gehadental.com

Dental ratesand benefits

Your Guide to 2017

your planGet the most from

Dear Federal Employee:

Thank you for your interest in GEHA Connection Dental® Federal. As one of the first insurers to provide dental coverage to federal employees and retirees under the FEDVIP program, GEHA knows how to help you have great oral health in 2017.

GEHA Connection Dental Federal offers two dental plans: Standard Option and High Option. Both offer comprehensive coverage, including fillings, root canals and other services. There are no waiting periods for most procedures, and no deductible. Premium rates are found on page 5.

With GEHA you get great out-of-network benefits and have the freedom to see any dentist you choose. For the most cost savings, we encourage you to visit our in-network providers. You can search our network at gehadental.com/FindDentist.

Know how much you’ll pay You can estimate costs for many in-network dental procedures with our pricing tool at gehadental.com/pricing.

You also have access to these great supplemental benefits* in 2017:

New for 2017! Teeth whitening. GEHA members receive a 20 percent discountoff the lowest published price on all Smile Brilliant products – custom-fittedtrays, teeth whitening gel and desensitizing gel.

Hearing. GEHA members save 30 percent to 60 percent off the average retailprice of hearing aids through TruHearing.

Vision. Through Connection Vision® powered by EyeMed, you and your coveredfamily members each pay only $5 for an annual routine eye exam when you usea qualified EyeMed participating provider.

Life Alert. You and your extended family members enjoy exclusive discounts,including free activation and a 10 percent discount for Life Alert® emergency-response services.

If you have questions, please visit gehadental.com or call us at 877.590.GEHA.

In good health,

Julie Browne

President & CEO

*GEHA supplemental benefits are neither offered nor guaranteed under contract with the FEHB or FEDVIP programs, but are made available to all enrollees and family members who become members of GEHA.

Go aheadand grin.When you choose a GEHA dental plan, confidence is always included. With free in-network preventive care, no deductible and the freedom to see any dentist you choose, your oral health has never had it so good.

With GEHA you get:

Free in-network preventive care includes exams, X-rays and two annual cleanings.

Large dental network with more than 340,000 provider locations nationwide. Choosing a dentist in the network can reduce your out-of-pocket costs.

Orthodontic care for the whole family is paid at 70 percent for children and adults, with no waiting period for High Option.

Comprehensive coverage for fillings, root canals and more.

Impressive calendar-year maximum with $35,000 for High Option.

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Find your code, then find your premium.Locate your state or ZIP code, then match your rate code to the premium charts (next page) to see how much you’ll pay.

PREMIUM RATE CODES BY STATE / ZIP CODE

IN

ME

KS

MI

KY

MN

MA

MO

MD

MT

IN

ME

KY

MI

LA

MN

MD

MS

MD

NC

ND

463, 464

038

All

480-485

Rest of the state

550-555, 563

All

All

219

All

Rest of the state

Rest of the state

410, 452, 459

Rest of the state

All

Rest of the state

205-212, 214, 217

All

Rest of the state

All

All

AK

DE

AR

FL

CA

GA

CO

IA

CT

IL

AL

FL

AZ

GA

CA

HI

CT

ID

DC

IL

IN

All

All

All

Rest of the state

939-941, 943-952, 954

Rest of the state

All

All

Rest of the state

600-608

All

330-334

All

300-303, 305, 311, 399

Rest of the state

All

064-069

All

All

Rest of the state

460-462, 470, 472

NE

OH

NJ

OR

NM

PA

NY

PA

NY

SC

NH

OK

NJ

PA

NV

PA

NY

RI

OH

TN

SD

All

Rest of the state

080-084

All

All

183

005, 100-119, 124-126

Rest of the state

Rest of the state

All

All

All

Rest of the state

173-174

All

189-196

063

All

430-432, 440-443, 450-455, 459

422

All

TN

WI

UT

WV

VA

WY

WA

GU

WA

FO

TX

WV

VA

WY

VT

PR

WA

VI

WI

Rest of the state

Rest of the state

All

Rest of the state

Rest of the state

Rest of the state

980-985

All

Rest of the state

International + all other areas not listed

All

254

201, 205, 220-227

834

All

All

986

All

540

PREMIUM

PREMIUM

1

1

2

2

3

3

4

4

5

5

Premium Rate Schedule*

Premium Rate Schedule*

Self Only

Self Only

$15.97

$34.60

$31.94

$69.20

$47.91

$103.81

$9.29

$20.13

$18.58

$40.26

$27.87

$60.39

$17.55

$38.03

$35.09

$76.03

$52.67

$114.12

$10.19

$22.08

$20.38

$44.16

$30.56

$66.21

$19.91

$43.14

$39.83

$86.30

$59.73

$129.42

$11.57

$25.07

$23.11

$50.07

$34.66

$75.10

$21.49

$46.56

$42.98

$93.12

$64.49

$139.73

$12.48

$27.04

$24.94

$54.04

$37.40

$81.03

$23.84

$51.65

$47.71

$103.37

$71.61

$155.16

$13.83

$29.97

$27.66

$59.93

$41.49

$89.90

High Option

High Option

Self Plus One

Self Plus One

Self and Family

Self and Family

Self Only

Self Only

Standard Option

Standard Option

Self Plus One

Self Plus One

Self and Family

Self and Family

*Rates based on member’s primary state of residence.

