GEHA offers two comprehensive dental plan options - our High Option and Standard Option plans.
DENTAL PLANS 2021 GEHA
Choose from two comprehensive dental plans.
gehadental.com | 877.590.4342
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What’s new in 2021.
Plan overview. GEHA offers two dental plan options – our High Option and Standard Option. Both plans include: X Comprehensive dental services, from preventive care to crowns, bridges and dentures. X No deductibles and no waiting periods¹ for most services. X Benefit levels are the same for in-network and out-of-network providers.
How to enroll To sign up for a GEHA
dental plan, visit benefeds.com
Lower premiums on average Nationally, on average, GEHA dental premiums have been reduced slightly for the 2021 plan year. Members in some areas will see a premium increase to more accurately reflect the cost of services for those areas. Update on adult cleanings High Option plan members with certain health conditions, such as pregnancy, diabetes and heart disease, can be eligible for a third cleaning in a calendar year if considered medically necessary. 37 new CDT dental procedure codes We have added 37 new codes. For a full list of new codes, see the plan brochure at gehadental.com/PlanBrochure
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
High Option
gehadental.com/High
X Includes an unlimited annual maximum benefit per person. X Pays a higher percentage for your covered services. X No waiting period for orthodontic services.
Standard Option
gehadental.com/Standard
X GEHA’s lowest premium dental plan. X Includes a $2,500 annual maximum benefit per person. X 12-month waiting period for orthodontic services.
gehadental.com 877.590.4342
1 No waiting period for Class A, Class B or Class C services. 12-month waiting period for Class D orthodontic services, Standard Option plan only. 2
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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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Step 1: Use your ZIP code to find rate code.
Step 2: Use your rate code to find your 2021 premium.
gehadental.com/Rates
Find your state and the first three digits of your ZIP code in the chart below to determine your rate code. Use that code on the next page to determine your 2021 dental premium. gehadental.com/Rates
High Option
Biweekly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
First 3 digits of ZIP code
Rate code
First 3 digits of ZIP code
Rate code
First 3 digits of ZIP code
Rate code
State
State
State
$16.89
$19.00
$20.77
$23.21
$25.16
Self Only
460-462, 470, 472, 473 2
1 2
AL, AR, FM, GU, IA, MH, MP, MS, ND, NE, PR, PW, VI ID, LA, MO, MT, NC, OK, SC, SD, TN, UT, VT AS, DE, HI, NM, OR
IN IN IN KS KS KY KY
NY NY
127, 129-139, 144-149
3 1 2 1 2 1 2 4
463, 464
Rest of state
$33.78
$37.97
$41.54
$46.41
$50.34
Self Plus One
1
Entire state or territory
Rest of state 660-662, 666 Rest of state
430-433, 437, 440-443, 446, 447, 450-455, 459
2
OH
$50.68
$57.00
$62.30
$69.65
$75.56
Self and Family
1 4 5 3 1
OH
Rest of state
2
Entire state
Retirees monthly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
PA PA PA PA
172-174
410
180, 181, 183
Rest of state
3
Entire state or territory
$36.60
$41.17
$45.00
$50.29
$54.51
Self Only
189-196
MA MA MD MD MD ME ME
012
CO, DC, NH, RI
Rest of state
Rest of state
$73.19
$82.27
$90.00
$100.56
$109.07
4
Self Plus One
Entire state
755-759, 763-769, 776-779, 783-785, 788-799, 885
205-212, 214, 216, 217 4
5 3 2
AK AZ AZ
Entire state 850-853, 864 Rest of state
1
TX
$109.81
$123.50
$134.98
$150.91
$163.71
Self and Family
3 2 4 3
219
Rest of state
3 2
TX TX VA VA
733, 786-787 Rest of state
Standard Option
039-042
900-931, 933-935, 939-952, 954, 956-959
5
CA
Biweekly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
Rest of state
201, 203, 205, 220-227 4
4
CA
Rest of state
2 5 3 4 3 2 4 1 2 1 5
