Member FAQs

A complete dental examination involves many things including checking the status of the gums, teeth, any restorations (fillings, crowns, veneers, etc.), and oral mucosa of tongue, cheeks, top and bottom of mouth and back of throat. There are many problems that can develop in the mouth that don't hurt until they do, and then the treatment may be more extensive, expensive, or even too late to save a tooth or teeth. In addition, the importance of periodic evaluation of the oral mucosa is to look for lumps, bumps and other irregularities that may even be signs of disease...even cancer.

If you are a Service Benefit Plan member, and have enrolled in the Blue Cross Blue ShieldBCBS FEP Dental Program and have visited the dentist, the dental provider sends the claim to the local Plan (or other carrier listed on your medical I.D. card) for processing and issuing an Explanation of Benefits (EOB). At the same time, the claim along with any balance will be forwarded to Blue Cross Blue ShieldBCBS FEP Dental. Blue Cross Blue ShieldBCBS FEP Dental will process the claim for secondary payment. The member will also receive an EOB from Blue Cross Blue ShieldBCBS FEP Dental.

Basic services, which include oral examinations, prophylaxis, diagnostic evaluations, sealants and X-rays.

Intermediate services, which include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions, and denture adjustments.

Major services, which include endodontic services such as root canals; periodontal services such as gingivectomy; major restorative services such as crowns, oral surgery, and bridges; and prosthodontic services such as complete dentures.

Orthodontic services are also included for both children and adults.

See chart below:

Yes, Blue Cross Blue ShieldBCBS FEP Dental offers a Self Plus One Option.

OPM establishes the options that will be available to Federal Employees. Eligible individuals can enroll in a dental and/or vision plan. They may enroll in a plan for Self Only, Self Plus One, or Self and Family coverage. Eligible family members include your spouse and unmarried dependent children under age 22. This includes legally adopted children and recognized natural children who meet certain dependency requirements. This also includes stepchildren and foster children who live with you in a regular parent-child relationship. Under certain circumstances, you may also continue coverage for a disabled child 22 years of age or older who is incapable of self-support.

For Retired Uniform Service members, eligible family members include your spouse, unmarried widow, unremarried widower, unmarried child, an unremarried former spouse who meets the U.S. Department of Defense's 20-20-20 or 20-20-15 eligibility requirements, and certain unmarried persons placed in your legal custody by a court. Children include legally adopted children, stepchildren, and pre-adoptive children. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of mental or physical incapacity.

FEDVIP rules and FEHB rules for family member eligibility are NOT the same. However, the Service Benefit Plan does offer a Self Plus One Option.

Yes, orthodontic services treatment and braces are covered for children and adults. The lifetime maximum amount is up to $3,500 for the High Option in-network and 50% of the allowed amount out-of-network. Under the Standard Option, the lifetime maximum is up to $2,000 for in-network services and up to $1,000 for out-of-network services.

Exams are limited to 2 per year. Cleanings are limited to 3 per year. There are no restrictions on the visits per year. There are, however, limits to annual benefit dollars paid as well as lifetime limits on orthodontia.

No. Benefits are available to replace missing or broken teeth under Prosthodontic Services.

No, coverage for dependents ends at age 22 for Federal Employees. Eligible family members include your spouse and unmarried dependent children under age 22. This includes legally adopted children. Stepchildren and foster children who live with you in a regular parent-child relationship are also included. For Retired Uniform Service members, unmarried dependent children may be included on your coverage if under age 21 if they are not a student or under age 23 if they are a full-time student. FEHB provides coverage for dependents up to age 26.

There is a $75 deductible per person for Standard Option and $50 deductible per person for High Option when you use an out-of-network provider. A deductible is a fixed amount of expenses you must incur for certain covered services and supplies before we will pay for covered services. You are also required to pay a coinsurance amount after meeting your deductible for out-of-network services and class B and C services. A coinsurance is the percentage of our allowance that you must pay for your care.

In most cases, you will not have to pay anything up front; the provider will bill you for any owed amount.

Blue Cross Blue ShieldBCBS FEP Dental plans include international coverage. Members may receive dental treatment from a dentist when they work or travel abroad. This service is available in approximately 100 countries throughout Europe, Africa, North America, South America and Asia. English-speaking customer service representatives are available to help members find a dentist. The list of participating dentists is available on this web site under Find a Provider. You are responsible for paying the dentist and submitting your claims to Blue Cross Blue ShieldBCBS FEP Dental. For more information, refer to our International Services web page or call Customer Service at 1-855-504 BLUE (2583) in the U.S. or 1-651-994-2583 collect outside the U.S.

Yes, FEDVIP age requirements for eligibility are unmarried dependent children under age 22 for Federal Employees. This includes legally adopted, natural children, stepchildren, and foster children in a regular parent-child relationship. For Retired Uniform Service members, unmarried dependent children may be included on your coverage if under age 21 if they are not a student or under age 23 if they are a full-time student. The FEHB rules view unmarried or married children under the age of 26 as eligible.

