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Enrollment
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General
Enrollment
I am currently enrolled in United
Concordia's FEDVIP. Do I need to enroll again during open
season to maintain my dental benefits for the next year?
No, you do not need to enroll again to maintain your coverage
in United Concordia's FEDVIP. To keep your dental
benefits hassle-free, your current coverage will
automatically renew from year to year, unless you make a
change during open season or make a change outside of open
season as a result of a qualifying life event.
How do I enroll?
During open season, go to www.BENEFEDS.com.
and follow instructions for selecting United Concordia's
FEDVIP.
When does coverage start?
The upcoming coverage period will begin on January 1,
2010. Coverage periods for FEDVIP will be on
a calendar year basis from January 1st to December 31st.
Is there a waiting period?
There is no waiting period for eligible dental services,
except for a 24-month waiting period for eligible dependents
under the age of 19 years for orthodontic services.
What if I miss the open enrollment
period - can I still sign up for the program?
No, you will have to wait for the next open season. There
are some exceptions. Enrollment can take place during times
other than the designated open season if there is a qualifying life
event such as a change in marital status, birth of a child,
change of employment, etc. For additional information,
go to www.BENEFEDS.com.
What family members and dependents are
eligible for the dental plan?
Eligible family members include an enrollee's spouse and
unmarried dependent children up to age 22, or older if
incapable of self-support.
I need to make changes to
my enrollment information. How do I do this?
You must use BENEFEDS to enroll or change enrollment in a FEDVIP
plan. BENEFEDS is a secure enrollment website
(www.BENEFEDS.com)
sponsored by OPM where you can enter your name, personal
information, the agency
you work for (or retirement system that pays your annuity),
and your chosen dental plan. If you do not have access to a
computer, call 1-877-888-FEDS (1-877-888-3337)
to enroll or change your enrollment.
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Benefits
Has anything changed for 2010?
Yes! For 2010, the annual maximum has increased to $3,500 and members
can visit any licensed dentist! However, because visiting a network
dentist can save you money, our National Fee-for-Service network
makes it easy to find a dentist near you, with more than 128,000 total dentist
locations nationwide.
How often can I go to the
dentist for a routine cleaning/check-up?
Twice a year.
How do I know if a service
is covered or not?
First, check
The Right Plan page, where you will find
the Benefits Summary. United Concordia's FEDVIP brochure
for a more detailed explanation of coverage and services.
Always consult with your dentist on treatments and request
a predetermination when you need to know whether or not a service
is covered and how much you can expect to pay out-of-pocket.
You can also call United Concordia's customer service
representatives at 1-877-FYI-UCCI
(1-877-394-8224) Monday - Friday,
8 a.m. to 8 p.m., ET.
What is an annual maximum?
It's the maximum dollar amount a program will pay toward the cost
of dental care incurred by an individual during a specified time
period. The annual program maximum per individual under United
Concordia's FEDVIP is $3,500 per calendar year.
What is a lifetime maximum?
A lifetime maximum is the maximum amount of benefit you or your covered
dependent(s) can receive toward a specific service or group of
services. United Concordia's FEDVIP has a $1,500
lifetime maximum for orthodontic services and a $2,000
lifetime maximum for dental accident services.
What is an EOB?
An EOB is an Explanation of Benefits statement sent to members each
time a dental claim is processed by United Concordia. The
EOB displays the expenses submitted by the dentist and how the
claim was processed.
The EOB has four major sections:
- Claim information includes the member and patient
name, ID number and the specific claim number. It also
identifies the dental care facility or dentist.
- Service and coverage information identifies dates of
services and charges and shows the amount paid, applicable discounts
and deductions and the total expense that was not covered.
- Explanations may be included to provide additional
information on the above sections. For example, if a claim was
not paid in full, the EOB notes what benefit limitations or
exclusions apply.
- Patient summary details the benefit period, the amount applied to the
individual annual program maximum and the group number.
What is a predetermination?
