United States 

Office of 

Personnel Management 

The Federal Government’s Human Resources Agency

Benefits Administration Letter 

Number: 06-602 Date: October 6, 2006

Subject: The Federal Employees Dental and Vision Insurance Program (FEDVIP): 

 Program Overview and Agency Responsibilities

This letter provides information on rules governing the new Federal Employees Dental and 

Vision Insurance Program (FEDVIP) and other aspects of the Program’s roll-out, including the 

roles and responsibilities of agency benefits officers in helping to administer the Program. As 

you can see, this letter is lengthy, so we’ve included a table of contents: 

Topic Page Number 

Background 1 

Sources of Information 2 

Agency Benefits Officers: Roles and Responsibilities 2 

FEDVIP vs. FEHB: What’s Different 3 

Eligibility 4 

Enrollment 6 

Premiums 14 

About FEDVIP Plans 15 

BACKGROUND 

On December 23, 2004, President George W. Bush signed the Federal Employee Dental and 

Vision Benefits Enhancement Act of 2004 (P.L. 108-496). The Act directed the U.S. Office of 

Personnel Management (OPM) to make supplemental dental and vision benefits available to 

Federal employees, annuitants, and their eligible family members. OPM recently signed 

contracts with 10 insurance carriers to provide coverage under the Program. 

Seven carriers will offer dental plans: 

• Aetna Life Insurance Company 

• CompBenefits 

• Government Employees Hospital Association, Inc. (GEHA) 

• Group Health, Inc. (GHI) 

• MetLife, Inc. 

• Triple-S, Inc. 

• United Concordia Companies, Inc. 
Three carriers will offer vision plans: 

• Blue Cross Blue Shield 

• Spectera, Inc. 

• Vision Service Plan (VSP) 

The Program’s first open season will be held November 13 through December 11, 2006, 

concurrent with the open seasons for the Federal Employees Health Benefits (FEHB) Program 

and the Federal Flexible Spending Account Program (FSAFEDS). Eligible employees and 

annuitants will be able to enroll in FEDVIP during open season. 

SOURCES OF INFORMATION 

The following sources of information may be helpful to you in learning more about FEDVIP. 

• BAL 06-203 where you can read background information on the role BENEFEDS will 

play in the FEDVIP program. 

• Public Law 108-496, the Federal Employee Dental and Vision Benefits Enhancement Act 

of 2004, the statutory authority for the Federal government’s dental and vision program. 

• Part 894 of title 5, Code of Federal Regulations, the regulations implementing the Federal 

Employee Dental and Vision Benefits Enhancement Act of 2004. We expect the 

regulations to be published soon. 

 

• The enrollment website at www.BENEFEDS.com, where employees and annuitants 

enroll in FEDVIP. It will also contain links to plans’ websites and to OPM’s FEDVIP 

website. 

• The FEDVIP website at www.opm.gov/insure/dentalvision where employees and 

annuitants can get information about the Program including plan rating areas and 

premiums, a plan comparison tool, and links to plans’ websites, plan brochures, and 

BENEFEDS.com. 

• The FEHB Guide, which will be available at www.opm.gov/insure/health, where 

employees and annuitants can review a chart comparing FEDVIP plans. 

AGENCY BENEFITS OFFICERS: ROLES AND RESPONSIBILITIES 

FEDVIP is a voluntary benefits program, like the Federal Long Term Care Insurance Program 

(FLTCIP) and FSAFEDS. Therefore your role in FEDVIP is very similar to your roles in those 

programs. Specifically, your responsibilities are to: 

• help make your employees aware of the new Program; 

• facilitate the efforts of the FEDVIP plans and BENEFEDS (which handles FEDVIP 

enrollment and premium administration) to provide information to your employees; 

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• direct employees and, for some of you, annuitants, to the appropriate entities to get 

further information; and 

• help your employees with FEDVIP eligibility questions and help them provide their 

FEDVIP plan with information on the eligibility of their dependent children in certain 

circumstances, as explained in more detail on page 6.

Although your responsibilities are limited, we’re providing extensive detail about FEDVIP in 

this BAL so that you will be well-informed on this new Program.

FEDVIP VERSUS FEHB: WHAT’S DIFFERENT? 

