Dominion's office hours are 8:00 a.m. to 6:00 p.m. (EST), Monday through Friday. Member Services Specialists are available from 7:30 a.m. to 6:00 p.m. (EST), Monday through Friday. After business hours, members have access to certain functions via our Interactive Voice Response (IVR) system and may leave a message.
You must choose a primary care dentist before you utilize the plan. Prior to your effective date, you will receive a notification prompting you to select a dentist. You can find a current list of dentists online at FederalDentalPlans.com/find-dentist.
You can also call us toll-free at 855.836.6337 to request a dentist list be mailed to you. After your effective date, simply call the dental office you selected and make an appointment. Except for out-of-area emergency care, you must receive treatment at the dental office you selected.
As long as you remain an eligible Federal employee, you will remain on the plan. For any questions regarding eligibility, please contact your ABO or BENEFEDS toll-free at 877.888.3337; TTY 877.889.5680. If you leave your place of employment and are no longer eligible for the FEDVIP program, please contact Dominion about plan options using a direct payment method.
You may go online to BENEFEDS.com or call BENEFEDS Call Center toll-free at 877.888.3337; TTY 877.889.5680.
You may go online to FederalDentalPlans.com or call our Member Services Department toll-free at 855.836.6337; TTY 711.
1 Dominion National Network Analysis Report, July 2017. Mid-Atlantic includes D.C., Delaware, Maryland, Pennsylvania and Virginia. Participating dentists are subject to change.
Federal and U.S. Postal Service employees and annuitants, including dependents, are eligible. Dependents include your spouse and unmarried children under age 22.
For any questions regarding eligibility, please contact your Agency Benefits Officer (ABO) or BENEFEDS toll-free at 877.888.3337; TTY 877.889.5680.
Yes. This benefit is part of the FEDVIP program and is endorsed by the U.S. Office of Personnel Management (OPM).
There are two ways for you to enroll.
Dominion's Dental HMO plan includes:
1 Dominion Dental Services, Inc. Network Analysis Report, July 2017. Mid-Atlantic includes D.C., Delaware, Maryland, Pennsylvania and Virginia. Participating dentists are subject to change.
Under the Dental HMO plan, you must use a participating dentist in the Dominion Dental HMO network. You simply pay any fee amounts listed on your Description of Benefits & Member Copayments directly to your participating dentist. Payment is due to your dentist upon receipt of services.
You must choose a primary care dentist before you utilize the plan. Prior to your effective date, you will receive a notification prompting you to select a dentist. At that time, you will be able to select your provider online or by calling our Member Services Department. You can find a current list of dentists online at FederalDentalPlans.com/find-dentist. You can also call us toll-free at 855.836.6337 to request that a dentist list be mailed to you. After your effective date, simply call the dental office you selected and make an appointment. Except for out-of-area emergency care, you must receive treatment at the dental office you selected.
Dominion’s comprehensive benefit package covers virtually all routinely performed procedures either in full or in part. We use the most up-to-date resources to design our benefit programs. For those services not listed on your Description of Benefits and Member Copayments, your dentist will charge their usual and customary rate.
Two cleanings per 12 months are covered at no charge (after the $10 office visit fee). An additional cleaning per year is also available for diabetics and expectant mothers at a $40 copayment. Please keep in mind that this procedure can only be applied to patients with healthy gingiva (gums). Your dentist may recommend a more comprehensive cleaning to bring your gums into a healthy state of maintenance. Additional charges may apply for these procedures. There is a $10 office visit charge for each visit to a participating dentist.
Your participating general dentist may refer you to a participating specialist or you may review our specialists on our online Dentist Search at FederalDentalPlans.com/find-dentist. Our Member Services Department may also assist you in obtaining specialty services. Specialty care is covered at the listed copayment. Should you need specialty care, your participating general dentist will refer you to a plan specialist to receive services. A referral by your participating general dentist to a participating specialist is necessary with the exception of orthodontic services.
First, you must enroll in the Dominion Dental plan of your choice through the BENEFEDS website. Once you enroll in the dental plan, premiums are withheld from your paycheck or annuity. Premiums are paid on a pre-tax basis (premium conversion) if you are an active employee and your salary is sufficient to make the premium withholding. Pre-tax premiums are not available to annuitants, survivor annuitants or compensationers.