A predetermination lets you and your dentist know what will be
covered, how much the plan covers, how much you can expect
to pay, as well as any alternate treatment options available
for a proposed treatment plan. United Concordia recommends that
you ask your dentist for a predetermination for all proposed
dental treatments over $500. Just ask your dentist and he
or she will submit information about the proposed treatment to
us and we'll send you both a predetermination.
Implant prosthetics are
listed as covered under Class C services. What is an implant
prosthetic?
An implant is typically composed of two main parts:
a post that is attached to the jawbone (to simulate
the root of the tooth) and a crown that is placed on
top of the post. If you and your dentist choose to replace
a single missing tooth with an implant, United Concordia
will provide coverage for the crown (or “prosthetic”)
that goes on top of the implant post. Please refer to
the United Concordia Program Guide for a list of implant-related
procedure codes that are covered under the plan. Also, be
sure to request a predetermination before treatment so you'll know
upfront how much your plan covers and how much you'll have to pay.
The image below shows the two main parts of an implant:
What is the missing tooth provision?
The missing tooth provision means that if you have a tooth
missing when you start your United Concordia FEDVIP coverage, United Concordia FEDVIP will not cover
the cost of replacing that tooth, whether through a bridge,
denture or other prosthetic.
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Cost
What are the premiums for United
Concordia's dental program?
The premiums vary by location or rating area. A rating area is a
group of zip codes that corresponds to a particular rate
charged. Go to
The Right Price page and use your residential zip code to
determine your premium.
How do I pay the premium?
Employees pay premium through payroll deduction, with
pre-tax dollars. Annuitants pay via deductions to annuity
payments.
Does the federal government contribute
to a portion of the cost?
No, by law there is no government contribution. Enrollees are
responsible for 100% of the cost, but premiums are competitive
since insurance is purchased on a group basis.
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Network
Can I visit any dentist?
Beginning in 2010, United Concordia FEDVIP members will be able
to choose any licensed dentist. This will allow you to keep your current
dentist, even if the dentist is not part of our network. However,
there are several benefits to visiting a network dentist, and
with more than 128,000 total dentist locations across the country,
no matter where you are, finding a United Concordia National Fee-for-Service
(NFFS) network dentist is easy. Just use our
Find a Dentist online network dentist search tool.
View information on
limited access areas.
I am not located in the
United States...can I still receive coverage?
You can receive coverage for care provided by any dentist outside
of the United States.
How do I find a dentist?
To find a National Fee-for-Service network dentist, go to
the
Find a Dentist page. You can search by last name,
specialty, city, county or zip code. You can also call
United Concordia at 1-877-FYI-UCCI (1-877-394-8224)
Monday - Friday, 8 a.m. to 8 p.m.,
ET, and our customer service representatives will
assist you with information regarding a dentist's
participation status, specialty and office location.
If my current dentist is not in
the National Fee-for-Service network, can I request that
he/she becomes a United Concordia dentist?
Yes! We gladly accept nominations for new network
dentists. To nominate a dentist, simply complete
and submit the
Nominating Your Dentist form under Forms & Publications. Your current dentist
can also obtain an application to participate in the National
Fee-for-Service network by calling our toll-free
customer service line or by downloading the application.
Can members of the same family
go to different dentists?
Yes. Members of the same family can visit different dentists,
even if the dentist is not in the National Fee-for-Service network.
However, visiting a network dentist can save you money. Visit the
Right Network
page to see an example of your potential savings.
View information on
limited access areas.
What if I need to see a
specialist?
If you need to see a specialist, you can see any specialist; however, there are a
few exceptions, including limited access areas and international care.
Also, your costs may be greater if you visit a non-network specialist.
It's always a good idea to discuss treatment options with your dentist
and specialist before receiving a service. Also, be sure to request
a predetermination of costs before extensive treatment to know what
your out-of-pocket costs might be.
View information on
limited access areas.
Will I need a referral from my
dentist to visit a specialist?