It’s important to understand that FEDVIP and FEHB are entirely separate programs. Some 

FEHB plans will continue to offer coverage of some dental and vision services. Some also offer 

non-FEHB dental and vision services. FEDVIP provides supplemental dental and vision 

insurance coverage. Some carriers participate in both FEHB and FEDVIP. 

Individuals eligible to enroll in both programs can choose to enroll in FEHB only, FEDVIP only, 

both, or neither. They can also choose different enrollment types for each program—enrolling, 

for example, in Self and Family coverage under FEHB, but Self Only coverage under FEDVIP. 

Here are some of the key differences between FEDVIP and FEHB, which are explained in more 

detail later in this letter: 

FEHB FEDVIP 

Types of Enrollment Self 

Self and Family 

Self 

Self Plus One 

Self and Family 

Premium conversion 

(pre-tax payment of 

premiums) 

Optional for employees 

Not available for annuitants 

Required for employees 

Not available for annuitants 

Qualifying Life Events Includes all events allowed 

by Internal Revenue Code 

Section 125 

Limited. See page 12 for 

more details 

Premium contributions Government contribution 

toward premiums 

No Government 

contribution; enrollees pay 

100% of premiums 

Enrollment Enroll through agency 

human resources office or 

retirement system, often via 

access to a self service 

system such as Employee 

Express, EBIS, MyPay, 

Annuitant Express, etc. 

Enroll through 

BENEFEDS.com 

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FEHB FEDVIP 

Carrying coverage into 

retirement and enrolling 

as an annuitant 

Must meet “5-year rule” to 

carry into retirement and 

generally cannot enroll as 

an annuitant. 

No 5-year rule. 

Can carry into retirement if 

retiring on an immediate 

annuity, including retiring 

on disability. Can enroll as 

an annuitant during any 

Open Season or because of 

a Qualifying Life Event. 

Disputed claims process Uniform claims review 

processes among plans. 

If claim still denied after 

reconsideration by plan, 

enrollee may request OPM 

review 

Claim review processes 

differ among plans. If plan 

still denies claim after 

completing all its review 

procedures, enrollee may 

request review by 

independent third party 

mutually agreed to by the 

plan and OPM. 

No OPM review of disputed 

claims. 

31-day extension of 

coverage 

Yes No 

Temporary continuation 

of coverage (TCC) 

Yes No 

Spouse equity coverage Yes No 

Right to convert to an 

individual policy 

Yes No 

Annuitant cancellation of 

coverage or suspension of 

enrollment 

Annuitants can cancel 

coverage at any time but 

cannot re-enroll. 

Annuitants can suspend 

coverage under certain 

circumstances. 

Annuitants can only cancel 

coverage during Open 

Season. Annuitants can reenroll during future Open 

Seasons. There is no 

suspension of coverage. 

ELIGIBILITY 

Who’s eligible to enroll? 

P.L. 108-496 and the forthcoming FEDVIP regulations specify who is eligible to enroll in 

FEDVIP. 

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Federal and USPS employees. Federal and U.S. Postal Service (USPS) employees are eligible 

to enroll in FEDVIP if they are eligible to enroll in the FEHB Program. It does not matter if they 

are enrolled in FEHB or not. Eligibility is the key. 

Some Federal and USPS employees are not eligible for FEHB coverage, and thus are not eligible 

to elect FEDVIP coverage. The list of excluded positions is the same as for the FEHB Program. 

 As with FEHB, OPM makes the final determination about whether categories of excluded 

positions apply to a specific employee or group of employees. 

Federal/USPS employees enrolled in FEDVIP who subsequently retire on an immediate annuity 

or for disability under CSRS, FERS, or another retirement system for employees of the 

Government may continue FEDVIP enrollment into retirement. There is no 5-year rule for 

continuing coverage into retirement as there is with the FEHB Program. 

Federal annuitants. Federal annuitants are eligible to enroll in FEDVIP if they retired on an 

immediate annuity under the Civil Service Retirement System (CSRS), the Federal Employees 

Retirement System (FERS) or another retirement system for employees of the Government. 

Individuals who retire for disability under CSRS, FERS, or another retirement system for 

employees of the Government are also eligible. 

• Federal/USPS employees retired on a deferred annuity (i.e., they are not eligible for an 

immediate annuity when they separate from Federal service) are not eligible to enroll in 

FEDVIP and cannot continue a FEDVIP enrollment into retirement. 

