Document list

Document Number Document Name Version Date Published
D24.00.1.1 Cover page v1.0 01/01/2025
D24.00.1.2 Introduction v1.0 01/01/2025
D24.00.1.3 Table of Contents v1.0 01/01/2025
D24.00.1.4 Changes for 2024 v1.0 01/01/2025
D24.00.2.1 A Choice of Plans and Options v1.0 01/01/2025
D24.00.2.2 Enroll Through BENEFEDS v1.0 01/01/2025
D24.00.2.3 Dual Enrollment v1.0 01/01/2025
D24.00.2.4 Coverage Effective Date v1.0 01/01/2025
D24.00.2.5 Pre-Tax Salary Deduction for Employees v1.0 01/01/2025
D24.00.2.6 Annual Enrollment Opportunity v1.0 01/01/2025
D24.00.2.7 Continued Group Coverage After Retirement v1.0 01/01/2025
D24.00.2.8 Compliance with the American Dental Association (ADA) v1.0 01/01/2025
D24.01.1 Federal Employees v1.0 01/01/2025
D24.01.1.1 Temporary/Seasonal Employees v1.0 01/01/2025
D24.01.2 Federal Annuitants v1.0 01/01/2025
D24.01.3 Survivor Annuitants v1.0 01/01/2025
D24.01.4 Compensationers v1.0 01/01/2025
D24.01.5 TRICARE-eligible individual v1.0 01/01/2025
D24.01.6 Family Members v1.0 01/01/2025
D24.01.7 Not Eligible v1.0 01/01/2025
D24.02.1 Enroll Through BENEFEDS v1.0 01/01/2025
D24.02.2 Enrollment Types v1.0 01/01/2025
D24.02.3 Dual Enrollment v1.0 01/01/2025
D24.02.4 Opportunities to Enroll or Change Enrollment v1.0 01/01/2025
D24.02.5 When Coverage Stops v1.0 01/01/2025
D24.02.6 Continuation of Coverage v1.0 01/01/2025
D24.02.7 FSAFEDS/High Deductible Health Plans and FEDVIP v1.0 01/01/2025
D24.03.01 Identification Cards/Enrollment Confirmation v1.0 01/01/2025
D24.03.02 Where You Get Covered Care v1.0 01/01/2025
D24.03.03 Plan Dentists v1.0 01/01/2025
D24.03.04 In-Network v1.0 01/01/2025
D24.03.05 Out-of-Network v1.0 01/01/2025
D24.03.06 Emergency Services v1.0 01/01/2025
D24.03.08 Pre-treatment Estimate v1.0 01/01/2025
D24.03.09 Alternate Benefit v1.0 01/01/2025
D24.03.10 Dental Review v1.0 01/01/2025
D24.03.11 FEHB First Payor v1.0 01/01/2025
D24.03.12 Example 1: High Option coverage (In-Network provider) v1.0 01/01/2025
D24.03.13 Example 2: High Option coverage (Out-of-Network provider) v1.0 01/01/2025
D24.03.14 Coordination of Benefits v1.0 01/01/2025
D24.03.15 Example 1: High Option coverage (In-Network provider) v1.0 01/01/2025
D24.03.16 Example 2: High Option coverage (Out-of-Network provider) v1.0 01/01/2025
D24.03.17 Rating Areas v1.0 01/01/2025
D24.03.18 Limited Access Area v1.0 01/01/2025
D24.04.0 Section 4 Your Cost For Covered Services v1.0 01/01/2025
D24.04.1 Deductible v1.0 01/01/2025
D24.04.2 Coinsurance v1.0 01/01/2025
D24.04.3 Annual Benefit Maximum v1.0 01/01/2025
D24.04.4 Lifetime Benefit Maximum v1.0 01/01/2025
D24.04.5 In-Network Services v1.0 01/01/2025
D24.04.6 Out-of-Network Services v1.0 01/01/2025
D24.04.6.1 Plan Allowance v1.0 01/01/2025
D24.04.7 Calendar Year v1.0 01/01/2025
D24.04.8 Emergency Services v1.0 01/01/2025
D24.04.9 In-Progress Treatment v1.0 01/01/2025
D24.05A.0 Section 5 Dental Services and Supplies Class A Basic v1.0 01/01/2025
D24.05A.1 Diagnostic Services v1.0 01/01/2025
D24.05A.2 Preventive Services v1.0 01/01/2025
D24.05A.3 Additional Procedures Covered as Basic Services v1.0 01/01/2025
D24.05A.4 Services Not Covered v1.0 01/01/2025
D24.05B.0 Class B Intermediate v1.0 01/01/2025
D24.05B.1 Minor Restorative Services v1.0 01/01/2025
D24.05B.2 Endodontic Services v1.0 01/01/2025
D24.05B.3 Periodontal Services v1.0 01/01/2025
D24.05B.4 Prosthodontic Services v1.0 01/01/2025
D24.05B.5 Oral Surgery v1.0 01/01/2025
D24.05B.6 Services Not Covered v1.0 01/01/2025
D24.05C.0 Class C Major v1.0 01/01/2025
D24.05C.1 Major Restorative Services v1.0 01/01/2025
D24.05C.2 Endodontic Services v1.0 01/01/2025
D24.05C.3 Periodontal Services v1.0 01/01/2025
D24.05C.4 Prosthodontic Services v1.0 01/01/2025
D24.05C.5 Oral Surgery v1.0 01/01/2025
D24.05C.6 Services Not Covered v1.0 01/01/2025
D24.05D.0 Class D Orthodontic v1.0 01/01/2025
D24.05D.1 Orthodontic Services v1.0 01/01/2025
D24.05D.2 Services Not Covered v1.0 01/01/2025
D24.05G.0 General Services v1.0 01/01/2025
D24.05G.1 Anesthesia Services v1.0 01/01/2025
D24.05G.3 Medications v1.0 01/01/2025
D24.05G.4 Post-Surgical Services v1.0 01/01/2025
D24.05G.5 Miscellaneous Services v1.0 01/01/2025
D24.05G.6 Services Not Covered v1.0 01/01/2025
D24.06.1 International Claims Payment v1.0 01/01/2025
D24.06.2 Finding an International Dentist v1.0 01/01/2025
D24.06.3 Filing International Claims v1.0 01/01/2025
D24.06.4 International Rates v1.0 01/01/2025
D24.07 Section 7 General Exclusions – Things We Do Not Cover v1.0 01/01/2025
D24.08.1 How to File a Claim For Covered Services v1.0 01/01/2025
D24.08.2 Deadline for Filing Your Claim v1.0 01/01/2025
D24.08.3 Disputed Claims Process v1.0 01/01/2025
D24.09 Section 9 Definitions of Terms We Use in This Brochure v1.0 01/01/2025
D24.10.1 Discounts v1.0 01/01/2025
D24.10.2 Tools and Resources v1.0 01/01/2025
D24.11.0 Summary of Benefits v1.0 01/01/2025
D24.11.1 High Option Benefits v1.0 01/01/2025
D24.11.2 Standard Option Benefits v1.0 01/01/2025
D24.12 Stop Health Care Fraud! v1.0 01/01/2025
D24.13 Rate Information v1.0 01/01/2025
D24.14 Rates v1.0 01/01/2025