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THIS WEBINARSPONSORED BYFederal Dental and Vision Insurance:FEDVIP ExplainedPresented by: Alan P. SpielmanSponsored by AetnaClosed Captioning (CC) is available on the recorded version of this webinar.1

AgendaFEDVIP BasicsDental BenefitsFEDVIP Dental InsuranceVision BenefitsFEDVIP Vision InsuranceResources2

FEDVIP Basics3

FEDVIP BasicsFEDVIP is the Federal Employees Dental and Vision Insurance Program Enacted in 2004 – Federal Employee Dental andVision Benefits Enhancement Act of 2004. Voluntary enrollee-pay-all dental and vision programadministered by the Office of Personnel Management(OPM). Enrollees have choice of benefit plans amongcompeting carriers. Available to federal employees and annuitants,active-duty military, certain retired uniformed servicemembers, and active-duty family members.4

FEDVIP BasicsWho is Eligible to Enroll in FEDVIP?Federal employeesand annuitantsPostal employeesand annuitantsRetired militaryand familiesActive-dutymilitary familymembers(vision only)5

FEDVIP BasicsImportant FEDVIP Eligibility Rules Federal employees must be eligible for FEHB (not necessarilyenrolled). Federal annuitants who retired on immediate annuity or disabilityunder CSRS, FERS, or other retirement system for employees of thefederal government. Dependent eligibility – up to age 22 (different than FEHB). Uniformed services. Dental – Most retirees, spouses and survivors are eligible.Vision – Family members of an active-duty service member enrolled in aTRICARE Health Plan are eligible.Active-duty uniformed service members are NOT eligible to enroll.6

FEDVIP BasicsHow Do I Enroll in a FEDVIP Plan? You must use www.BENEFEDS.com to enroll in a FEDVIP Plan. Online by computer or smartphone.By phone (1-877-888-3337) or TTY (1-877-889-5690). Steps to enrollment.1.2.3.4.Verify your eligibility.Create a My BENEFEDS account.Review and compare plans, and choose one to enroll in.Confirm your choice.7

FEDVIP BasicsKey Facts About FEDVIP enrollmentWhen can I enroll? If newly hired, within 60 days ofstart date. Open Season: November 8 –December 13, 2021. Qualifying Life Events (QLEs). Examples – Marriage, loss ofother dental/vision coverage. Retirement from federal serviceis NOT a QLE.What are the options and rules? Self.Self Plus One.Self and Family.No dual enrollment.Enrollment automaticallycontinues for next year, unlessenrollee changes or cancels duringOpen Season.8

FEDVIP BasicsFEDVIP Premiums Enrollees pay 100 percent of the premium for FEDVIPdental and vision coverage – there is no governmentpremium contribution. Tax status. Premiums are pre-tax for federal employees.Premiums are post-tax for: Retired federal employees and other annuitants;Uniformed services-related enrollees. For dental, where you live affects your premium. Most FEDVIP premiums paid through payroll/annuitydeductions.9

FEDVIP BasicsFEDVIP Benefit Payments are Secondary to FEHB Plan Benefits Be sure your dental or vision provider has your enrollmentinformation on both plans and knows that FEHB is primary toFEDVIP. For retirees with Medicare Part B, this is the order of benefitpayments: First payor – Medicare Part B;Second payor – FEHB plan;Third payor – FEDVIP plan. Note – Medicare Part B only covers dental expenses that are amedically necessary part of another covered service.10

FEDVIP BasicsMajor Differences Between FEDVIP and FEHBPremiumsFEDVIPEnrollee pays allFEHBGovernment pays share of premiumsEligibility of retireesEligible regardless of prior enrollmentin or eligibility for FEHBEligible if enrolled in FEHB for fiveyears prior to retirementEligibility of childrenUnmarried dependent children up toage 22Children up to age 26EnrollmentOnly through BENEFEDS online atwww.BENEFEDS.com or by phoneSF-2809 formAgency electronic enrollment sitesBenefit limitsAnnual maximum dollar limits onbenefitsNo annual maximum dollar limitsAppealsPlan appealIndependent external reviewPlan appealOPM review11