• Federal/USPS employees enrolled in FEDVIP who retire on a Minimum Retirement Age 

+10 annuity and elect to postpone receipt of their annuity lose FEDVIP coverage upon 

separation from service. Such individuals can again enroll in FEDVIP within 60 days of 

when they start receiving their annuity. They do not have to enroll in the same plan, 

option or same enrollment type they had when they separated. 

Survivor annuitants. Survivors of deceased Federal/USPS employees or annuitants may be 

eligible to enroll or continue the enrollment of the deceased. 

• A member of a family who receives an immediate annuity as the survivor of an employee 

or of a retired employee is eligible to enroll in FEDVIP. The survivor does not have to 

have been covered under the deceased person’s FEDVIP enrollment. 

• If an employee or annuitant enrolled in FEDVIP dies while enrolled in Self Plus One or 

Self and Family, the enrollment will continue for their eligible family members who 

become survivor annuitants. 

Compensationers. Compensationers are eligible to enroll in FEDVIP or continue FEDVIP 

enrollment into compensation status. 

• A family member receiving monthly compensation from the Office of Workers’ 

Compensation Programs (OWCP) as the surviving beneficiary of an employee who dies 

as a result of illness or injury sustained while in performance of his/her duty can enroll in 

FEDVIP or continue the deceased’s FEDVIP enrollment. 

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Family members. FEDVIP follows FEHB rules for family member eligibility. Additional 

information on this topic is available in the FEHB Handbook at 

www.opm.gov/insure/handbook/fehb28.asp#Family. 

Self-certification and Documentation

During the enrollment process with BENEFEDS, eligible Federal/USPS employees and 

annuitants self-certify their eligibility for FEDVIP, and those who elect Self Plus One or Self and 

Family coverage in FEDVIP self-certify the eligibility of their dependent(s). Employees who do 

not know whether they or their family members are eligible for coverage should check with their 

employing agency for guidance. 

FEDVIP plans may ask an enrollee to provide documentation that confirms a family member’s 

eligibility (such as a marriage certificate or adoption papers), either when an individual initially 

enrolls or when an enrollee adds a family member to an existing enrollment. If the employing 

agency or retirement system has already made a determination regarding a child’s eligibility 

under the FEHB Program or the Federal Employees’ Group Life Insurance (FEGLI) Program as 

a foster child or a child age 22 or over who is incapable of self support because of a mental or 

physical disability that began before age 22, the enrollee can provide the FEDVIP plan with a 

copy of that determination. If such a determination has not already been made, the enrollee must 

request that determination from his/her agency/retirement system and then submit a copy to the 

plan that will make the final determination of eligibility, as required in the law. Please comply 

promptly with requests from enrollees for this documentation. 

In addition, FEDVIP plans may accept a physician’s statement that a child has a medical 

condition listed in OPM’s FEHB Handbook at www.opm.gov/insure/handbook/fehb30.asp and 

he/she had the condition before reaching age 22 as acceptable documentation that the child is 

incapable of self support. Please note that the physician statement must specify the diagnosis or 

condition of the child. 

Who is not eligible to enroll? 

Same-sex spouses and domestic partners are not eligible family members under FEDVIP. For 

Federal benefit programs, the 1996 Defense of Marriage Act (DoMA) defines the word ‘spouse’ 

as a person of the opposite sex who is a husband or wife. DoMA supersedes any state or local 

laws. 

Parents and other relatives not listed in the FEHB Handbook as eligible are not eligible family 

members, even if they live with and are dependent upon the enrollee. Exception: Siblings and 

parents may be covered under a child survivor annuitant’s enrollment if they are eligible family 

members of the deceased employee or annuitant. 

Grandchildren are not eligible family members unless they qualify as foster children. 

ENROLLMENT 

What Types of Enrollment are Available? 

Three types of enrollment are available under FEDVIP: 

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Self Only. A Self Only enrollment covers only the enrolled employee or annuitant. An eligible 

individual may enroll in Self Only even though he/she has a family, but the family members are 

not covered. 

Self Plus One. A Self Plus One enrollment covers the enrolled employee or annuitant plus one 

eligible family member. Eligible individuals may enroll in Self Plus One even though they have 

more than one eligible family member, but the additional family members are not covered. The 

enrollee must specify during the enrollment process which one eligible family member he/she 

wishes to cover under a Self Plus One enrollment. The enrollee may change the covered family 

member to another eligible family member during an Open Season or because of a Qualifying 

Life Event. Please note that a self plus one enrollment is NOT available under the FEHB 

Program. The FEHB law prohibits such a category. 

