New Voluntary Dental Plan Option
How Do I Enroll: After November 13th, enroll in the GHI Preferred Dental plan through the BENEFEDS Portal at www.BENEFEDS.com.
Enrollment begins November 13, 2006. GHI can offer you a new dental Plan or add to your existing plan.
GHI is pleased to make this new dental benefits program available to Federal members and their families in the New York area.
The new GHI offering, available to employees living and working in New York State and select locations in New Jersey, Pennsylvania and Connecticut, is a unique dental insurance program that blends all the features that are important to you:
- Access to a large PPO network of participating dentists.
- Freedom to see any dentist of your choice, without having to pre-select and commit to a specific dental practice.
- No co-payments.
- No co-insurance.
- A wide variety of covered services.
- Specialist referrals and pre-approvals are not required.
- Automatic payment made directly to the participating dental office. It's a completely hassle-free experience when receiving care from a network practice.
- Orthodontic benefits for dependent children after an initial 12-month waiting period.
Please review the program information below. We are confident you will find that GHI FEDVIP Dental is the best option for Federal members in New York and delivers the best value for your benefits dollars.
GHI FEDVIP Dental is available to Federal employees who reside in the following locations:
| State | Counties |
| New York | All counties |
| New Jersey | Bergen, Essex, Hudson, Middlesex, Monmouth, Morris, Passaic, Somerset, Sussex, Union |
| Connecticut | Fairfield, Litchfield, New Haven |
| Pennsylvania | Monroe, Pike |
Large Network and Freedom of Choice
With GHI FEDVIP Dental, you can select from thousands of fully-credentialed general dentists and specialists. And there is no need to pre-select your general dentist. The choice is yours at the time of care. In fact, it's okay to choose a different network dentist for every member of the family, and no specialist referrals are required.
You also have the freedom to see a dentist who is not in the GHI network, although your out-of-pocket expenses will likely increase. Claims for non-network care are reimbursed at the in-network fee schedule levels.
Check our network to see if your dentist participates.
Paid-in-Full Prevention - The Best Medicine
Regular dental visits can help to prevent serious and costly dental and medical problems. That's why preventive and diagnostic care - cleanings, x-rays, fluoride treatments (for dependent children) and check-ups - are covered at no cost to you when you visit a participating network dentist in the GHI FEDVIP Dental Plan.
The GHI plan covers the following preventive and diagnostic services at no cost to you:
- Two examinations in a calendar year
- Two adult or child prophylaxes (routine cleanings) in a calendar year
- Two fluoride treatments in any 12 consecutive months for dependent children to age 19
- Sealants for molars for dependent children to age 18
- A full mouth series of x-rays, payable once in a three-year period, and four bitewing x-rays each calendar year
- Space maintainers for dependent children to age 19
Many Other Covered Services
After you have met your annual $50 deductible, GHI FEDVIP Dental includes paid-in-full in-network coverage for a wide variety of surgical procedures, basic and major restorations, tooth extractions, bridge and denture repairs, and other services.
The GHI plan covers the following services at no cost to you:
- Amalgam (silver) fillings and composite (white) fillings on anterior teeth
- Simple extractions
- Surgical extractions and oral surgery
- Periodontal treatment
- Root canals (endodontics)
- Anesthesia and IV sedation in conjunction with approved surgical procedures
- Palliative (emergency) treatment to relieve pain
- Crowns (caps) made of base metal
- Full and partial dentures
- Fixed bridgework
- Denture, crown and bridge repairs
- Specialist consultations
You may incur some out-of-pocket expenses for in-network services when voluntary upgrades in material are elected for items such as single crowns, bridge abutment crowns and pontics (false teeth), or fillings on posterior teeth.
Pre-determinations or Pre-treatment Estimates
Pre-determinations (also called pre-treatment estimates) are not mandatory, but GHI suggests pre-determination of benefits for procedures including surgeries, prosthetics, major restorations, orthodontics and other expensive treatments. Pre-determinations are recommended for treatment costing $300 or more.
Through pre-determination of benefits, you can ensure there are no surprises regarding your out-of-pocket expenses. Your dentist will work with GHI to verify the necessity and cost effectiveness of a proposed treatment plan for high-dollar procedures. Pre-determinations are a valuable tool to help patients estimate their costs for treatment. Out-of-pocket expenses, if any, are clearly defined.
Emergency treatment is excluded from the pre-determination process.
Standard Exclusions, Limitations and Guidelines
Of course, not all dental procedures are covered. Some services, such as those that are purely cosmetic in nature, are excluded. And the plan includes an annual benefits maximum of $1,250, determined by calendar year. Below is a list of some procedures that are not covered under GHI FEDVIP Dental.
- Implants and services related to implants
- Orthodontics for minor tooth movement
- Habit control appliances
- Cosmetic surgery or treatment
- Temporary appliances
- Prescription drugs or medications
- TMJ disorders (Services and appliances for the treatment of temporo-mandibular joint dysfunction syndrome are not covered).
- Costs incurred for behavior management
Enrolled in GHI's PPO medical option?
The GHI medical PPO and EPO options include preventive and diagnostic dental benefits coverage through our Preferred Dental network. Enrollment in the GHI medical PPO or EPO option, in conjunction with the purchase of the GHI FEDVIP Dental plan, allows you to expand the number of covered services through a Preferred participating network office. In addition, your $1,250 annual maximum will stretch further, since many of your preventive services will be covered under the medical plan. Coordination between the preventive coverage on the medical plan and the FEDVIP dental will be handled seamlessly by GHI. No additional paperwork or claim submission is required.
The Preferred Dental coverage under GHI's PPO and EPO medical plans is considered the primary coverage.
(Please note GHI's HMO option does not include a preventive dental benefit).
