2021 GEHA Dental Benefits Guide

Compare plan benefits.

In-network preventive care covered 100%.

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 Option plan only. 2 If your out-of-network dentist charges more than GEHA’s agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance. 3 High Option plan members with certain health conditions can be eligible for a third cleaning in a calendar year if considered medically necessary.

No deductibles. No waiting periods. 1

gehadental.com/Choose

2021 plan year

High Option

Standard Option

GEHA dental plan members get access to more than 388,000 in-network locations nationwide and enjoy worldwide coverage. To get the greatest value from your GEHA plan, you are encouraged to use in-network providers. All in-network preventive care is covered at 100% with any GEHA dental plan. For other services, network providers will not bill you more than the agreed-upon fees for covered services. To find a provider, or to see if your provider is in-network, visit geha.com/Find-Care

What the plan pays

In-network or out-of-network 2

In-network or out-of-network 2

Basic – Class A Two exams, two cleanings 3 and one X-ray per calendar year Intermediate – Class B Fillings, extractions and periodontal maintenance Major – Class C Root canals, crowns, bridges, dentures, periodontal surgery (implants limited to $2,500 per person/year)

100%

100%

80%

55%

50%

35%

70% No waiting period $3,500 lifetime maximum

70% 12-month waiting period $2,500 lifetime maximum

If your out-of-network dentist charges more than GEHA’s agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance. If you have a FEHB medical plan with dental coverage, your medical plan will be considered the primary payer for some preventive, restorative and other services before any benefits are paid by any FEDVIP dental plan. This includes GEHA’s FEDVIP plan. GEHA does not cover cosmetic treatment or orthodontic work in progress (except for High Option members with orthodontics started under TRICARE).

Orthodontics – Class D Adults and children

Out-of- network services

Calendar year maximum for Class A, B and C services

Unlimited per person

$2,500 per person

For FEHB medical plans

This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal Plan Brochure available online at gehadental.com/PlanBrochure

How to enroll To sign up for a plan, visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal. You can also call BENEFEDS toll-free at 877.888.3337 TTY: 877.889.5680

Prior orthodontic services

gehadental.com 877.590.4342

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