No. You do not need a referral from your dentist to visit a
specialist. Visiting a network specialist could help keep your
out-of-pocket costs down. To find a National Fee-for-Service
specialist, use Find a Dentist.
Do I need to take a claim form
when I visit the dentist?
If you visit a National Fee-for-Service dentist,
you do not need to take a claim form, as our
network dentists have agreed to file claims for
you. However, it is a good idea to bring a claim
form if you are visiting a non-network dentist.
You can print one from our
Forms & Publications page.
For what amounts can a dentist
bill me?
United Concordia National Fee-for-Service network dentists
accept our reimbursements, also known as maximum allowable
charges (or MACs), as payment-in-full for
covered services. United Concordia National Fee-for-Service
network dentists can charge you for applicable
coinsurance amounts, but they cannot balance-bill you for
the difference between their standard charges and the MACs. Non-network
dentists can bill you for the difference between their standard
charges and the MACs, which means you could save more by visiting
a network dentist.
What if I have a question on a
bill or service that I receive from my dentist?
First, talk with your dentist. If you still have questions or
concerns, call United Concordia's customer service
representatives at 1-877-FYI-UCCI
(1-877-394-8224) Monday - Friday,
8 a.m. to 8 p.m., ET.
What is meant by “limited access
area?” How do I find out if I live in one of these areas?
Please remember that as a FEDVIP member, you
may visit any licensed dentist, but you could save more money
by visiting a network dentist. However, FEDVIP members
that live in an area specifically defined as a limited
access area may visit any dentist.*
Limited access areas are geographic regions in which
OPM has identified a smaller number of network providers
in proportion to the federal employee population.
While United Concordia has participating dentists in
many of these areas, the plan benefits are extended
to non-network costs for covered services to
ensure convenient access to care.
To view the list of approved limited access areas,
visit
The Right Network page.
* Applicable coinsurance,
maximums and other benefit features still
apply. The member is also responsible
for any difference between the amount
billed and our allowable charge.
My family also has coverage through
the TRICARE Dental Program (TDP). Can I continue to see the
same dentist if I enroll in FEDVIP?
Yes. Both programs use the National Fee-for-Service
network. However, beginning in 2010, United Concordia
FEDVIP members will be able to choose any licensed
dentist, although visiting a network dentist could
help to reduce your out-of-pocket costs. You can
search for a National Fee-for-Service network
dentist using our Find a Dentist tool.
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Coordination of Benefits
What is coordination of benefits (COB)?
Coordination of benefits is a method by which two or more carriers
or plans coordinate their respective benefits so the total benefit paid
does not exceed 100% of the total expenses incurred. The purpose of
COB is to allow patients to receive the highest level of benefits
that they are entitled to.
United Concordia coordinates benefits payments with:
- FEHB - If you have dental coverage through both an FEHB plan and FEDVIP,
your FEHB plan is the first payor of any benefit payments. Please ask your
dentist to submit the charges to your FEHB plan. Please note that
it is not your responsibility to submit any claim information or an
explanation of benefits (EOB) to United Concordia.
If no EOB is received, United Concordia will coordinate benefits by estimating the
amount the FEHB plan will pay.
- Non-FEHB carriers - If you are the policy holder for both FEDVIP
and a commercial carrier, the plan that has been in effect the
longest is primary.
- Group health benefits carriers.
- No-fault insurance carriers that pay benefits without
regards to fault.
United Concordia is the primary payor if we do not have an indication
of other insurance on our enrollment files and there is no indication of
other insurance on the claim form.
For more information, please see United Concordia's FEDVIP brochure on
the Forms & Publications page.
My FEHB medical plan covers some dental
services. If I enroll in FEDVIP, will that replace my FEHB coverage?
No. Any coverage provided under your FEHB medical plan remains as your
primary coverage, meaning that claims have to be submitted to the
medical plan first. FEDVIP coverage would pay secondary to that coverage, and
is not intended to replace any existing coverage. Your dentist should
include any explanation of benefits (EOB) statement received from FEHB with the
claim form when submitting to United Concordia.