Dental Benefits12

Dental BenefitsImportance of Dental Care In 2000, the surgeon general released a report on the “silent epidemic” of dental and oral diseases in the U.S.Numerous studies show the connection between oral health and overallhealth. Oral exams can spot: Nutritional deficiencies;HIV;Infections and some cancers. Advanced gum disease is associated with cardiovascular risk. According to the CDC, these are the oral conditions that most affectoverall health/quality of life: Cavities;Severe gum disease;Severe tooth loss.13

Dental BenefitsDental Care Can Be Expensive According to a June 2021 New York Timesarticle:“The median cost across the United States lastyear for a root canal and crown, extraction of 4teeth and a partial upper denture was 4,800according to an ADA survey median cost forperiodontal treatment, 3 fillings and 2 crowns,was 4,360.”14

Dental BenefitsSources of Dental BenefitsFEHB Plan Covered FEHB benefits. Non-FEHB benefits/programs.FEDVIP Plan Preventive & Restorative. Orthodontia.FSAFEDS Pre-tax spending account. Not available to retirees.Traditional Medicare Limited to medically necessary/accidental injury.Medicare Advantage Widely available preventive dental. Some with broader benefits.15

Dental BenefitsFEHB Coverage of Dental Care FEHB plans generally cover oral surgery for accidental injury andcertain other conditions. “Surgery needed to correct accidental injuries to jaws, cheeks, lips, tongue,roof and floor of mouth.”“Removal of impacted wisdom teeth.” Many FEHB plans cover preventive care, and some provide moreextensive benefits. OPM’s FEHB plan comparison tool and the plan’s summary ofbenefits and coverage have information on dental benefits.16

Dental BenefitsFEHB Coverage of Dental CareFEHB Plan Comparison Tool From www.OPM.gov17

Dental BenefitsFEHB Coverage of Dental Care – Summary of Benefits and Coverage18

Dental BenefitsFEHB Coverage of Dental Care – Summary of Benefits and Coverage Dental (and vision) benefits for children are listed in each plan’sSummary of Benefits and Coverage.19

Dental BenefitsNon-FEHB Dental Benefits Examples: Discount plans;Dental insurance. Not part of an FEHB contract. Listed in Section 5 of the brochure.20

Dental BenefitsFEDVIP Dental OverviewIn-network preventive services, such as cleaningsand x-rays.No deductibles when using in-network dentists.No waiting period for major services such ascrowns, bridges, dentures and implants.Under most plan options, there is no 12-monthwaiting period or age limit for orthodontic coverage.21

Dental BenefitsTraditional Medicare Traditional Medicare (Parts A and B) provide minimal dentalbenefits, paying only for “medically necessary” procedures. Social Security Act explicitly excludes coverage for most dental servicesdefined as “services in connection with the care, treatment, filling,removal, or replacement of teeth or structures directly supporting teeth.” Out-of-pocket annual spending on dental care by Medicarebeneficiaries is 874 – the highest level of financial barriers thatbeneficiaries face.Source: Kaiser Family Foundation22

Dental BenefitsMedicare Advantage Most Medicare Advantage Plans provide dental benefits. In 2021, 94 percent of Medicare Advantage enrollees are in a planthat offers some dental coverage. All have preventive coverage.Most have access to more extensive benefits.Those with more extensive benefits have an average maximum dollar limitof 1,300.Source: Dental, Hearing and Vision Costs and Coverage Among Medicare Beneficiaries inTraditional Medicare and Medicare Advantage, Kaiser Family Foundation, September 21, 202123

FEDVIP Dental Insurance24

FEDVIP Dental InsuranceFive Key Things to ernational25

FEDVIP Dental InsuranceUnderstanding FEDVIP Dental Benefit LevelsClass A“Basic”Class B“Intermediate”Class C“Major”Class D Diagnostic and treatment. Preventive. Additional Procedures. Minor restorative. Endodontic, Periodontal. Prosthodontic. Major restorative. Endodontic, Periodontal. Prosthodontic. E.g., braces.“Orthodontic”26

