2010 Benefits & Rates
For Federal Employees with Standard Option Medical
Federal DentalBlue Standard Option Dental |
||
|---|---|---|
| Benefits 1 | Network Dentist | Non-Network Dentist 2 |
| Deductible Individual/Family (Deductible applies to Type III Services Only) |
$50/$150 | $50/$150 |
| Annual Maximum | $1,500 | $1,500 |
Type I Services
|
100% | 70% |
Type II Services
|
80% | 50% |
Type III Services
|
50% | 30% |
| * A 12-month waiting period for new enrollees will apply to Major Restorative and Prosthodontic Services. | ||
Type IV Services
|
Up to $1,000 savings | Not Available |
| Orthodontia services will be billed at a 20% discount, with up to $1,000 in lifetime savings off network providers' usual charge. This non-insured discount is available only through network providers. | ||
Monthly Rates - Standard Option |
|||
|---|---|---|---|
| Regional descriptions (determined by ZIP Code where you reside) | Employee | Employee +1 | Family |
| Region 1 | $30.30 | $51.55 | $84.90 |
| Region 2 | $26.45 | $44.90 | $74.00 |
Regions By ZIP Code |
|
|---|---|
| Region | Three Digit ZIP Code |
| Region 1 | 600-608 |
| Region 2 | 609-629 |
For Federal Employees with Basic Option Medical
Federal DentalBlue Basic Option Dental |
||
|---|---|---|
| Benefits 1 | Network Dentist | Non-Network Dentist 2 |
| Deductible Individual/Family (Deductible applies to Type III Services Only) |
$50/$150 | $50/$150 |
| Annual Maximum | $1,500 | $1,500 |
Type I Services
|
Not Available (Preventive & Diagnostic are covered under your Basic Option medical plan.) |
Not Available |
Type II Services
|
80% | 50% |
Type III Services
|
50% | 30% |
| * A 12-month waiting period for new enrollees will apply to Major Restorative and Prosthodontic Services. |
||
Type IV Services
|
Up to $1,000 savings | Not Available |
| Orthodontia services will be billed at a 20% discount, with up to $1,000 in lifetime savings off network providers' usual charge. This non-insured discount is available only through network providers. |
||
Monthly Rates - Basic Option |
|||
|---|---|---|---|
| Regional descriptions (determined by ZIP Code where you reside) | Employee | Employee +1 | Family |
| Region 1 | $20.65 | $35.10 | $57.85 |
| Region 2 | $18.50 | $31.50 | $51.85 |
Regions By ZIP Code |
|
|---|---|
| Region | Three Digit ZIP Code |
| Region 1 | 600-608 |
| Region 2 | 609-629 |
1 Your dental care benefits are highlighted above. To fully understand all the terms, conditions, limitations, and exclusions which apply to your benefits, please read the entire Policy.
2 For services received from an non-network dentist, the claimant will be responsible for any difference between the dentist's charges and the maximum allowable charge. The maximum allowable charge is based on our network negotiated fees. Further information regarding the maximum allowable and network status of dentists is available by calling the toll free telephone number on the back of your dental identification card.