Self and Family. A Self and Family enrollment covers the enrolled employee or annuitant and 

all eligible family members. Enrollees should list all eligible family members when they enroll 

through BENEFEDS in order to ensure timely claim payments. All of the enrollee’s eligible 

family members are automatically covered, even if the enrollee fails to list all of them when 

enrolling on BENEFEDS, but claim payments may be delayed for family members who were 

omitted. 

An eligible individual may enroll in Self and Family coverage before he/she has any eligible 

family members. The family member (such as a newborn child or a new spouse) is 

automatically covered by the Self and Family enrollment from the date he/she becomes a family 

member. However, enrollees should still add new family members to existing Self and Family 

enrollments through BENEFEDS to ensure timely payment of claims. 

Family Member Loses Eligibility 

For both Self Plus One and Self and Family enrollments, when an eligible family member on an 

existing enrollment loses eligibility (e.g. reaches age 22 or remarries) and there is at least one 

other eligible family member remaining on the enrollment, the enrollee should remove the 

ineligible family member through BENEFEDS. Failure to remove ineligible family members 

does not make them eligible. 

Both Husband and Wife Eligible to Enroll

If both spouses are eligible to enroll in their own right (e.g., they are both Federal employees), 

they may be able to choose between several different enrollment scenarios. To illustrate, let’s 

look at Mark and Melissa, married Federal employees with three children. 

Who Wants Coverage Possible Enrollment Scenarios 

Mark Self Only 

Mark and Melissa Each enrolls in Self Only. 

One spouse enrolls in Self Plus One and names 

the other as the covered dependent. 

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Who Wants Coverage Possible Enrollment Scenarios 

Mark, Melissa, and one child One spouse enrolls in Self Only; the other 

enrolls in Self Plus One and names the child as 

the covered dependent. 

One spouse enrolls in Self and Family to cover 

the other spouse and the child. Note: in this 

scenario, all of the eligible children in the family would 

be covered.

Mark, Melissa, and two children Each spouse enrolls in Self Plus One and 

chooses a different child to name as the 

covered dependent. 

One spouse enrolls in Self and Family to cover 

the other spouse and the children. Note that in 

this scenario, all of the eligible children in the 

family would be covered. 

Mark, Melissa, and three children One spouse enrolls in Self and Family to cover 

the other spouse and the children. 

Different Enrollment Types Allowed for Dental Plans and Vision Plans 

Within FEDVIP, dental insurance plans and vision insurance plans operate completely 

independently of one another. That means that eligible employees and annuitants can enroll for 

dental insurance only, vision insurance only, neither, or both. 

If they’re enrolled in both, they can choose different enrollment types for each. So, for example, 

Mark could choose Self and Family for his dental plan and Self Plus One for his vision plan. 

In addition, employees/annuitants who enroll in both a dental plan and vision plan and choose 

Self Plus One coverage for each plan can opt to cover a different dependent in each plan. For 

example, Melissa could choose to cover Mark under her Self Plus One dental plan but choose to 

cover her son under her Self Plus One vision plan. 

Dual Enrollments 

An eligible individual may be enrolled or covered under a FEDVIP dental plan and a separate 

FEDVIP vision plan at the same time; this is not a dual enrollment. 

Dual enrollment is when an individual is covered under more than one FEDVIP dental 

enrollment or more than one FEDVIP vision enrollment. Generally, dual enrollment is 

prohibited except when elimination of the dual enrollment would cause a covered person to lose 

coverage. See the section below entitled “When Dual Enrollment is Allowed.” 

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Please note that the point of permitting a dual enrollment is to avoid an eligible enrollee or 

family member’s loss of coverage. It is not intended to allow double coverage for any one 

individual. No enrollee or family member may receive benefits under more than one FEDVIP 

dental enrollment or more than one FEDVIP vision enrollment. 

