Frequently Asked Questions New Enrollee General Coordination Provider Network Benefits - Plan Design Eligibility New Enrollee                                                                                                              Back to Top Q: When will I receive my ID cards? A: BENEFEDS sends GEHA your enrollment record after your coverage is effective with us. GEHA will mail your ID cards and plan information within 15 days after your effective date. For example, if your effective date is January 1, you should receive your ID cards by January 15. Q: If I decide to change FEDVIP plans this Open Season, will the change be effective on January 1? A: Yes, that is correct. Coverage for all FEDVIP plans begins January 1 of the new plan year. Q: Why isn't my spouse's name or dependent's name on his/her card? A: ID cards are produced under the member's name and are useable for all covered family members. Q: If I have other coverage primary, do I still have to send my claim to them? A: If you have other additional dental coverage, you must first submit your dental claim to your other dental plan(s), then submit your dental claim to GEHA, along with the other plan's explanation of benefits (EOB). If you are not a GEHA FEHB medical plan member, you must first submit your dental claim to your FEHB medical plan, and then submit your dental claim to GEHA, along with the FEHB medical plan's explanation of benefits (EOB). If the EOB from your FEHB medical plan is not submitted, we may estimate the amount they would have paid. Q: If my primary medical coverage doesn't pay dental charges, where should I submit my claims? A: Submit your claims directly to: GEHA Connection Dental Federal P.O. Box 2336 Independence, MO 64051-2336 Q: How can I locate a new dentist? A: Click on our online Provider Search. You may search by doctor's name or by location. Using an in-network dentist may save you money as you will not be responsible for the difference between the billed amount and the maximum allowable charge. Q: How can I get a Plan Brochure? A: You can download a Plan Brochure and other plan materials in our Forms & Brochures section. Q: I need some additional member ID cards. How do I get them? A: Contact our Customer Service department at (877) 434-2336 to request an additional set of permanent ID cards. Q: When will my premiums start? Usually your premium deductions begin the first pay period after your effective date of coverage. If you have more questions about premiums, contact BENEFEDS (the enrollment vendor contracted by the government for the FEDVIP program) at (877) 888-3337. General                                                                                                                         Back to Top Q: How do I change my address? A: You must update your address or enrollment and eligibility information through the BENEFEDS portal at www.BENEFEDS.com or by calling (877) 888-3337. Please be sure to update both your residence address and your mailing address. Q: When is Open Season? A: Open Season for the 2012 plan year runs from November 14, 2011, through December 12, 2011. Q: Does your website provide coverage information (i.e., specifics on services, coverage by service, what is "reasonable and usual," etc.)? A: Yes. On our website at www.gehadental.com, you'll find a summary of plan information and the plan brochure, which includes specifics on covered services as well as any limitations and exclusions. We also have an online tool to allow our members to look up the maximum allowable charge for common dental services. Q: Is there any more talk about a "Self Plus One" coverage option for either dental plans or health plans? A: "Self Plus One" coverage is currently available only for FEDVIP plans. Making that change for the FEHB medical program will require Congressional approval. Q: Does your FEDVIP plan include vision coverage? A: Yes. All GEHA health and dental plan members receive vision coverage for no additional premium. GEHA makes this non-FEDVIP, non-FEHB benefit available through EyeMed Vision. If you are a GEHA Connection Dental Federal FEDVIP plan member or covered dependent, you only pay a $5 copay on an eye exam at a participating EyeMed in-network location. Or, you may receive up to a $45 reimbursement benefit at a non-participating out-of-network location. You can also receive discounts off the retail price of lenses, frames, specialty items such as tints, lightweight plastics, scratch-resistant coatings, contact lenses and surgical procedures (including LASIK) at participating EyeMed locations. For a list of participating locations, go to www.eyemedvisioncare.com and select the Insight network from the list in the "Locate a Provider" box. Or call (866) 804-0982. Coordination                                                                                                               Back to Top Q: Will you pay benefits for an employee who is also covered by the TRICARE dental program? A: Yes. We will coordinate benefits with TRICARE dental and other group dental coverage. Q: If GEHA is also my FEHB health insurance, do I need to submit the claim twice? A: No. If GEHA is your carrier for both FEHB and FEDVIP coverage, you only need to submit the bill once. We will take care of the rest for you. Q: GEHA is not my FEHB health carrier. When my FEHB plan pays for some dental services, which plan