Monthly cost

Biweekly cost

2017 gehadental.com 5

Your teeth need vitamins, too.Calcium is key for strong bones and

healthy teeth.

* Member pays any difference between the plan allowance and the billed amount.

** Plans cover two cleanings per calendar year.

*** Implants are limited to $2,500 per covered person per year, included in the calendar year maximum.

† Class A, B, and C Covered Services are limited to a combined Calendar Year Maximum Benefit of $35,000 for High Option and $2,500 for Standard Option, per covered person.

†† Limited to a lifetime maximum of $2,500 under High and Standard Option, per covered person.

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 GEHA Connection Dental Federal Plan Brochure.

As with all FEDVIP plans, dental benefits available from your FEHB carrier will be considered before we calculate benefits paid by GEHA.

BENEFIT

Calendar year maximum

Exams, Cleanings**, X-rays

Fillings, Extractions and Periodontal maintenance

Root canals, Crowns, Bridges, Dentures, Periodontal surgery and Implants***

No waiting period for High Option. Orthodontic services after a 12-month waiting period for Standard Option for children and adults.

Basic–Class A†

Intermediate–Class B†

Major–Class C†

Orthodontic–Class D††

$35,000 / person

In-network In-networkOut-of-network* Out-of-network*

High Option

StandardOption

$2,500 / person

2017 Plan Year WaitingPeriod

None

None

None

None 12months

None

None

None

None

100%

80%

50%

70%

100%

80%

50%

70%

100%

55%

35%

70%

100%

55%

35%

70%

Calendar Year Deductible

High Option BenefitPlan pays the following

percentage of the plan allowance:

Standard Option BenefitPlan pays the following

percentage of the plan allowance:

All classes of service are included in both High Option and Standard Option as part of the plan. This is a brief description of services covered under the GEHA Connection Dental Federal plan. Do NOT rely on this chart alone. All benefits are subject to

the definitions, limitations and exclusions set forth in the dental brochure.

Find your plan below to see what’s covered.

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It's easy. Enroll today.To sign up for a plan online, visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal. You can also call Benefeds toll-free at 877.888.3337 / TTY: 877.889.5680

It’s about more than avoiding cavities. Your oral health has a lot to do with your

overall health. Studies show a link between inflammation in the

mouth and the management of blood glucose which can make diabetes harder to control.

Researchers are looking into a relationship between gum disease in pregnant women and low birth weight, as well as possible connections between oral health and osteoporosis, rheumatoid arthritis, pulmonary disease, heart disease and obesity.

Stop problems before they happen.When you see an in-network dentist, your preventive care is free. That means you get two exams and cleanings a year, and a set of X-rays included. Children qualify for free fluoride treatments and tooth sealants. Other procedures, designed to monitor gum conditions and restore problem teeth, are also considered preventive. It’s all about keeping your oral health a priority.

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 estimate of how the services will be covered.

Choosing a dentistYou have the choice of providers. However, for many services, your out-of-pocket costs may be lower when you visit in-network providers. Network providers will not bill you more than the Plan's maximum allowable charge for covered services.

Get the most from your dental plan.

Call the dentist if… A tooth is visibly cracked.

A permanent tooth feels loose.

Your mouth, jaw or face aches.

Your gums are red, swollen or

bleeding, or appear to be

receding.

You have pain accompanied by a popping or clicking sound in your jaw. Teeth become

sensitive to hot or cold.

You experience a persistent odd taste or bad breath.

You have a mouth sore that

doesn’t heal.

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Nature'stoothbrushes.Fibrous fruits and veggies act as a natural scrubber.

MemberBenefits

All GEHA Connection Dental Federal members receive year-round benefits that will keep you and your family smiling – and seeing, hearing and feeling secure – with discounts offered only to our members. This year, we’ve partnered with Smile Brilliant to add professional teeth whitening to your supplementary benefits. So your family’s smiles can be brighter than ever.

Simple, affordable whitening is easier than ever with Smile Brilliant. Whiten your teeth with a custom-made system from the comfort of home. All GEHA members will receive a 20 percent discount off the lowest published price on all Smile Brilliant products – custom-fitted trays, teeth whitening gel and desensitizing gel.