When Dual Enrollment is Allowed 

Dual enrollment must be authorized by BENEFEDS and will only be allowed when the enrollee 

or an eligible family member would otherwise lose coverage. Some examples of allowable dual 

enrollment include when: 

• the enrollee and spouse legally separate and both of them retain custody of their children 

by prior marriages; 

• the enrollee and spouse have children from prior marriages who don't live with them; 

• the enrollee and spouse legally separate and the enrollee or his/her children would lose 

full dental/vision coverage (e.g., the enrollee moves outside the service area when 

enrolled in a plan with a geographically restricted service area and the spouse refuses to 

change health plans; or the spouse refuses to pass along reimbursements for dental/vision 

claims filed); or 

• the enrollee is under age 22, covered by his/her parent's enrollment as a dependent, and 

becomes a parent. 

If BENEFEDS authorizes a dual enrollment, the enrollee may be covered and receive benefits 

only under his/her own enrollment. If the enrollee or a family member receives benefits under 

more than one plan, it is considered fraud and the enrollee is subject to disciplinary action. 

Eliminating a Dual Enrollment 

If BENEFEDS and/or a FEDVIP plan discover an unauthorized dual enrollment, one of the 

enrollments must be canceled prospectively from the date the dual enrollment was discovered. 

The premiums paid for the cancelled enrollment will not be refunded to the enrollee. The 

enrollee is not required to refund any benefits paid under the cancelled enrollment. 

If the enrollee and spouse are unable to agree on which enrollment to continue, the enrollment of 

the spouse with a court order to provide coverage for the children will be continued. Otherwise, 

the second (later) enrollment must be canceled. 

Example: A Federal employee and his/her Federal spouse have children from that marriage and 

also stepchildren from previous marriages who live with the employee in a regular parent-child 

relationship. When all of either the employee’s children or the enrollee’s spouse's children live 

with the employee, only one Self and Family enrollment is needed. If both the employee and 

his/her spouse are enrolled in Self and Family, the dual enrollment must be eliminated. 

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How do eligible employees and annuitants enroll or change an enrollment?

There are three ways for eligible employees/annuitants to enroll or change an enrollment in a 

dental and/or vision plan in FEDVIP. 

1. The primary enrollment method utilizes the secure, Section 508-compliant 

BENEFEDS website (www.BENEFEDS.com). BENEFEDS.com will contain an online 

tutorial and an extensive online help and Frequently Asked Questions section (easily 

navigated by keyword search, index, and table of contents) to assist enrollees through the 

enrollment process. 

 

2. Alternatively, eligible employees/annuitants can call toll-free 1-877-888-FEDS (1-877-

888-3337), TTY 1-877-889-5680, to have a BENEFEDS customer service representative 

(CSR) enroll them over the telephone. 

3. In the very rare situation an eligible employee/annuitant doesn’t have access to a 

computer AND doesn’t have access to a telephone during the BENEFEDS hours of 

operation (see the next section for hours of operation), he/she can mail a paper 

enrollment form to BENEFEDS for processing. Use of the paper enrollment form will be 

extremely limited and its distribution will be managed by OPM. If you have any 

employees you believe fit these limited requirements, please let us know as soon as 

possible by emailing BENEFEDSportal@opm.gov. 

Please note that employees/annuitants cannot enroll in a FEDVIP plan using the Health Benefits 

Election Form (SF 2809) or through a self-service system, such as Employee Express, 

PostalEase, EBIS, MyPay, or Employee Personal Page or Annuitant Express. However, we have 

encouraged those sites to provide a link to BENEFEDS. 

Prior to enrolling via BENEFEDS, eligible employees/annuitants will be encouraged to explore 

available plan options by visiting a “research” section on the BENEFEDS.com website. This 

research section will contain links to information and tools located on OPM’s FEDVIP website, 

including the FEDVIP portion of the FEHB Guide and a Plan Comparison Tool, as well as links 

to each FEDVIP plan’s website. 

How does the enrollment process work? 

Enrolling is easy, and involves two parts. First, an enrollee must create a BENEFEDS.com 

account, by providing demographic and employment information. When this one-time step is 

complete, eligible employees/annuitants can compare plans, and enroll. Employees/annuitants 

who want to enroll in both a dental and vision plan must complete this second part for each plan. 

 BENEFEDS estimates that it will take no more than 20 minutes to enroll. Note: once an 

enrollee successfully creates a BENEFEDS.com account, he/she can come back at any time 

during Open Season to complete enrolling in a dental plan and/or vision plan, or to change 

plans without having to re-enter demographic and employment information. 

The telephone enrollment process is very similar. Enrollees will be issued a username which 

they will use in subsequent calls or online transactions with BENEFEDS. 

