Warning

No content found for: ‭portal site/z6_000000000000000000000000a0/z6_mai21141l0ns50qehkn8631pj7/z6_mai21141l08pf06a4if0de2d21/who-is-eligible‭

Faqs

Select FAQs Category

You must use a participating dentist in Dominion’s EPO network. Our expansive EPO dental network provides access to nearly 13,000 dentist listings in the Mid-Atlantic.¹ Dominion’s EPO network provides enrollees with more options, flexibility and access. Enrollees must receive services from an in-network dentist, but do not need to select a primary care dentist. Renewing Dominion enrollees will get to keep their current dentist in the new EPO program and family members may continue to go to different dentists.

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 and make an appointment. Except for out-of-area emergency care, you must receive treatment from an in-network dentist.

Yes. You and your dependents may receive care from different dental offices.

Once you have received your enrollment confirmation email or Membership ID Card, simply call your dentist’s office to make an appointment. If you have not received an ID card, you can access a digital ID card at DominionMembers.com, or through the Dominion National Go mobile communication service (DominionNational.com/go).

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 the EPO plan will occur when you receive services from an in-network provider or participating specialist. If you visit an out-of-network provider, there will be no benefit from the EPO plan. This is only a summary; please see the plan brochure for more information.

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 the EPO plan will occur when you receive services from an in-network provider or participating specialist. If you visit an out-of-network provider, there will be no benefit from the EPO 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.

EPO plan as Primary under COB with non-FEHB plans

When the FEDVIP EPO plan is determined to be primary coverage, the maximum fee collected by the dentist will be the EPO copayment. Secondary coverage will be applied to (deducted from) the subscriber’s EPO copayment. If the secondary insurer’s payment is less than the EPO copayment, the subscriber would then be responsible for paying the difference between the copayment and the reimbursed amount.

Example EPO plan as primary:

Code	Description	Copay
D2160	Amalgam – Three surface filling	$76.00
	Office Visit	$10.00
	Dominion Copayment:	$76.00
	Secondary Insurer (80% coverage)	- $60.80
	Subscriber Owes:	$15.20
	Plus: Dominion Office Visit Copay	+ $10.00
	Total Subscriber Owes:	$25.20

Dominion EPO as Secondary under the First Payor Process with FEHB Plans
When facilitating the first payor process with our FEDVIP EPO plan 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 EPO 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 an EPO 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..

Code	Description	Copay
D2751	Crown - Porcelain fused to predominantly base metal	$555.00
	Dentist’s Usual Charge submitted to primary insurer:	$850.00
	Dominion copayment:	$555.00
	Less: Primary Insurer paid (50% coverage):	- $425.00
	Subscriber Owes:	$130.00
	Office Visit	$10.00
	Total Subscriber Owes:	$140.00

2. No copay coordination: primary payment and zero-dollar copay
In the case where an EPO 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.

Example A:

Code	Description	Copay
D0120	Periodic Oral Evaluation	$0.00
	No primary payment due.
	Office Visit	$10.00
	Total Subscriber Owes:	$10.00

Example B:

Code	Description	Copay
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
	Dominion copayment:	$55.00
	Less: Primary Insurer (Primary benefit does not offer Filling coverage	- $0.00
	Subscriber Owes:	$55.00
	Dominion Office Visit copayment	+ $10
	Total Subscriber Owes:	$65

Federal and U.S. Postal Service employees and annuitants, as well as TRICARE retirees, 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).

Competitive rates
Price transparency with predictable, pre-determined fees
No annual maximums, deductibles or waiting periods
No copayment for virtual appointments
Third annual cleaning provided at a reduced fee
$20 back per family member with Prevention Rewards
Discounts on Invisalign and teeth whitening procedures
Orthodontic coverage for children and adults (no lifetime maximum), as well as access to SmileDirectClub’s clear aligners and teeth whitening
Virtual care through an innovative teledentistry app
Access to digital ID card, dentist search and more via Dominion's Go mobile notification service

1 Dominion National Network Growth Report, 2021. Mid-Atlantic includes D.C., Delaware, Maryland, New Jersey, Pennsylvania and Virginia. Participating dentists are subject to change.

There are two ways for you to enroll.

Go to BENEFEDS.com, which contains extensive support and FAQs to assist you through the enrollment process. If you don’t already have an online BENEFEDS account, you will be prompted to create one prior to enrolling.
Call BENEFEDS Call Center toll-free at 877.888.3337; TTY 877.889.5680.

First, you must enroll in the Dominion National 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.

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.

Under the EPO plan, you must use a participating dentist in the Dominion National EPO 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.

Your copayments are listed by ADA code. You may refer to your Description of Benefits and Member Copayments (EPO Standard/EPO 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).

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.

Your copayments are due at the time treatment is rendered. Please refer to your Description of Benefits & Member Copayments (EPO Standard/EPO High) for you specific fees.

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.

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 in-network 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:
Dominion National
ATTN: Accounting Dept
P.O. Box 211424
Eagan, MN 55121

Yes, orthodontia is covered for adults and children. There are no waiting periods for orthodontic services. There are 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 (EPO Standard/EPO High) for plan fees regarding specific orthodontic procedures.

SmileDirectClub Orthodontic Clear Aligners:

You will also have access to a discounted rate of $1,850 on clear aligners. This could save you up to 67% compared to the national average cost of traditional braces. Learn more at DominionNational.com/sdc.

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.

Example:

Claim submitted 2/1/2020
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

Two cleanings per 12 months are covered at no charge (after the $10 office visit copay). An additional cleaning per year is also available 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.

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). If you participate with FSAFEDS, Dominion may coordinate the reimbursement through your FSA. For more information, please go to FederalDentalPlans.com/PreventionRewards.

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.

Should you need specialty care, your participating general dentist will refer you to a plan specialist to receive services. You may review our specialists on our online dentist search at FederalDentalPlans.com/find-dentist. A referral by your participating general dentist to a participating specialist is necessary with the exception of orthodontic services.

Specialty care is covered at the listed copayment. Refer to your Description of Benefits and Member Copayments (EPO Standard/EPO High).

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 (EPO Standard/EPO High) as code D9990.

A PPO plan lets you use any dentist. The EPO plan requires the use of a participating dentist that has been certified by Dominion.
A PPO plan has annual maximum dollar limits. The EPO plan does not have any maximum annual dollar limits.
A PPO plan covers procedures as a percentage of coverage where it might not be clear what the member’s out-of-pocket costs will be. On the EPO plan there are specific copayments listed for each covered service (and no member out-of-pocket guess work).