Smile Brilliant’s lab-direct system replicates the results dentists have been providing for years, with both in-office treatments and custom-fitted teeth whitening trays, at a 70 percent discount. For your convenience, your Smile Brilliant kit is mailed to your home.

Make your upper and lower dental impressions – a simple process that takes about 10 minutes – and mail them back to the lab in the postage-prepaid envelope provided. Your handcrafted, customized trays are mailed back within eight business days.

A 100 percent refund is guaranteed within the first 45 days if you are not completely satisfied. Learn more at smilebrilliant.com/geha.

FlossFlossing cleans between teeth

where a toothbrush can’t reach.

Your plan goes beyond dental care.

2017 gehadental.com 9

New for 2017: An exclusive teeth-whitening offer for GEHA members from Smile Brilliant

SECTION THREEGet connected to the lifestyle you want. Year-round benefits for all GEHA Connection Dental Federal members keep you in charge of feeling great.

Connection Hearing powered by TruHearingGEHA members get exclusive access to low prices on TruHearing hearing aids through our Connection Hearing program. Most members see savings of 30 to 60 percent off their hearing devices, an average of more than $1,960 per pair. Best of all, this benefit can be shared with extended family members.

TruHearing offers more than 100 options selected from the newest models from top companies such as Starkey, Phonak, ReSound, Oticon and Widex. With more than 4,800 nationwide hearing care providers, TruHearing has a 95 percent customer satisfaction rate.

Here’s how it works. Call TruHearing at 844.224.2712.

A consultant will answer all your questions, check your GEHA enrollment, and set up an appointment with an affiliated audiologist or hearing instrument specialist near you.

At your appointment, you’ll receive a comprehensive hearing exam. Your audiologist or specialist will recommend hearing aids that fit your level of hearing loss, budget and lifestyle needs. Your choice will be ordered from TruHearing.

When your hearing aids arrive, your audiologist or specialist will have them programmed and customized. After that, you’ll receive full support from TruHearing, including a 45-day trial period, 3-year warranty, 48 free batteries per device, and professional follow-up visits to ensure your satisfaction.

Life Alert®

Emergency ResponseYou can’t put a price on round-the-clock peace of mind, but all GEHA members and their extended family (including adult children, parents and grandparents) can receive discounted emergency response services from Life Alert, a leader in responsive emergency care.

Life Alert protects all family members in ahome health emergency.

Using Life Alert can help seniors remain independent because they’re never alone, even if they’re still living alone.

Every 10 minutes, Life Alert responds to calls that range from medical emergencies to falls, fires, home invasions and carbon monoxide exposure.

Life Alert provides access to emergency help, 24/7, even if you can’t reach a phone.

To receive this exclusive GEHA discount (free activation plus a 10 percent monthly discount), call 800.640.0036 and request a free Life Alert brochure. A representative will follow-up after the brochure arrives to discuss your options.

10 gehadental.com 2017

Connection Vision powered by EyeMedAs a GEHA member, your vision coverage is included for no extra premium. You and covered family members can get annual eye exams for only a $5 copay, when you visit an EyeMed provider. For eye exams at out-of-network providers, EyeMed will reimburse you up to $45 per covered member.

Benefits include: Access to thousands of network providers, including LensCrafters, Pearle Vision, Sears Optical, Target Optical, JCPenney Optical and private practitioners.

Preferred pricing with fixed discounts for lenses, lens options, frames and contact lenses, at participating EyeMed providers.

No limit on the number of discounted glasses or contacts purchased each year, High Option and Standard Option only.

Savings on surgical procedures, including LASIK, at participating locations.

SuperviseKids should start

brushing as early as age 2, with parents

helping until they’re 6.

Surprises are for birthdays, not dental bills. When you sign up for a GEHA dental plan, you get the power to verify whether a service is covered – and estimate how much it will cost. To check your coverage and access our dental pricing tool, visit gehadental.com/switch.

Save even more by staying in-network.GEHA Connection Dental Federal allows you to use any dentist you choose. GEHA will pay the same level of benefits for all qualified providers. But you can save even more money by using an in-network dentist, because network providers will not bill GEHA members for costs above their agreed-upon fees. And with more than 340,000 provider locations nationwide, you have lots of great choices.

P.O. Box 2336Independence, MO 64051-2336

PRESORTEDSTANDARD

U.S. POSTAGE

PAID GEHA

© 2016 Government Employees Health Association, Inc. All rights reserved.

DMM0916/gehahealth

Enroll at benefeds.com For plan questions, call GEHA: 877.590.GEHA / gehadental.com

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