Rest of state
3
MI
480-485
$9.84
$11.04
$12.09
$13.50
$14.63
Self Only
5
CT
064-069
WA WA WA
980-985
2
MI
Rest of state
$19.68
$22.08
$24.14
$26.98
$29.24
Self Plus One
986
4
CT
Rest of state
3
MN
550-555, 563
Rest of state
3
FL
329-334, 349
$29.51
$33.11
$36.21
$40.46
$43.87
Self and Family
2
MN
Rest of state
WI WI
540
2
FL
Rest of state
3
NJ
080-084
Retirees monthly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
Rest of state
300-303, 305, 306, 311, 399
3
GA
5
NJ
Rest of state
WV WV WY WY
254
$21.32
$23.92
$26.20
$29.25
$31.70
Self Only
5
NV
897
Rest of state
2 3 2 1
GA
Rest of state 600-609, 613
834
IL IL IL
$42.64
$47.84
$52.30
$58.46
$63.35
Self Plus One
3 5 4
NV NY NY
Rest of state
620, 622
Rest of state
005, 100-119, 124-126
$63.94
$71.74
$78.46
$87.66
$95.05
Self and Family
Rest of state
INTL
All International
063
* Rate based on member’s primary state of residence.
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Vision discounts are included with both dental plans.
An electric toothbrush discount is included with both dental plans.
Teeth whitening discount
Hearing aid discount Get discounts through TruHearing on hearing aids. Most members save 30% to 60% off their hearing aids, averaging more than $2,100 in savings per pair.
GEHA members can save more than 70% off a premium electric toothbrush by cariPRO ™ . The cariPRO premium electric toothbrush helps reduce plaque buildup and improve gum health.
With GEHA dental plans, you get discounts on eye exams, frames and lenses through EyeMed ™ .
Get a 20% discount off the lowest price listed on all Smile Brilliant home teeth whitening products including custom-fitted trays, whitening geland desensitizing gel.
The EyeMed network includes LensCrafters, Target Optical, independent eye doctors and top optical retailers. Members also save on LASIK at participating US Laser Network locations. This is a sampling of the supplemental vision discounts available with GEHA dental plans. To learn more, visit gehadental.com/Vision
Learn more about this discount at gehadental.com/Toothbrush
gehadental.com/Hearing
Enjoy a whiter and brighter smile in just a few weeks.
gehadental.com/Whitening
Examples of common in-network vision services for both plans.
High Option
Standard Option
Routine eye exams at qualified EyeMed providers (what you pay)
$5
$5
Medical alert discount Get free activation on LifeAlert ® services, plus a 10% monthly discount.
$45 per covered member, per year
$45 per covered member, per year
Out-of-network exams are reimbursed by EyeMed
Discount glasses purchased per year
gehadental.com/LifeAlert
No limit
No limit
X Replacement brush heads with high-quality DuPont ™ bristles are also available at this exclusive, member-only price. X The cariPRO premium electric toothbrush removes 7x more plaque than a regular toothbrush, is completely waterproof, and comes with a 2-year manufacturer’s warranty.
Discount conventional contact lenses purchased per year
No limit
No limit
gehadental.com 877.590.4342
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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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Helpful resources.
Talk with a helpful GEHA Benefits Adviser.
877.590.4342
gehadental.com 877.590.4342
Compare GEHA’s Standard Option and High Option dental plans.
gehadental.com/Choose
/gehahealth
Find a dentist or see if yours is in-network.
geha.com/Find-Care
/company/gehahealth
See if a dental service is covered and estimate how much you’ll pay.
gehadental.com/Pricing
gehadental.com/Rates
Check rates for 2021.
benefeds.com
Enroll online for a dental plan.
877.888.3337 TTY 877.889.5680
Call BENEFEDS to enroll by phone for a dental plan.
Download the plan brochure For information and changes, see the official, detail-filled plan brochure. gehadental.com/PlanBrochure
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