FEDVIP Dental InsuranceUnderstanding FEDVIPDental Procedure Codes Within each benefitlevel, a list of procedurecodes defines what iscovered. List appears only in theplan brochure. Lists are not identicalfrom plan to plan. Same code/differentlevel.“Missing codes.”Different wording.EXAMPLESProcedureCodeDO160Plan APlan BClass ANot ListedD1321Not ListedClass AD1355Class ANot listed27

FEDVIP Dental InsuranceUnderstanding Benefit Limits – Frequency Limits Covered procedure codes may have frequency limits associatedwith them.2021 – D0210 Intraoral – complete set of radiographic images including bitewingsFrequency LimitCarrierNo limit specifiedHumana , Triple-S Salud , UnitedConcordia One/36 months (or 3 years)Aetna , Dominion National,EmblemHealth , GEHA , HealthPartners One/48 monthsDelta Dental One/60 monthsBlue Cross Blue Shield , MetLife ,UnitedHealthcare 28

FEDVIP Dental InsuranceUnderstanding Benefit Limits – Age Limits Coverage for a specific service may be limited to children or adultsD1353 SealantRepairLimited to childrenunder age 19D1510 SpaceMaintainer FixedLimited to patients upto age 2229

FEDVIP Dental InsuranceMany FEDVIP Dental PlansHave Annual Dollar Limits onthe Benefits You Receive Annual dollar limitsmay be on out-ofnetwork or in-networkservices, or both. Standard and Highoption plans may haveannual dollar limits.EXAMPLESOptionPlan A StandardPlan B - HighPlan C - HighIn-Network Out-ofNetwork 1,500 750 30,000 3,000NoneNone30

FEDVIP Dental InsuranceOrthodontic Service Benefits in FEDVIP Dental PlansWhat is orthodontia? Treatment of irregularities in the teeth(especially of alignment and occlusion) andjaws, including the use of braces (OxfordDictionary).FEDVIPbenefits 30-65% coinsurance. Lifetime dollar maximums in all nationwideplans ( 2000- 4000). 12-month waiting period (6 nationwide planoptions in 2021).31

FEDVIP Dental InsuranceUnderstanding Region Ratings inFEDVIP Dental Plans Where you live affects yourpremium rate. Plans can have up to five ratingcategories. Areas in rating categories are notidentical from plan to plan. To avoid confusion, use the plancomparison tool (enter zipcode).32

FEDVIP Dental InsuranceInternational Coverage inFEDVIP Dental All nationwide FEDVIPdental plans coverinternational care. Some have dental networks.Patients must pay providerupfront and file claim forreimbursement.33

FEDVIP Dental InsuranceFEDVIP Dental CarriersNational/International Aetna DentalBlue Cross Blue Shield FEPDental Delta Dental GEHA Connection Dental FederalMetLife Federal Dental PlanUnited Concordia DentalUnitedHealthcare DentalRegional Dominion NationalEmblemHealth DentalHealthPartners DentalHumana DentalTriple-S Salud 34

FEDVIP Dental InsuranceFEDVIP Plan Comparison Tool OPM and BENEFEDSwebsites contain plancomparison tools. Compare up to three planoptions at a time. Major benefit classes. In-network vs. out-ofnetwork benefits. Premium for your zip codeis displayed.35

FEDVIP Dental InsuranceDental Benefits Checklist Review FEHB plan benefits. Plan brochure. Plan comparison tool. Summary of benefits. Explore FSAFEDs (if eligible). Assess dental care needs. Major procedures needed? Orthodontics? Research FEDVIP plans. Plan comparison tool. Plan brochure. Ask your dentist. In-network? Good prior experience?36

Vision Benefits37

Vision BenefitsDo I Need a FEDVIP Vision Plan? Weigh the considerations. Am I “due” for an exam? Do I need new frames? Should I “self-insure”? What is exam fee?Alternatives?»»Other benefits.Retail discounts (e.g. Costco,Wal-Mart, Warby Parker).38

Vision BenefitsSources of Vision BenefitsFEHB planFEDVIPFSAFEDS Covered FEHB benefits. Non-FEHB benefits/programs. Vision plan benefits. Non-FEDVIP benefits. Pre-tax spending account. Not available to retirees.Traditional Medicare Limited to medically necessary/accidentalinjury.Medicare Advantage Widely available. Low annual benefit limits.39