BCBSBlue Cross Blue Shield FEP Dental provides comprehensive dental coverage your medical coverage does not provide. For instance, Blue Cross Blue ShieldBCBS FEP Dental will cover a percentage of your charges for services such as crowns, root canals, periodontal scaling, dentures, and orthodontic. Whereas the medical coverage is limited to services such as exams, cleanings, some X-rays, etc.

With Blue Cross Blue ShieldBCBS FEP Dental, you automatically pay premiums through payroll deductions using pre-tax dollars. Annuitants/retired uniformed service members automatically pay premiums through annuity deductions using post-tax dollars. The FEDVIP rules are not applicable to Federal DentalBlue.

Blue Cross Blue ShieldBCBS FEP Dental is a nationwide program and also covers overseas employees. Federal DentalBlue is only offered in a few states.

Yes, you can keep your Federal DentalBlue coverage, but it will not be subject to payroll deductions and unlike Blue Cross Blue ShieldBCBS FEP Dental, it will not have the tax advantages.

Simple! If you have our medical coverage your benefits will automatically be coordinated with Blue Cross Blue ShieldBCBS FEP Dental. Just show your dental I.D. card and your medical I.D. card to your dentist. Your dentist will file directly with the local BCBS Plan (or other medical carrier listed on your medical coverage I.D. card) for primary coverage and then the claim will be sent to Blue Cross Blue ShieldBCBS FEP Dental making it seamless to you and your dentist.

You can submit your FEDVIP co-payments/deductibles as eligible expenses against your FSA account. However, FEDVIP insurance premiums are not reimbursable under an FSA.

The Paperless Reimbursement (PR) is an optional program available to Blue Cross Blue ShieldBCBS FEP Dental participants who have elected to participate in the FSAFEDS program. Participants can have their out-of-pocket dental expenses sent electronically from Blue Cross Blue ShieldBCBS FEP Dental to FSAFEDS for processing towards their health care FSA account. To enroll in PR, visit www.FSAFEDS.com and log into "My Account Summary", then Paperless Reimbursement. You may also contact FSAFEDS at 1-877-FSAFEDS (372-3337), TTY: 1-800-952-0450, Monday through Friday, 9 AM- 9 PM EST.

No.

You can obtain care from any licensed dentist in the United States or overseas. You are not required to select a primary care dentist. Members are free to select the dentist of their choice. If you use an in-network provider, you are responsible only for covered charges up to our negotiated plan allowance per procedure.

If the dentist you use is not part of our network, benefits will be considered out-of-network. Because these providers are out of our network, we pay for their services based on an out-of-network plan allowance. You are responsible for the difference between the plan's payment and the amount billed.

There are over 375,000 access points nationwide to receive in-network services. To find a provider in your area, please visit www.bcbsfepdental.com and click on Find A Provider or call 1-855-504-BLUE (2583).

You can find the in-network dentists on our website - www.bcbsfepdental.com and click on Find A Provider or call 1-855-504-BLUE (2583).

Yes. By checking with your dentist or looking on www.bcbsfepdental.com (click on Find a Provider), you are assured that your dentist is still participating in the network. Additionally, only providers listed with their corresponding locations are in network. Not all dentists at a location may be in network and the same provider at a different location may not be in network. It is your responsibility to ensure the listed provider is active and in network at the time you receive services. Consult your Blue Cross Blue Shield FEP Dental Brochure for more information regarding your plan design.

Yes, generally you will pay less out of your pocket if you use our in-network dentists. If the dentist you use is not part of our network, benefits will be determined based on the out-of-network benefit level. Because these providers are out of our network, payment will be based on the lesser of the provider's actual charge or the maximum allowed amounts established by Blue Cross Blue Shield FEP Dental for services rendered by out-of-network providers. You are responsible for the difference between our payment and the amount billed. If a member chooses to go out of network, payment will be made directly to the member. Additionally, if you use an out-of-network dentist you may have to pay the dentist first, and then submit the claim to Blue Cross Blue Shield FEP Dental.

There is a $75 deductible per person for Standard Option and $50 deductible per person for High Option when you use an out-of-network provider. A deductible is a fixed amount of expenses you must incur for certain covered services and supplies before we will pay for covered services. You are also required to pay a coinsurance amount after meeting your deductible for out-of-network services and class B and C services. A coinsurance is the percentage of our allowance that you must pay for your care.

In most cases, you will not have to pay anything up front; the provider will bill you for any owed amount.

No. If you are currently eligible for enrollment under the FEHB program, (even if you are not currently enrolled) you are eligible to enroll in FEDVIP. Eligible family members include your spouse and unmarried, dependent children under age 22, or over age 22 if incapable of self-support. For Retired Uniform Service members, unmarried dependent children may be included on your coverage if under age 21 if they are not a student or under age 23 if they are a full-time student.

If you go to a dentist that participates with Blue Cross Blue ShieldBCBS FEP Dental, your dentist will submit the claim on your behalf.

You can reach our dedicated Customer Service department at 1-855-504-BLUE (2583) 8 a.m. - 8 p.m. Eastern Time, Monday - Friday.