Standard Option 2021
No deductibles. No waiting periods.1
To compare the Standard Option side by side with the High Option, click Choose & Compare Plans.
For 2020 benefits, see Section 5 of the 2020 plan brochure (PDF).
2021 Plan Year Standard Option Benefit Schedule
|What the plan pays
||In-network or out-of-network2
|Basic – Class A
Two exams, two cleanings and one X-ray per calendar year
|Intermediate – Class B
Fillings, extractions and periodontal maintenance
|Intermediate – Class C
Root canals, crowns, bridges, dentures, periodontal surgery (implants limited to $2,500 per person/year)
|Orthodontics – Class D
Adults and children
12-month waiting period
$2,500 lifetime maximum
|Calendar year maximum
for Class A, B and C services
|$2,500 per person
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.
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.
Coordination of benefits – As with all FEDVIP plans, dental benefits available from your FEHB carrier will be considered before we calculate benefits paid by GEHA.
Orthodontic services – GEHA does not cover orthodontic services previously started with another carrier, except for High Option members with orthodontics started under TRICARE.
Pretreatment estimate – Before you receive treatment, estimate how much your care will cost. You or your provider can send in an itemized proposed treatment plan and we will send you and your dentist an explanation of how the services will be covered.
Choosing a dentist – You have the choice of providers. However, for many services, your out-of-pocket costs may be lower when you visit in-network locations. Network providers will not bill you more than the Plan's maximum allowable charge for covered services.
Claim forms – No special claim forms are required. Just send in the itemized bill from your provider.
Limitations and exclusions – This plan has certain limits on dental coverage in order to keep plan rates affordable for you and your dependents. A complete list of plan limitations and exclusions may be found in the Plan Brochure.