits based on a published fee schedule;
           • Low vision services are offered and members can receive discounts on laser
                vision correction.
           • UnitedHealthcare Vision offers prosthetic eye replacement on a lifetime
                maximum basis.
           • Coverage for elective contact lenses and medically necessary contract lenses.
           • UnitedHealthcare Vision provides an out-of-network benefit.
           • Name Change for Spectera to UnitedHealthcare Vision Plan.
    Vision Service Plan (VSP)
    VSP is offering an insured vision plan. VSP is a U.S. based not-for-profit corporation.
    Thirty-eight million people are currently covered under VSP funded vision plans with an
    addition six million covered by discount plans. In 2006, for the second consecutive year,
    J.D. Power and Associates ranked VSP "Highest in Overall Member Satisfaction Among
    National Vision Plans."

           •   VSP will pay international benefits based on a published fee schedule;
•   VSP offers an Eye Health Management program, which complements disease
    management and wellness initiatives and concentrates on diseases such as
    diabetes, glaucoma and macular degeneration.
•   Members can receive discounts on laser vision correction.
•   Coverage for elective contact lenses and medically necessary contract lenses.
•   VSP provides an out-of-network benefit.

				
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