When can eligible employees and annuitants enroll? 

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Eligible individuals can enroll: 

• during the annual open season; 

• within 60 days after first becoming eligible as: 

o a new employee, 

o a previously ineligible employee who transferred to a covered position, or 

o a survivor annuitant, if not already covered under FEDVIP; 

• within 60 days after returning to service following a break in service of at least 31 days; 

or 

• within 60 days after a Qualifying Life Event (QLE) that allows enrollment. (See the 

section on QLEs, below, for more details on which QLEs allow enrollment.) 

Open Season 2006 

FEDVIP open seasons will run concurrently with the open seasons for FEHB and FSAFEDS —

for this year, that is November 13 through December 11, 2006. The BENEFEDS.com website 

will “turn on” all enrollment functions by 5:00 a.m. Eastern Time on November 13 and “turn 

off” open season enrollment functions at midnight Eastern Time on December 11. 

Agencies cannot extend the open season. 

The BENEFEDS phone representatives can be reached by phone during the following hours: 

Open Season

9:00 a.m. to 9:00 p.m. Eastern Time, Monday through Friday 

9:00 a.m. to 9:00 p.m. Eastern Time, Saturday and Sunday during the last weekend of Open 

Season (this year, December 9 and 10). 

Non-Open Season

9:00 a.m. to 7:00 p.m. Eastern Time, Monday through Friday.

Belated enrollments and changes in enrollments 

The time limit for enrolling or changing an enrollment may be extended for up to six (6) months 

after the individual first becomes eligible, or has a QLE (see section on QLEs below), or after 

the end of open season, if the individual provides evidence to BENEFEDS that he/she was 

unable to enroll or change enrollment timely for reasons beyond his/her control. Agencies do 

not make decisions on belated enrollments. BENEFEDS has this responsibility for FEDVIP. If 

BENEFEDS allows a belated enrollment or change in enrollment, the individual must enroll or 

change enrollment within 30 days after BENEFEDS notifies him/her. BENEFEDS will allow 

belated enrollments and changes only in exceptional circumstances, and its decisions cannot be 

appealed. 

When do enrollments become effective? 

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This open season 

The effective date of FEDVIP Open Season enrollments for this very first open season is 

Sunday, December 31, 2006. (We know that date is in the middle of a pay period for many 

employees—see the Premiums section below for more on how premium deductions will work.) 

Enrollees and covered dependents are considered eligible for services on and after the effective 

date of coverage. 

Future open seasons 

The effective date for enrollments during future open seasons will be set by OPM. 

New hires and QLE enrollments/changes 

Generally, enrollments which occur outside of open season (e.g., new hires) and changes to 

enrollments outside of open season become effective the first day of the pay period or annuity 

cycle following the one in which BENEFEDS receives the enrollment or change. 

Belated enrollments and belated changes 

For belated enrollments or belated changes in enrollments, the effective date will be retroactive 

to the date the enrollment or change in enrollment would have been effective if made timely. 

For example, a retroactive 2006 Open Season enrollment will be made effective back to 

December 31, 2006. BENEFEDS will begin withholding premium prospectively from the 

enrollee’s pay/annuity and will then bill the enrollee directly for the retroactive premiums due, 

which will not be pre-tax. If the enrollee does not pay the retroactive premiums within 90 days, 

BENEFEDS will notify the enrollee’s dental and/or vision plan, as applicable. Plans may use 

their standard collection procedures or may offset the uncollected amount against future claims 

payments. 

Enrollees will receive confirmation of their open season enrollment from the plan(s) they 

enrolled in within 15 calendar days after the end of open season. Those who enroll outside of 

open season will receive confirmation from their plan within 15 days after the date they enrolled 

using BENEFEDS. 

Opportunities to Change Enrollment: Qualifying Life Events (QLEs) 

A qualifying life event (QLE) is an event that may allow eligible individuals to enroll, or allow 

those already enrolled to change their enrollment, outside of an open season. Since employees 

pay FEDVIP premiums on a pre-tax basis, OPM must follow Internal Revenue Service rules in 

determining what events are QLEs. The number and type of permitted QLEs are more limited 

than in the FEHB Program. In addition, the rules for QLEs in FEDVIP apply to annuitants as 

well as employees. 

The enrollment action taken must be consistent with the QLE. For example, an enrollee can 

change from Self Only to Self Plus One when the QLE is “acquiring an eligible family member”. 

 However, the enrollee cannot decrease from Self Plus One to Self Only since that action is not 

consistent with adding a family member. Some QLEs allow enrollment and some allow changes 

in enrollment, but no QLE allows every type of enrollment action. An individual taking an 

enrollment action based on experiencing a QLE may later cancel that action if he/she does so 

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within the time limit allowed for the QLE. 

The following chart summarizes the QLEs that permit enrollment changes outside of open 

season along with the changes that can be made. 

Possible FEDVIP Enrollment Changes Outside of Open Season

QLE that may permit a change 

in enrollment 

From Not 

Enrolled 

to 

Enrolled

INCREASE from Self 

Only to Self Plus One or 

to Self and Family or 

from Self Plus One to 

Self and Family

DECREASE from 

Self and Family to 

Self Plus One or to 

Self Only or From 

Self Plus One to 

Self Only

Cancel

CHANGE 

from one 

plan to 

another 

Acquiring an eligible 

family member No Yes No No No 

Losing a covered family 

member No No Yes No No 

Losing other dental/vision 

coverage (eligible or 

covered person) 

Yes Yes No No No 

Moving out of regional 

plan's service area No No No No Yes 

Return to pay status from 

active military duty Yes No No No No 

Annuity or Compensation 

restored Yes No No No No 

The time frame for requesting a QLE change is from 31 days before to 60 days after the event. 

There are a few exceptions: 

• There is no time limit for a change based on moving from a regional plan’s service area: 

and 

• An individual cannot request a new enrollment based on a QLE before the QLE occurs. 

He/she must make the change no later than 60 days after the event. 

As noted above, an enrolled employee can request a change in his/her enrollment up to 31 days 

prior to an event, such as marriage. If an employee changes his/her enrollment in anticipation of 

a permitted QLE, and that event does not occur, the QLE can be cancelled. 

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Canceling an enrollment 

Enrollees can cancel their enrollment only during the annual open season (except as noted 

above). An eligible family member’s coverage also ends upon the effective date of the 

cancellation. 

Re-enrollment 

Like FEHB (but unlike FSAFEDS), re-enrollment is automatic each year unless an enrollee 

chooses to make a change during open season or a plan terminates its participation in FEDVIP. 

PREMIUMS 

Premiums will be deducted from enrollees’ pay or annuity when possible. Deductions from pay 

will be on a pre-tax basis (premium conversion) for employees. Deductions from annuity 

payments will not be on a pre-tax basis for annuitants. For open season enrollments, FEDVIP 

coverage will be effective December 31, 2006, even though premium deductions will not begin 

until the pay period that starts on or after January 1, 2007. This gap between the start of 

coverage and premium payments has already been factored into the FEDVIP premiums. 

BENEFEDS is responsible for premium collection for all FEDVIP plans, and has been working 

closely with agency payroll providers to effect payroll and annuity deductions of FEDVIP 

premiums. In some cases, however, an enrollee’s premium deduction may not occur. This can 

happen because the enrollee made an error while enrolling--for example, mistyping his social 

security number. In this case, BENEFEDS will work with agency payroll offices and/or contact 

the enrollee in order to resolve the error. Sometimes an enrollee’s pay or annuity may be 

insufficient to pay premiums; or an enrollee may go on leave without pay, transfer to another 

agency, or retire. In cases of insufficient pay or leave without pay, after two consecutive 

attempts to obtain premium deductions, BENEFEDS will bill the enrollee directly for premiums. 

 Please note that direct payments made to BENEFEDS will be post-tax, so employees will lose 

the benefit of premium conversion. If an employee has transferred to another agency or retired, 

BENEFEDS will work with the agency payroll office and the enrollee to establish deductions 

from the enrollee’s new pay/annuity location. 

Rating areas 

For dental plans, premiums are determined based on where the enrollee lives. This is called a 

rating area. Each dental plan may have up to six rating areas, including an international rate. 

However, the zip codes included in each rating area differ from plan to plan. Consequently, an 

enrollee could be in rating area 4 under one plan but in rating area 2 under another plan. A chart 

with the rating areas for each plan is available on the FEDVIP website. You’ll be glad to know 

that when employees and annuitants call or visit BENEFEDS.com to enroll in a dental plan, they 

won’t have to sort this out. BENEFEDS will provide them only the plans and premiums 

available based on their zip code. It’s important to remember that enrollees who move after 

enrollment must update their address through BENEFEDS. Their rates might change because of 

the move. 