is the first payor? A: Any dental benefits available from your FEHB carrier will be considered before we calculate benefits payable by us. You must include your FEHB plan ID number on your claims when you submit them to GEHA. As a courtesy, we'll forward your claim to your FEHB plan. Provider Network                                                                                                      Back to Top Q: How do I find an in-network dentist? A: Click on our online Provider Search. You may search by doctor's name or by location. Using an in-network dentist may save you money as you will not be responsible for the difference between the billed amount and the maximum allowable charge. Q: Am I required to go to certain dentists when using my FEDVIP dental insurance? A: Under GEHA's FEDVIP dental plan, you are NOT required to go to a specific dentist. You can go to any covered provider. We define a covered provider as any licensed dentist, dental hygienist or denturist acting within the scope of such license. Q: Will you pay a lesser amount if I use an out-of network dentist? A: No. We will pay the same percentage whether you use an in-network dentist or out-of-network dentist. Q: Is there a deductible or a difference in the calendar year maximum for out-of-network care? A: No. We will pay the same percentage whether you use an in-network dentist or out-of-network dentist. Q: How do I nominate my dentist to be part of your network? A: You may nominate your dentist by clicking on Provider Nomination. Simply complete and submit the online form. Or, you may download a form to mail or fax to GEHA. Benefits - Plan Design                                                                                              Back to Top Q: Do FEDVIP plans give you a "discount" for procedures or are they more like our health plans, which actually pay a percentage of costs? A: GEHA Connection Dental Federal pays a percentage of costs. You can find the percentages paid for covered services in section 5 of the GEHA Connection Dental Federal plan brochure. Q: Do you cover dental implants and, if so, what percentage do you cover? A: GEHA Connection Dental Federal does not cover implants and implant-related services. Q: Does the $1,500 lifetime maximum apply to children's orthodontic care only or does it also apply to other treatment for that child, such as routine cleanings? A: Charges for other work, such as routine cleanings, apply to the calendar year dental maximum per covered person. The orthodontic lifetime maximum of $1,500 is separate and applies to orthodontic treatment only. Q: Is there a chart that shows what benefits are covered in each class? A: Yes. You can find this information in Section 5 of the GEHA Connection Dental Federal brochure, which can be accessed as a PDF file by clicking here. Q: My dentist charges the total fee up front for my child's braces. Can I submit the claim for the full treatment at one time? A: Dentists often contract for payment of the total treatment charge when the bands are placed. If the waiting period has been met, we will divide the total fee by the number of months in the proposed treatment plan and make quarterly payments as long as the patient remains eligible and covered by the plan. You do not need to resubmit the charges each quarter, but we will require your dentist to verify to us that your child is still receiving active treatment. Eligibility                                                                                                                      Back to Top Q: If someone was enrolled in CONNECTION Dental Plus and wanted to switch to your new FEDVIP plan, will that prior enrollment count toward the 24-month orthodontic waiting period of the new plan? A: Unfortunately, time covered by CONNECTION Dental Plus will not count toward the orthodontic waiting period for GEHA Connection Dental Federal. These are separate programs and eligibility will not transfer from one to another. Q: You stated that orthodontic coverage for children ends at age 19. Is there any allowance for children to continue until age 22 if they are enrolled in college, as happens with the regular health plans? A: No. Orthodontia coverage ends when a child turns age 19. However, dental coverage for other services continues for dependent children up to age 22. Q: Do employees have to be enrolled in a GEHA health plan in order to be enrolled in GEHA's FEDVIP dental plan? A: No. You can be enrolled in any health plan and still enroll in GEHA Connection Dental Federal. Your only requirement is that you must be eligible to participate in the FEDVIP program. Q: Are employees eligible to enroll in the FEDVIP supplemental dental plans if they are not enrolled in FEHB or do not plan to enroll in an FEHB plan? A: Yes, as long as they are eligible to participate in the FEHB program. You do not have to join an FEHB plan to participate in the FEDVIP program. Q: Before FEDVIP was offered, federal employees could join your CONNECTION Dental Plus plan at any time during the year. Will that change? A: No. We still offer enrollment in CONNECTION Dental Plus all year long. However, federal employees may enroll in our GEHA Connection Dental Federal FEDVIP plan only during Open Season unless there is a qualified life event that allows otherwise.   © 2011 Government Employees Health Association, Inc. All rights reserved.