GEHA will be closed in observance of Thanksgiving on Thursday, November 22, and Friday, November 23. We will reopen at 7 a.m. Central time on Monday, November 26.

FAQs

Welcome. If your question isn't answered below, please call 877.434.2336.

Have a question about GEHA's medical plans? Click GEHA Medical Plan FAQs.

Enrollment

  • 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?

    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.
  • Before FEDVIP was offered, federal employees could join your Connection Dental Plus plan at any time during the year. Has that changed?

    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 they experience a qualifying life event that allows otherwise.
  • Do employees have to be enrolled in a GEHA health plan to be enrolled in GEHA's FEDVIP dental plan?

    No. You can be enrolled in any health plan and still enroll in GEHA Connection Dental Federal. The only requirement is that you must be eligible to participate in the FEDVIP program.
  • How can I get a Plan Brochure?

    You can download a Plan Brochure and other plan materials in our Form & Document Library section.
  • How do I change my address?

    You must update your address or enrollment and eligibility information at BENEFEDS.com or by calling 877.888.3337. Please be sure to update both your residence address and your mailing address.
  • I need additional member ID cards. How do I get them?

    Contact our Customer Care department at 877.434.2336 or cs.gehadental@geha.com to request an additional set of permanent ID cards. If you need a temporary ID card until your replacement cards arrive in the mail, you can sign into your web account and print a temporary member ID card.

    Print-outs of GEHA Connection Dental Federal member ID cards will show only the plan member's name, but may be used by eligible dependents.

    Temporary ID cards printed from this site will expire in 30 days.

  • If I decide to change FEDVIP plans this Open Season, will the change be effective on January 1?

    Yes, that is correct. Coverage for all FEDVIP plans begins January 1 of the new plan year.
  • If someone was enrolled in Connection Dental Plus and wanted to switch to your FEDVIP plan, will that prior enrollment count toward the 12-month orthodontic waiting period of the FEDVIP plan?

    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.
  • When is Open Season?

    Open Season for the 2019 plan year begins on Monday, November 12, 2018, and ends on Monday, December 10, 2018.

    By federal regulation, open seasons are held each fall, from the Monday of the second full week in November to the Monday of the second full week in December.

  • When will I receive my ID cards?

    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.

    In a separate mailing, you’ll receive your vision ID card from EyeMed. This is not your dental ID card. Members in all GEHA plans get vision benefits through Connection Vision Powered by EyeMed.

  • When will my premiums start?

    Premium deductions usually begin the first pay period after the effective date of coverage. If you have more questions about premiums, contact BENEFEDS (the enrollment and premium vendor contracted by the government for the FEDVIP program) at 877.888.3337.
  • Why isn't my spouse's name or dependent's name on his/her card?

    ID cards are produced under the member's name and are to be used by all covered family members.

Benefits

  • Can you please explain how the alternate benefit provision works?

    For some services, there may be more than one acceptable choice of treatment. Our plan will limit benefits to the lowest-cost treatment option that meets accepted standards of professional dental care. Limiting benefits to the lowest-cost treatment option allows us to provide coverage for as many common procedures as possible while keeping our members' premiums affordable. When we apply an alternative benefit to limit reimbursement, our action is not meant to dictate treatment or to question the professional judgment of your provider.

    In Section 5 of the Plan Brochure we have added asterisks (*) to help you identify procedures that we determined have a lower-cost treatment option.
  • Can you summarize the 5-year replacement rule?

    This plan will cover the replacement of an existing appliance, such as a bridge, denture or implant, if the appliance needs to be replaced, is at least 5 years old and cannot be fixed.
  • Do FEDVIP plans give you a "discount" for procedures or are they more like our health plans, which actually pay a percentage of costs?

    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.
  • Do you have a missing-tooth clause?

    No, we do not have a missing-tooth limitation.

  • Does the lifetime maximum apply to orthodontic care only or does it also apply to other treatment for that person, such as routine cleanings?

    Charges for other work, such as routine cleanings, apply to the calendar year dental maximum per covered person. The orthodontic lifetime maximum is separate and applies to orthodontic treatment only.
  • Does GEHA's FEDVIP plan include vision coverage?

    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 pay only a $5 copay on an eye exam at participating EyeMed in-network locations. 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, and scratch-resistant coatings; contact lenses and surgical procedures (including LASIK) at participating EyeMed locations. For a list of participating locations, go to eyemedvisioncare.com and select the Insight network from the "Choose Network" drop-down list, or call 866.804.0982.
  • Is there a chart that shows what benefits are covered in each class?

