Standard dental 2027

1 These benefits are neither offered nor guaranteed under contract with the FEDVIP Program but are made available to all Enrollees who become members of G.E.H.A and their eligible family members.

2 If your out-of-network dentist charges more than G.E.H.A'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.

3 Two sets of bitewing X-rays covered per year for members 22 and under. One set of bitewing X-rays covered per year for members ages 23+.

4 For Standard, implants are limited to $2,500 per person per year in-network, or $2,000 per person per year out-of-network.

5 Benefits are based on the plan allowance that is the amount allowed for a specific procedure.

Coordination of benefits — As with all FEDVIP plans, dental benefits available from your FEHB/PSHB carrier will be considered before we calculate benefits under your G.E.H.A FEDVIP plan.

Orthodontic services — G.E.H.A does not cover orthodontic services previously started with another carrier, except for High and Standard members with orthodontics started under TRICARE.

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.

This is a brief description of services covered under the G.E.H.A Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the G.E.H.A Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental