2021 GEHA Dental Benefits Guide

Definitions.

Coverage for major dental needs.

1 There is no waiting period for Class A, Class B or Class C services. There is a 12-month waiting period for Class D orthodontic services on the Standard plan only.

You pay $0 deductible. No waiting period ¹ on most services. GEHA’s plans let you start treatments right away, even when your needs go beyond annual cleanings.

BENEFEDS is the government-authorized and U.S. Office of Personnel Management (OPM)-sponsored enrollment portal that eligible participants use to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP). benefeds.com

BENEFEDS

Night guards (occlusal guards)

Calendar year maximum

The annual benefit maximum that you can receive per person each calendar year.

Coverage

Orthodontics

Dental implants

Basic services that include oral examinations, cleanings, diagnostic services, sealants and radiographic images. Intermediate services that include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions and denture adjustments. Major services that include endodontic services such as root canals, periodontal services such as gingivectomy, major restorative services such as crowns, oral surgery, bridges, implants and prosthodontic services such as complete dentures.

Class A services

You pay your regular coinsurance and/or any amount that exceeds the lifetime benefit maximum.

You pay your regular coinsurance and/or any amount that exceeds the annual benefit maximum.

You pay your regular coinsurance and/or any amount that exceeds the annual benefit maximum.

In-network

Class B services

You pay any charges that exceed the plan allowance, plus any regular coinsurance.

Out-of-network

Class C services

Members age 13 or older

Age limit

None

None

Class D services

Orthodontic services.

High Option maximum benefit

$3,500 lifetime max, per covered member

$2,500 annual max, per covered member

Coinsurance

Once per calendar year

Coinsurance is the stated percentage of covered expenses you must pay.

A cosmetic procedure is any procedure or portion of a procedure performed primarily to improve physical appearance or is performed for psychological purposes.

Standard Option maximum benefit

$2,500 lifetime max, per covered member

$2,500 annual max, per covered member

Cosmetic procedure

Once per calendar year

In-network provider

Any licensed dentist, dental hygienist or denturist who is a part of GEHA’s provider network.

High Option waiting period

None

None

None

The amount we allow for a specific procedure. When you use an in-network provider, your out-of-pocket cost is limited to the difference between the plan allowance and our payment. The plan allowance may vary by geographic location and/or an in-network provider’s contracted fee schedule. When you use an out-of-network provider, you are responsible for the difference between our payment and the provider’s billed amount.

Standard Option waiting period

12 months

None

None

Plan allowance

Cosmetic treatment or orthodontic work in progress ( except for High Option members with orthodontics started under TRICARE ).

Any service associated with implants not specifically listed in the plan brochure.

Guards used to treat temporomandibular joint dysfunction (TMJ).

Not covered

Premium

The total amount paid to an insurance company for coverage, typically paid biweekly or monthly.

gehadental.com 877.590.4342

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