Federal Employees Dental and Vision Insurance Program

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1 Federal Employees Dental and Vision Insurance Program The Federal Employees Dental and Vision Insurance Program (FEDVIP) is a supplemental dental and vision program authorized by the Federal Employee Dental and Vision Benefits Enhancement Act of OPM contracts with 10 insurance carriers to provide comprehensive coverage under the Program. Seven dental plans: Aetna Life Insurance Company CompBenefits Government Employees Health Association, Inc. (GEHA) Group Health, Inc. (GHI) MetLife Inc. Triple-S, Inc. United Concordia Companies, Inc. Three vision plans: FEP BlueVision (Blue Cross Blue Shield) UnitedHealthcare Vision Plan (formerly Spectera, Inc.) Vision Service Plan (VSP) Three types of enrollment are available under FEDVIP: Self Only: A Self Only enrollment covers only the enrolled employee or annuitant. Self Plus One: A Self Plus One enrollment covers the enrolled employee or annuitant plus one eligible family member. Self and Family: A Self and Family enrollment covers the enrolled employee or annuitant and all eligible family members. Covered Services Vision plans will provide comprehensive eye examinations and coverage for lenses, frames and contact lenses (in lieu of eye glasses). There are no deductibles or waiting periods. Other benefits such as discounts on lasik surgery may also be available. Dental plans provide a comprehensive range of services. Dental services are divided by the four categories as follows: Class A (Basic) services, which include oral examinations, prophylaxis, diagnostic evaluations, sealants and x-rays. Class B (Intermediate) services, which include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions, and denture adjustments. Class C (Major) services, which include endodontic services such as root canals, periodontal services such as gingivectomy, major restorative services such as crowns, oral surgery, bridges and prosthodontic services such as complete dentures. Class D (Orthodontic) services with up to a 24- month waiting period. Who is eligible to enroll in FEDVIP? Federal and U.S. Postal Service (USPS) employees are eligible to enroll in FEDVIP if they are eligible for the Federal Employees Health Benefits (FEHB) Program. And, annuitants (regardless of FEHB status). Key FEDVIP Facts The FEDVIP program is separate and different from the FEHB program. Coordination of benefits (COB) with the FEHB plan, if enrolled in a FEHB plan, is a requirement under the FEDVIP law. The FEDVIP plan is secondary to the FEHB plan. Premiums for the nationwide dental plans and one regional dental plan are based on home ZIP codes. This is called a rating region. Vision plans do not have rating regions. There is no 31-day extension of coverage, Temporary Continuation of Coverage (TCC), spouse equity coverage, or right to convert to an individual policy (conversion policy).

2 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 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 innetwork benefits, even in areas where access is adequate. As noted in the chart, the Aetna plan has no deductibles. 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 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. GEHA s High Option non-orthodontia annual maximum will increase to $3,500.

3 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 innetwork benefits, even in areas where access is adequate. MetLife 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. 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 outof-network services. MetLife will provide a benefit for implants. United Concordia 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 United Concordia will provide a single high option dental plan.

4 There is no deductible associated with United Concordia s plan. 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 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. Triple-S does not offer an out-of-network benefit in areas that meet access standards. GHI 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 CompBenefits Service Area All of Alabama, Arkansas, Arizona, California, Colorado, DC, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Missouri, Mississippi, North

5 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.

6 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;

7 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.