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Sections
Cover Page
Introduction
Table of Contents
Changes for 2025
FEDVIP Program Highlights
Section 1 Eligibility
Section 2 Enrollment
Section 3 How You Obtain Care
Section 4 Your costs for Covered Services
Section 5 Dental Services and Supplies Class A Basic
Class B Intermediate
Class C Major
Class D Orthodontic
General Services
Section 6 International Services and Supplies
Section 7 General Exclusions - Things We Do Not Cover
Section 8 Claims Filing and Disputed Claims Process
Section 9 Definitions of Terms We Use in This Brochure
Discounts
Tools and Resources
Summary of Benefits
Stop Health Care Fraud!
Rate Information
Rates
 
 

Blue Cross Blue Shield FEP Dental Brochure - 2025

 
 

 

Blue Cross Blue Shield FEP Dental
Summary of Benefits

 

Summary of Benefits

 

  • Do not rely on this chart alone. This page summarizes your portion of the expenses we cover; please review the individual sections of this brochure for more detail.
     
  • If you want to enroll or change your enrollment in this plan, please visit www.BENEFEDS.gov or call 1-877-888-FEDS (3337), TTY number 1-877-889-5680.
     
  • Out-of-network services under Class A, B and C are subject to a $50 deductible per person under High Option and a deductible of $75 for Standard Option per person per calendar year.
     
  • For children age 13 and under, you pay $0 for in-network Class B and Class C covered services as defined by the plan, subject to plan maximums.
 

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