If I enroll in FEDVIP, will my FEHB plan
reduce my premiums because I will no longer use my FEHB plan's dental benefits?
No. Your FEHB plan will still be the primary payor for your dental care up
to the limits of its coverage.
Why should I enroll in FEDVIP when I
already have dental coverage with my FEHB plan?
United Concordia's FEDVIP provides comprehensive dental coverage
beyond diagnostic and preventive care like your annual cleanings
and exams. It also offers extensive coverage for intermediate
and major services like fillings, oral surgery,
periodontal care, crowns and even dental accident coverage.
I am enrolled with the TRICARE Dental
Program (TDP) and FEDVIP. I do not have FEHB coverage. How
will COB apply?
In this instance, FEDVIP will process the claims as primary and
TDP will process as secondary.
Who is responsible for submitting a claim to
United Concordia for coordination of benefits?
One of the benefits of visiting a network dentist is that your dentist
will handle all of your paperwork for you. However, if you visit a
non-network dentist, you are responsible for submitting a claim form
and any explanation of benefits (EOB) statement received from FEHB
to United Concordia.
What if my FEHB health insurance is a dental
HMO and I cannot get an explanation of benefits statement from them?
If the EOB is not available, the participating dentist may indicate
the amount paid for each reported service by the primary carrier on
the claim form. In the absence of this detail, the participating
dentist may indicate the total amount paid by the primary carrier on
the claim form. If you paid a copayment for a service, this should
also be noted on the form. If no information on payment is
available, United Concordia will coordinate benefits by
estimating the amount the FEHB plan will pay.
How is the primary dental plan determined
between FEDVIP and dental insurance other than FEHB?
If you have FEDVIP coverage and additional coverage through your spouse,
FEDVIP is primary for you and your spouse's coverage is secondary.
Your spouse's coverage is primary for him or her and your FEDVIP coverage
is secondary. If you have dependent children, usually the plan of the
parent with the earliest date of birth (month and day only) pays
first for the children. If you are the policy holder for both FEDVIP
and a commercial carrier, the plan which has been in effect the longest
would be primary.
I want FEDVIP to be primary to my FEHB
plan for coordination of dental benefits. How do I make this happen?
By law, FEDVIP must be secondary to the FEHB plan. Your FEDVIP
coverage cannot be primary to dental coverage offered through your FEHB plan.
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General
What is FEDVIP?
The Federal Employees Dental and Vision Insurance Program (FEDVIP)
is available to eligible federal and postal employees, retirees and
their eligible family members on an enrollee-pay-all basis.
This program allows dental and vision insurance to be purchased on a
group basis, which means you receive comprehensive coverage at
competitive premiums.
Employees must be eligible for FEHB in order to be eligible to enroll in
FEDVIP. It does not matter if an employee is actually enrolled in
FEHB - eligibility is the key. Annuitants are eligible to enroll
in FEDVIP no matter what their FEHB status is.
I see references to FEHB and FEDVIP.
What is FEHB?
FEHB stands for the Federal Employees Health Benefits (FEHB) Program.
The FEHB Program is the largest employer-sponsored group health insurance
program in the world, covering over 9 million Federal employees,
retirees, former employees, family members and former spouses.
If you have questions about FEHB coverage, please contact your
Agency Benefits Office.
I do not speak English. Do you
have a translator?
Yes, we have bilingual English/Spanish customer service
representatives. We also have translation services for
140 other languages.
What if I have other questions or
concerns regarding the United Concordia FEDVIP?
Questions about your dental treatment should first be discussed with
your dentist. If you have questions about eligibility,
enrollment or premium deductions, please contact BENEFEDS.
If you have general questions or would like clarification on your
benefits, please call Customer Service at 1-877-FYI-UCCI
(1-877-394-8224). Monday - Friday,
8 a.m. to 8 p.m., ET. If you're new to
United Concordia, call 1-877-GET-UCCI
(1-877-438-8224)
Monday - Friday, 8 a.m.
to 8 p.m., ET.
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