Vision plans do not have separate rating areas as they each charge a nationwide rate. 

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ABOUT FEDVIP PLANS 

As noted on pages 1 and 2, OPM has contracted with seven plans to provide dental insurance and 

three plans to provide vision insurance under FEDVIP. 

Four dental plans offer nationwide coverage: 

• Aetna 

• GEHA 

• MetLife 

• United Concordia. 

Three dental plans are regional: 

• GHI (in New York and parts of New Jersey, Pennsylvania and Connecticut) 

• CompBenefits (in 21 states) 

• Triple-S, Inc. (in Puerto Rico). 

Some dental plans will offer two plan options: Standard and High, while others will offer only 

the High option. 

All three vision plans offer nationwide coverage: 

• BlueCross BlueShield 

• Spectera, Inc. 

• Vision Service Plan (VSP). 

You’ll note that some of the carriers offering FEDVIP plans also offer FEHB plans—namely, 

Aetna, Blue Cross Blue Shield, GEHA, GHI, and Triple S. Keep in mind that their FEDVIP and 

FEHB plans are completely separate. Individuals who are enrolled in one of these carriers’ 

FEHB plans do not have to choose the same carrier’s FEDVIP plan, and vice versa. 

Each plan will have a brochure stating its premiums and benefits. We’ll issue another BAL on 

available FEDVIP materials, and have already provided you a list of contacts at each FEDVIP 

plan with whom you can arrange appearances at health fairs. 

Key Program-wide Features 

No pre-existing condition exclusions and waiting periods for orthodontia only 

There is no exclusion for pre-existing conditions for FEDVIP plans. Waiting periods are 

allowed only for orthodontic services. If a plan has a waiting period, the person receiving the 

services must be enrolled in the same plan for the entire duration of the waiting period, as 

specified by the plan. Waiting periods satisfied under FEHB plans or other supplemental dental 

plans cannot be applied toward FEDVIP plans. 

Network Access: Regional versus National 

All of the plans have provider networks. Plans vary according to whether or to what extent they 

will pay benefits for services provided by a non-network provider. Eligible individuals should 

study a plan’s brochure and provider directory carefully before enrolling. 

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Regional plans have limited service areas and may require that enrollees receive care from 

providers who contract with them in order to receive benefits, except for emergencies. If an 

enrollee or a covered family member moves outside of a regional plan’s service area, the 

enrollee can change to another plan, as explained in the section on Qualifying Life Events. 

Coordination of Benefits 

Some FEHB plans already cover some dental and vision services. If a FEDVIP enrollee’s FEHB 

plan does provide any benefits for dental and vision services, the FEHB plan will be the first 

payor of any benefits. FEDVIP plans are responsible for coordinating benefits with the primary 

payor. 

FEDVIP plans will also coordinate benefit payments with the payment of benefits under other 

group health benefits coverage enrollees may have and the payment of dental or vision costs 

under no-fault insurance that pays benefits without regard to fault. They will also coordinate 

benefits with other group dental or vision insurance, if that information is provided by enrollees. 

 

FEDVIP plans may request that enrollees verify/identify their health insurance plan(s) annually 

or at the time of service. Please note that enrollees who change FEHB plans during open season 

after enrolling on BENEFEDS should communicate that change to BENEFEDS. Providing 

FEHB information may reduce enrollees’ out-of-pocket costs. 

Claims Dispute and Resolution 

Each plan has its own process and timeframe for reviewing disputed claims, which are explained 

in its FEDVIP brochure. Enrollees should study this section of the brochure carefully before 

enrolling. If an enrollee has completed the plan’s claims dispute process and still disagrees with 

the plan’s decision, he or she may request that an independent third party, mutually agreed to by 

the plan and OPM, review the decision. The decision of the independent third party is final and 

binding. OPM does not review disputed FEDVIP claims. 

CONCLUSION 

We look forward to working with you over the coming weeks to roll out this much-anticipated 

new benefit. We appreciate your leadership in educating and informing employees about 

FEDVIP. 

 

 Sincerely, 

 Robert F. Danbeck 

 Associate Director 

 for Human Resources Products and Services 

 

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