    Yes. You can find this information in Section 5 of the dental plan brochure.
  • My dentist charges the total fee up front for braces. Can I submit the claim for the full treatment at one time?

    Dentists often contract for payment of the total treatment charge when the bands are placed. If the waiting period has been met, the total case fee and the maximum allowed amount will be divided by the number of months for the total treatment plan. Each resulting portion will be considered to be incurred on a quarterly basis until the lifetime maximum is paid, treatment is completed or eligibility ends – whichever comes first. You do not need to resubmit the charges each quarter, but we will require your dentist to verify that you or your child is still receiving active treatment.

  • Where can I locate coverage information (e.g., specifics on services, coverage by service, what is "reasonable and usual," etc.)?

    You can view our plan summary information or download the plan brochure, which include specifics on covered services as well as any limitations and exclusions. We also have a dental pricing lookup tool to allow members and prospective members to look up the general non-network maximum allowable charge for common dental services.

Network

  • Am I required to go to certain dentists when using my FEDVIP dental insurance?

    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.

    If you use an out-of-network provider, you would be responsible for paying the difference between their charge and the GEHA allowable amount.

  • How do I find an in-network dentist?

    Visit our online Provider Search, and search by the dentist's name or 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.

  • How do I nominate my dentist to be part of your network?

    You may nominate your dentist by downloading a form to mail or fax to GEHA.
  • I would like to join the Connection Dental Network. How do I apply?

    To apply to be in the network, you must complete and sign both an Application and a Participating Provider Agreement, and submit any requested supporting documentation. You can begin the process by downloading these forms at connectiondental.com.
  • Is there a deductible or a difference in the calendar year maximum for out-of-network care?

    No. We will pay the same percentage whether you use an in-network dentist or an out-of-network dentist.
  • Will you pay a lesser amount if I use an out-of network dentist?

    No. We will pay the same percentage whether you use an in-network dentist or an out-of-network dentist.

    If you use an out-of-network provider, you would be responsible for paying the difference between their charge and the GEHA allowable amount.

Coordination of Benefits

  • What is coordination of benefits?

    When a member has more than one insurance plan, GEHA needs to know so we can determine how to coordinate your coverage to ensure you’re getting the most out of your plan.

    One plan becomes your “primary” plan and will process your claims first. The “secondary” plan may pay toward the remaining charges. This process is called coordination of benefits.

    I’m a GEHA dental member. Why is GEHA asking for information about my health plan?

    The Federal Employees Dental and Vision Insurance Program (FEDVIP) requires the FEHB plan to be primary over the FEDVIP plan. This is known as “coordination of benefits.” Many FEHB plans have limited preventive dental benefits. When GEHA is secondary, our payment will be the lesser of 1) our regular benefit or 2) the remaining balance which when added to the primary carrier's payment will not exceed the dentist billed amount or the negotiated rate. In addition to benefits payable by your FEHB medical plan, you should let GEHA know if you or your covered dependents have other dental coverage.

    How is it determined which plan is “primary” or “secondary”?

    We apply guidelines from the National Association of Insurance Commissioners (NAIC).

    The most common rules for determining the order of payment are the Non-Dependent/Dependent Rule, the Active/Inactive Rule and the Birthday Rule.

    • Non-dependent/Dependent Rule: The plan that covers an individual as an enrollee or subscriber is the primary payer over a plan that covers an individual as a dependent, for example, as a spouse.
    • Active/Inactive Rule: The plan that covers an individual as an active employee or as the dependent of an active employee is the primary payer over the plan that covers the individual as a retired or laid off employee or as the dependent of such an employee.
    • Birthday Rule: This rule determines whether a plan is primary or secondary for a dependent child who is covered by both parents' benefit plans and those parents live together. The plan covering the parent whose birthday (month and day only) falls first in a calendar year provides primary coverage for the child. If both parents have the same birthday, then the plan that has been in effect the longest pays as primary.

