On December 23, 2004, President George W. Bush signed the Federal Employee Dental and Vision Benefits Enhancement Act of 2004 (Public Law 108-496). The law directed the Office of Personnel Management (OPM) to establish supplemental dental and vision benefit programs to be made available to Federal employees, annuitants, and their eligible family members. In response to the legislation, OPM established the Federal Employees Dental and Vision Insurance Program (FEDVIP). OPM has contracted with dental and vision insurers to offer an array of choices to Federal employees and annuitants. Section 715 of the National Defense Authorization Act for Fiscal Year 2017 (FY 2017 NDAA), Public Law 114-328, expanded FEDVIP eligibility to certain TRICARE-eligible individuals.
This brochure describes the benefits of EmblemHealth (formerly GHI) under our contract OPM02-FEDVIP-02AP-07 with OPM, as authorized by the FEDVIP law. The address for our administrative office is:
55 Water Street New York, NY 10041
This brochure is the official statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclusions of this brochure. It is your responsibility to be informed about your benefits. You and your family members do not have a right to benefits that were available before January 1, 2022, unless those benefits are also shown in this brochure.
If you are enrolled in this plan, you are entitled to the benefits described in this brochure. If you are enrolled in Self Plus One, you and your designated family member are entitled to these benefits. If you are enrolled in Self and Family coverage, each of your eligible family members is also entitled to these benefits, if they are also listed on the coverage.
OPM negotiates benefits and rates with each plan annually. Rates are shown at the end of this brochure.
EmblemHealth is responsible for the selection of in-network providers in your area. Contact us at 1-877-842-3625 for the names of participating providers or to request a provider directory. You may also view the most current directory via our web site at www.EMBLEMHEALTH.com. The continued participation of any specific provider cannot be guaranteed. Thus, you should choose your plan based on the benefits provided and not on a specific provider’s participation. When you phone for an appointment, please remember to verify that the provider is currently in-network. If your provider is not currently participating in the provider network, you may nominate him or her to join. Nomination forms are available on our web site, or call us and we will have a form sent to you. You cannot change plans, outside of Open Season, because of changes to the provider network.
Provider networks may be more extensive in some areas than others. We cannot guarantee the availability of every specialty in all areas. If you require the services of a specialist and one is not available in your area, please contact us for assistance.
The EmblemHealth Dental Plan and all other FEDVIP plans are not a part of the Federal Employees Health Benefits (FEHB) Program.
We want you to know that protecting the confidentiality of your individually identifiable health information is of the utmost importance to us. To review full details about our privacy practices, our legal duties, and your rights, please visit our website, www.EMBLEMHEALTH.com then click on the “Privacy and Security” link at the bottom of the page. If you do not have access to the internet or would like further information, please contact us by calling 1-877-842-3625.
Discrimination is against the Law
EmblemHealth complies with all applicable Federal civil rights laws, to include both Title VII of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act. Pursuant to Section 1557, EmblemHealth does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex.