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Insurance FAQs

Dental & Vision

  • For FEDVIP, eligible family members are your:  spouse, unmarried dependent child(ren) under age 22 (including an adopted child, stepchild, foster child, and recognized natural child), and child(ren) age 22 or over who are incapable of self-support because of a mental or physical disability that existed before age 22. Please note that family member eligibility under the Federal Employees Dental and Vision Insurance Program (FEDVIP) is NOT the same as for the Federal Employees Health Benefits (FEHB) Program. Changes in dependent eligibility under the Affordable Care Act (also known as health care reform) do NOT affect eligibility for children under FEDVIP.
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  • No. Parents are not eligible for coverage under FEDVIP.
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  • For dental benefits, there is a waiting period for orthodontia services of up to 12 months, for all but one dental plan. Your eligible dependent must be enrolled in the same dental plan/option over the duration of the waiting period to receive orthodontia services. There are no waiting periods for any other dental services or any vision services.
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  • For an employee to be eligible for FEDVIP, you must be eligible for the Federal Employees Health Benefits Program (FEHB).  You do not have to be enrolled in FEHB; you only need to be eligible for FEHB.  You can read more about FEDVIP eligibility at www.opm.gov/healthcare-insurance/dental-vision/eligibility/. If you have questions about your eligibility, please contact BENEFEDS at 1-877-888-3337 or go to www.benefeds.com.
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  • Yes, all FEDVIP dental plans cover orthodontic services (braces).  Most plans have a waiting period before you can receive this benefit. 
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  • Yes, most plans offer orthodontic services for children up to age 19 and adults.
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  • Under FEDVIP, unmarried dependent children are eligible until age 22.
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  • Except for Humana Dental, which has a closed network, and Dominion Dental, which will assign a provider, you may go to any doctor. Keep in mind that you will pay less out-of-pocket when you use an in-network dentist.
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  • It depends. You must contact BENEFEDS in order to change your address: www.benefeds.com or 1-877-888-3337, TTY 1-977-889-5680. If you change your residential ZIP Code, then your dental premiums may also change. Premium changes are prospective to the date the enrollee notifies BENEFEDS of the address change. Generally, changes are effective on the first day of the pay period following the one in which BENEFEDS receives the change. There will be no premium collection or refund because of an address change. Vision premiums are not based on where you live.
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  • Monday November 13, 2017 - Monday December 11, 2017. Each year, Open Season runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December.
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  • When you enroll in FSAFEDS, you can elect to have your family’s claims paid from a second health care flexible spending account once the first health care flexible spending account is depleted. If you have questions about how to submit a claim please call 1-877-FSAFEDS, Monday - Friday 9am to 9pm ET.
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  • Yes, retirees/annuitants are eligible to participate in a FEDVIP dental plan, a FEDVIP vision plan, or both. Retirees must have retired with an immediate annuity (a FERS Minimum Retirement Age plus 10 annuity, postponed, counts as an immediate annuity). Those in receipt of a deferred annuity are not eligible to enroll in FEDVIP. Retirees can cover their eligible family members with a Self Plus One or Self and Family enrollment. More information is available on types of enrollments and eligible family members
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  • Monday November 13, 2017 - Monday December 11, 2017. Each year, Open Season runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December.
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  • There are questions you should ask yourself when deciding to enroll in FEDVIP or selecting a FEDVIP plan. By considering these questions thoroughly, you will be able to determine if FEDVIP is a good option for you. 1. Does my FEHB plan provide dental or vision coverage? 2. Does the FEDVIP plan coordinate benefits with the FEHB plan and how is the coordination of benefits calculated? 3. How affordable is the plan? - How much will it cost me on a bi­weekly or monthly basis? Can I afford that for the entire year? - Must I pay a deductible? - If I use a FEDVIP provider outside of the network, how much will I pay to get care? - How frequently can I visit the dentist and how much do I have to pay at each visit? - Will the plan provide benefits if I am also covered by another dental or vision plan? 4. Do I have access to any provider? - Does the plan give me the freedom to choose my own dentist or am I restricted to a panel of dentists selected by the plan? - Are there enough of the kinds of dentists I want to see? Where will I go for care? Are these places near where I work or live? - Do I need to get permission before I see a dental specialist? - Will the plan allow referrals to specialists? Will my dentist and I be able to choose the specialist? 5. Does the plan provide coverage for specialty services? - Are dentures, orthodontics, implants or replacement of missing teeth covered? - What are the plan’s limitations or exclusions? - Are there annual limits on the types of services included?
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  • The IRS created the "use or lose" rule, which states that all money left in your FSA is forfeited after the benefit period ends. If you don't use all of your FSA funds during the benefit period, you risk losing money. However, the HCFSA and the LEX HCFSA have Carryover, which can allow you to carry over up to $500 in unused funds into the next benefit period. Any remaining unused funds over $500 will be forfeited. To be eligible for carryover you must both:
    • Actively employed by an FSAFEDS-participating agency and contributing to a HCFSA or LEX HCFSA through December 31, and
    • Reenroll in the FSAFEDS
    A DCFSA does not have Carryover, but this account has a grace period of 2 1/2 months (January 1 - March 15) during which you can incur eligible dependent care expenses and use funds remaining in your DCFSA from the previous benefit period. You have until midnight Eastern Time on April 30 following the end of the benefit period to file claims for eligible expenses incurred during the previous benefit period or grace period. When you contribute to an FSA, you agree to reduce your salary by a specified amount and your employing agency contributes that amount to an FSA for you. Since you never received that money, you cannot be taxed on it. If you were to receive the unused amount at the end of the benefit period, the IRS would consider this "deferred compensation". Section 125 of the IRS Code prohibits deferred compensation, thus the "use or lose" rule. Your Agency cannot provide waivers for any employee regarding funds that might be forfeited. Neither OPM, nor your employing agency, has the authority to make any exception to the "use or lose" rule. To reduce your risk of losing money at the end of the benefit period, carefully estimate your expenses when choosing your annual election amount before enrolling in an FSA. Please also keep in mind that reimbursement for expenses is generally based on when an expense is incurred, not when it is paid. You can use the "Savings Calculator" on www.FSAFEDS.com to help you calculate allotments based on your individual situation, as well as indicate your potential tax savings.  If you are a Qualified Reservist, you may be eligible to request a Qualified Reservist Distribution (QRD) in order to avoid forfeiting money in your FSA account. For more information, see the HEART Act Quick Reference Guide on www.FSAFED.com.
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  • If you are a new employee eligible for FEDVIP, or an employee who has become newly eligible to enroll, you may enroll within 60 days of first becoming eligible. This is a one­time opportunity outside of Open Season to enroll. There is a separate 60­day enrollment period for dental and vision. For example: you may enroll in a dental plan on day 30 and a vision plan on day 59. Once you enroll, your 60­day opportunity for that type of plan ends. An eligible employee or retiree may also enroll during the annual Federal Benefits Open Season, which runs from the Monday of the second full work week in November through the Monday of the second full work week in December. An eligible employee or retiree may enroll, cancel, or change enrollment type or options during Open Season. They may enroll or make changes outside of Open Season if they experience a qualifying life event (QLE) such as a change in family or other insurance coverage status. Please see Appendix H for more information about QLEs that permit employees and retirees to enroll or make changes in FEDVIP. If you enroll during Open Season, premiums are deducted beginning the first full pay period on or after January 1. For new or newly eligible employees who elect to enroll, coverage is effective the first day of the pay period following the one in which BENEFEDS receives your enrollment. An Open Season enrollment or change is effective January 1.
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  • Yes. The 5 year requirement rule does not apply under FEDVIP. You can enroll and disenroll every open season.
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  • You may enroll on the Internet at www.BENEFEDS.com. BENEFEDS is a secure enrollment website sponsored by OPM. For those without access to a computer, please call 1­-877-­888-­FEDS (1­-877-­888­-3337) (TTY number, 1­-877-­889-­5680). You cannot enroll in a FEDVIP plan using the Health Benefits Election Form (SF 2809) or through an agency self­service system, such as Employee Express, MyPay or Employee Personal Page. However, those sites may provide a link to BENEFEDS.
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  • Yes, premiums must be paid even if you are in a non-pay status. If premium payments aren’t received the you do not pay your premiums timely, your enrollment will be terminated inactivated.
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  • Yes, all unmarried dependent children under age 22 are eligible to be covered under FEDVIP, including adopted children, stepchildren, and recognized foster children.  There is no requirement that the child be a student.
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Total Count: 208, Number of Pages: 11, Page: 9
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