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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
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Summary of Benefits
Stop Health Care Fraud!
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Blue Cross Blue Shield FEP Dental Brochure - 2025

 
 

 

Blue Cross Blue Shield FEP Dental
Section 4 Your Cost for Covered Services

 

Out-of-Network Services

 

If the dentist you use is not part of our network, benefits will be considered at the out-of- network level. All services provided by an out-of-network dentist will be paid at out-of-network levels, except for limited access benefits. We pay for services rendered by an out-of-network dentist based on an out-of-network plan allowance. You will be responsible for your co-insurance percentage plus the billed amount over plan allowance.
 

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