Your copayments are listed by ADA code. You may refer to your Description of Benefits and Member Copayments (Select Standard/Select High) for your specific fees. Sometimes there are multiple codes and charges associated with a single service (For example, crowns consisting of semi-precious or precious metals will have an additional charge).
Yes, you will always be responsible for paying your $10 office visit copay, even if there is no other additional cost to you. For example, if you only receive an exam (D0120) and a cleaning (D1110) when you visit your dentist, for which there are no additional copays, you will still be responsible for paying your $10 office visit copayment.
Your dentist has set aside time in his/her schedule for your dental treatment. If you cannot make a previously scheduled appointment, the dental office should be notified as soon as possible. Please note there is a $50 copayment for broken appointments or cancellations with less than 48 hours advance notice. This is listed on your Description of Benefits and Member Copayments (Select Standard/Select High) as code D9990.
Your plan has coverage for emergency treatment due to injury, toothache or accident when temporarily more than 50 miles from your home. Out-of-area emergency care is covered for palliative (pain management) treatment only. The member is not required to call their assigned dentist but must send in a copy of receipt to Dominion for reimbursement. Dominion will reimburse up to $100 in these cases.
All claims for emergency treatment need to be submitted to the following address:
ATTN: Accounting Dept
251 18th Street South, Suite 900
Arlington, Virginia 22202
Because the cost of precious and semi-precious metals can fluctuate, you may be charged an additional fee for certain procedures. You should ask your dentist before treatment begins if any such fees will be charged. These would typically be added to a crown or bridge where gold or another semi-precious metal is used.
No, you must use a participating dentist in Dominion’s Select Plan (Dental HMO) network prior to receiving service. You will have the choice of any participating dentist in our Select Plan (Dental HMO) network, which is one of the largest DHMO networks in the Mid-Atlantic.
Yes. You and your dependents may receive care from different dental offices. You must notify our Member Services Department of any additional provider selections or selection changes. You can also contact us through our secure Interactive Voice Response System or make changes securely online. Both are available 24 hours a day.
Once you have received your enrollment confirmation email or Membership ID Card and you have selected your participating dentist, simply call your dentist’s office to make an appointment. Your plan dentist’s name and phone number are listed on the front of your ID card. If you have not received a card, you may contact our Member Services Department for information on scheduling an appointment.
Transfers between dental offices are fast and easy. You can select or change dental offices securely online. Please go to the member login area of our web page. Once logged in, choose “Change Dentists” on the member screen.
You can also call our Member helpline or email our Member Services Department. Please make available your name, membership number, new plan dentist selection, the reason for changing and the date of your last appointment. It is very important to follow the treatment plan prescribed to you by your dentist. Should you choose not to follow his/her recommendations, your doctor reserves the right to refer you to another office. Making sure you understand your treatment and following through with your treatment plan are important steps in maintaining a healthy mouth.
Yes, orthodontia is covered for adults and children. There are no waiting periods for orthodontic services. There is also no pre-authorization requirements. You simply make an appointment with a participating orthodontist to begin services. Please refer to your Description of Benefits and Member Copayments (Select Standard/Select High) for plan fees regarding specific orthodontic procedures.
When a member becomes effective with Dominion and is currently in treatment, Dominion will pay a total of $500 to the orthodontist for the remaining treatment, or the balance remaining from the previous insurer’s agreed-upon payment amount, whichever is lower. The member will be responsible for paying the difference remaining between the previous insurer’s payment, Dominion’s payment of $500, and the previous insurer’s total allowable. Dominion’s payment will be paid in one lump sum upon receiving the claim.
Claim submitted 2/1/2016
18 months of treatment remaining
Previous insurer’s total allowable: $4,000 (Total allowed: amount which would have been paid to the orthodontist over the lifetime of the case by both the previous insurer and the member had coverage remained effective with the previous insurer for the full duration.)
