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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. New employees, previously ineligible employees
who transfer to a covered position and survivor annuitants
if not already covered under FEDVIP can enroll within 60 days
of becoming eligible. In addition, eligible employees can
enroll within 60 days after returning to service following a break
in service of at least 31 days or after a qualifying life event
that allows enrollment.
When does coverage start?
The upcoming coverage period will begin on January 1,
2008. Subsequent coverage periods for FEDVIP will be on
a calendar year basis from January 1st to December 31st.
(The initial coverage period for FEDVIP
was December 31, 2006 through December 31, 2007.)
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.
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 2008?
Yes! For 2008, we've significantly lowered the
annual deductible on Class B and C services to
$25 for an individual and $50 for a family.
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. You can also refer to the Program Guide
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).
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 $1,200 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 is found on the reverse side of the
EOB. It 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 $200. 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.
What is the dental accident benefit?
United Concordia provides an additional benefit, with a
separate $2,000 lifetime maximum per covered person,
that covers certain dental procedures that are the direct
result of an accident occurring while you are enrolled in United
Concordia's FEDVIP. United Concordia will pay 100% of
the program allowance for those covered services specifically
related to the accident, subject to the $2,000 dental
accident lifetime maximum per covered person. You can see
the list of the procedure codes that are
covered here.
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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?
To help ensure that you and your covered family members receive
quality, affordable dental care, you must receive services
from a dentist in our National Fee-for-Service network.
What happens if I have an emergency
when traveling and I can't find a dentist in the United Concordia
National Fee-for-Service network?
If you have a dental emergency and cannot visit your National
Fee-for-Service dentist, you may visit any licensed
dentist and United Concordia will cover emergency (palliative) treatment.
A dental emergency is defined as an acute condition occurring suddenly and
unexpectedly, which usually includes pain, swelling or bleeding,
and demands immediate professional dental services.
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)
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
Nominate Your Dentist form. 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.
What if I want to visit a
different dentist?
You can! As long as the dentist is in United Concordia's
National Fee-for-Service network, you can
change your dentist at any time and still receive coverage.
Can members of the same family
go to different dentists?
Yes. But they must be United Concordia National
Fee-for-Service network dentists to receive any
covered benefits.
What if I need to see a
specialist?
If you need to see a specialist, you can see any
specialist as long as he/she participates in the
United Concordia National Fee-for-Service network.
However, there are a few exceptions, including
emergency and international care. 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 treatment
to know what your out-of-pocket costs might be.
Does the specialist have to
be in the United Concordia National Fee-for-Service network?
Yes. However, there are a few exceptions, including emergency
and international care.
Will I need a referral from my
dentist to visit a specialist?
No. You can visit any specialist in the National Fee-for-Service network.
Do I need to take a claim form
when I visit the dentist?
No. One of the benefits of visiting a National
Fee-for-Service provider is that they will take care
of all the paperwork for you.
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 deductibles and
coinsurance amounts, but they cannot balance-bill you for
the difference between their standard charges and the MACs.
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).
What is meant by “limited access
area?” How do I find out if I live in one of these areas?
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 out-of-network
costs for covered services to ensure convenient access to care.
This means that if you live in a limited access
area, you can visit any dentist. Applicable
coinsurance, deductibles, maximums and other
benefit features apply. You are also responsible for
any difference between the amount billed and our allowable
charge.
You can find out if you live in a limited access area by going
to
The Right Network page.
My family also has coverage through
the TRICARE Dental Program (TDP). Can I continue to see the
same dentist if I enroll in FEDVIP?
To make sure you receive coverage through United Concordia's
FEDVIP, be sure that the dentist is a member of the National
Fee-for-Service network before you enroll in United Concordia's FEDVIP.
Unlike the TDP, the United Concordia's FEDVIP is a
network-only plan, which means that you must visit a network
dentist for the coverage to apply. The dentist you currently see through
TDP may not necessarily be a participating dentist in the network.
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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. The actual reimbursement depends on the participation
status of the dentist with the primary plan.
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.
FEDVIP is not intended to replace any existing coverage.
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?
It is your participating dentist's responsibility to submit a claim
to United Concordia for coordination of benefits.
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. If this detail is not available, 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.
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). If you're new to
United Concordia, call 1-877-GET-UCCI.
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