Appendix I: FEDVIP Plan Comparison Charts
This is a brief summary of the features of the dental and vision plans. Before making a final
decision, please read the plan brochures and provider directories thoroughly. All plans are
not the same. All benefits are subject to the definitions, limitations, co-payments, annual
maximums and exclusions set forth in the individual plan brochures. Go to our website at
www.opm.gov/insure/dental to find the rating region assigned to the area where you
live and the related premium cost you will pay.
Reading the Chart:
The table on the following pages highlights the selected features/classes of dental and/or vision
services. Always consult plan brochures before making a decision. The chart does not show all of your
possible out-of-pocket costs.
Dental Insurance
The deductibles shown for the dental plans are the amount of covered expenses that you pay before
the plan begins to pay. Service Class refers to the level of benefits for each plan. The Service Classes
are listed below. Calendar year maximum refers to the annual amount of benefits that you can receive
per person.
Please Note: Most plans require that you be continuously enrolled in the same dental plan for the full
waiting period before accessing orthodontia services. There are no other waiting periods for services.
Dental plans provide a comprehensive range of services, including but not limited to the following:
- 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 for dependents up to age 19.
Please review the dental plans' benefits material for detailed information on the benefits covered, costsharing
requirements and provider directories.
Vision Insurance
Vision plans provide comprehensive eye examinations and coverage for lenses, frames and contact
lenses (in lieu of eye glasses). Other benefits, such as discounts on lasik surgery, may also be available.
Please review the vision plans' benefits material for detailed information on the benefits covered, cost-sharing
requirements and provider directories.