Previous insurer payment: $1,000
Dominion’s total payment: $500
Member responsibility: Agreed-upon amount – (Previous insurer payment + Dominion Payment)
$4,000 - ($1,000 + $500) = $2,500
First Payor Process for FEHB and Other Coordination of Benefits (COB)
If you have dental coverage through your FEHB plan, your FEHB plan will be the first payor of any benefit payments. This is called the First Payor process. The First Payor process and/or coordination of benefits for a Dental HMO will occur when you receive services from your assigned in-network provider or participating specialist. If you receive services from a general dentist to which you are not assigned, or visit an out-of-network specialist, there will be no benefit from the Dental HMO plan. This is only a summary; please see the plan brochure for more information.
I have FEHB coverage, as well as FEDVIP. Do I have to provide my FEHB ID card when I have a dental appointment?
Yes, when you receive dental services, you should present both your FEHB and your FEDVIP ID cards. The dentist’s office can then bill both plans and the plans will facilitate the first payor process. If your dentist will only bill one plan, make it the FEDVIP plan. Your FEDVIP plan will then contact your FEHB plan to facilitate the first payor process.
I signed up for FEDVIP to cover dental expenses. Why do I have to submit my dental claim to my FEHB plan?
The law which established FEDVIP states that if an individual has dental coverage under FEHB and also has FEDVIP coverage, the health benefits plan shall be the first payor of any benefit payments.
Dental HMO as Primary under COB with non-FEHB plans
When the FEDVIP Dental HMO plan is determined to be primary coverage, the maximum fee collected by the dentist will be the Dental HMO copayment. Secondary coverage will be applied to (deducted from) the subscriber’s Dental HMO copayment. If the secondary insurer’s payment is less than the Dental HMO copayment, the subscriber would then be responsible for paying the difference between the copayment and the reimbursed amount.
Example Dental HMO as primary:
|D2160||Amalgam – Three surface filling|
|Secondary Insurer (80% coverage)||- $60.80|
|Plus: Dominion Office Visit Copay||+ $10.00|
|Total Subscriber Owes:||$25.20|
Dominion Dental HMO as Secondary under the First Payor Process with FEHB Plans
When facilitating the first payor process with our FEDVIP Dental HMO and a member’s FEHB medical plan, with an embedded dental benefit, the FEHB plan is the designated first payor and will pay benefits first, however the FEDVIP plan allowance will be the prevailing charge. This is important for the HMO process due to the fact that the allowed amount for any service is the member’s copay, and for most preventive and diagnostic services, the copay is zero. Therefore, the allowed amount is also zero. In these situations there will be no primary payment due from the FEHB plan.
1. Simple Coordination: Primary payment and member copay
With a Dental HMO product, the member will never have a financial responsibility greater than the combined total of the $10 office visit charge and the agreed-upon copay(s) for performed procedure(s). In the case where there is a primary payment from a different plan, the primary amount paid will be applied to the Dominion member copayment, thus reducing the member’s responsibility.
|D2751||Crown - Porcelain fused to predominantly base metal||$555.00|
|Dentist’s Usual Charge submitted to primary insurer:||$850.00|
|Less: Primary Insurer paid (50% coverage):||- $425.00|
|Total Subscriber Owes:||$140.00|
2. No copay coordination: primary payment and zero-dollar copay
In the case where a Dental HMO member has services performed in which there is no copayment owed to the provider, there will also be no primary payment for those services, as the FEDVIP’s allowance is the prevailing charge (the member copay). There will be no additional responsibility from either the primary payor or the member.
|D0120||Periodic Oral Evaluation||$0.00|
|No primary payment due.|
|Total Subscriber Owes:||$10.00|
|D0120||Periodic Oral Evaluation||$0.00|
|D1110||Prophylaxis (cleaning) – adult||$0.00|
|D2330||Resin Based Composite Filling – one surface||$55.00|
|Dentist Usual Charge Submitted to Primary Insurer:||$162.00|
|Less: Primary Insurer (Primary benefit does not offer Filling coverage||- $0.00|
Dominion Office Visit copayment
Each family member enrolled with Dominion who receives two cleanings during the plan year will be reimbursed for their $10 office visit copayments made to the dentist at the time of service (a total reimbursement of $20 per family member). Dominion will submit a check for the reimbursement(s) to the primary subscriber at the end of the plan year. If you participate with FSAFEDS, Dominion may coordinate the reimbursement through your FSA. For more information, please go to FederalDentalPlans.com/PreventionRewards.