    A different set of rules applies to a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:

    1. If a court decree states that one of the parents is responsible for the child's health care expenses/coverage ("health care coverage responsibility") and the plan covering that parent has actual knowledge of those terms, that plan is primary. If the responsible parent has no coverage for the child’s health care expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan.
    2. If a court decree states that both parents are responsible for the child’s health care expenses/coverage, the Birthday Rule determines the order of benefits;
    3. If a court decree states that the parents have joint custody without specifying that one parent has health care coverage responsibility, the Birthday Rule determines the order of benefits; or
    4. If there is no court decree allocating health care coverage responsibility for the child, the order of benefits for the child is as follows:
      1. The plan covering the custodial parent;
      2. The plan covering the custodial parent's spouse;
      3. The plan covering the non-custodial parent; and then
      4. The plan covering the non-custodial parent's spouse.

    For additional information on NAIC rules regarding the coordinating of benefits, visit the NAIC website.

    How does the coordination of benefits happen?

    If it is determined that GEHA is the secondary plan, copies of the primary carrier’s Explanation of Benefits (EOB) forms will need to be submitted by you or your provider. Once we have a copy of the EOB, GEHA can determine our payment on the remaining balance.

    If the primary plan is a FEHB plan, GEHA will estimate benefits payable if the FEHB EOB is not received. The estimation of benefits is based on the dental benefits listed in the FEHB brochure.

    How does GEHA know who my FEHB carrier is?

    GEHA receives information every Open Season, through BENEFEDS, indicating the 3-digit FEHB Health Plan enrollment code. GEHA may request that you verify your health insurance plan annually or at the time of service. You may call or mail other coverage information or report it online at gehadental.com/cob.

    Can’t the plans just work it out? Why do I have to get involved?

    Most commercial plans only share protected health information with their members or providers.

    Update your information to process claims faster

    Coordinating your benefits helps us process your claims faster and maximizes your benefits, which can lower your out-of-pocket expenses. It is important that we keep your information up-to-date. We’ll send you a letter from time to time asking if you have any additional coverage. Please respond to that letter. If we don’t receive your response, we may delay processing your claims until the information is received.

    We appreciate you taking an active role in making certain your information is correct.

  • As a provider, how do I determine if my patient is eligible for coverage and find a list of your plan benefits?

    You’ll need to sign in to your GEHA web account using the Account Sign In box on the left. Be sure to check the box next to “Provider.” If this is your first time signing in, you’ll need to click “Register Now” to get started. Once you’re signed in, you’ll have access to eligibility information as well as up to 18 months of claims data.
  • GEHA is not my FEHB health carrier. When my FEHB plan pays for some dental services, which plan is the first payor?

    Dental benefits available from your FEHB carrier will be considered before we calculate benefits payable by GEHA. You must include your FEHB plan ID number on your claims when you submit them to GEHA.
  • If GEHA is also my FEHB health insurance, do I need to submit the claim twice?

    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.

  • If I have other coverage primary, do I still have to send my claim to them?

    If you have 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 with your claim, we may estimate the amount your plan would have paid.

  • If my primary medical coverage doesn't pay dental charges, where should I submit my claims?

    Submit your claims directly to:
    GEHA Connection Dental Federal
    P.O. Box 21542
    Eagan MN 55121-9930

  • Will you pay benefits for an employee who is also covered by the TRICARE dental program?

    Yes. We will coordinate benefits with TRICARE dental and other group dental coverage.

Outside U.S.

  • How should I file a claim if I live outside the United States?

    GEHA offers multiple ways to submit a claim.

    1. GEHA will accept an itemized bill or receipt that includes all of the following information:
    • Name of patient and relationship to member
    • Member identification number
    • Name, degree (MD, RN, PhD, etc.) and address of provider
    • Date of services or treatments
    • Description, in English, of each service or treatment
    • Tooth number, tooth surface, quadrant, and/or arch on which treatment or service was performed
    • Charge for each service or treatment

    Note: In most cases we are able to convert charges into dollars and translate services into English. You may aid this process by submitting a separate English-language outline of the rendered services and/or treatments. Be sure to include your name and GEHA ID number on this outline and on the original itemized bill. We will do our best to work with what you send us.

        2. You may also print an ADA claim form.

    You or your provider may send paper claims to:

    GEHA Connection Dental Federal
    P.O. Box 21542
    Eagan MN 55121-9930

    You may also send them via e-mail to overseas.gehadental@geha.com or fax them to 816.257.3241. Please send a separate fax for each patient. Also, please designate on the claim whether you want payment to be distributed to you or your provider.
  • I live outside the United States. How can I contact you?

    You may email us at overseas.gehadental@geha.com.