Frequently Asked Questions

FEDVIP is separate and different from the FEHB Program. Each program has its own regulations. Members do not have to enroll in the same carrier plans. If they're eligible, federal employees can enroll:

• in one FEHB plan, another carrier's FEDVIP dental plan, and a third carrier's FEDVIP vision plan
• in a family plan for FEHB, self plus one for FEDVIP dental, and self only for FEDVIP vision

Additional differences:

• FEDVIP coverage continues when an employee retires. There is no five-year prior coverage requirement like there is for the FEHB Program.
• For FEDVIP, dependent coverage ends on the dependent's 22nd birthday; for the FEHB Program, on the dependent's 26th birthday.
• There is no temporary continuation of FEDVIP coverage.
• FEDVIP coverage cannot be converted into an individual policy.

By law, FEDVIP plans are required to facilitate the first payor process with the FEHB Program. FEDVIP carriers will always be secondary to any dental or vision benefits contained in the FEHB Program.

During open season
If an eligible federal civilian or retired uniformed service member enrolls during open season, their FEDVIP coverage will be effective on January 1, the start of the next plan year.

Outside open season
If a federal civilian is newly eligible and enrolls outside of open season, their FEDVIP coverage will be effective the first day of the first pay period following the date we receive their enrollment.

If a retired uniformed service member is newly eligible and enrolls 31 days prior to retirement, their FEDVIP coverage will be effective on their retirement date. If they enroll within 60 days after retirement, their FEDVIP coverage will be effective the first of the month following their enrollment date.

If someone experiences a qualifying life event, their FEDVIP coverage is effective the first day of the first pay period following the date BENEFEDS receives their enrollment.

The following family members are eligible for FEDVIP.

Federal civilians:

• spouses
• dependent children under age 22 (including recognized natural children, adopted children, stepchildren and foster children, if living with an employee or annuitant in a regular parent-child relationship)
• dependent children age 22 and older who are incapable of self-support due to a mental or physical disability that began before age 22

Uniformed service members:

• spouses
• dependent children under age 21 (including recognized natural children, adopted children, stepchildren and foster children, if living with an employee or annuitant in a regular parent-child relationship)
• dependent children who are incapable of self-support due to a mental or physical disability that began before age 21 (non-students) and age 23 (full-time students)

Federal civilians
It is the employing agency's responsibility, under FEDVIP, to determine whether a dependent child age 22 or older is incapable of self-support (ISS) due to a mental or physical disability that existed before age 22.

Prior to a dependent's 22nd birthday
BENEFEDS will send a letter to the enrollee 60 days prior to a dependent child's 22nd birthday, informing them that their dependent will be dropped from their FEDVIP enrollment as of their 22nd birthday. If the dependent is incapable of self-support, the enrollee will be advised to contact their employing agency or retirement system to provide eligibility verification documentation for approval or denial. BENEFEDS does not make determinations as to whether a child is or is not incapable of self-support. BENEFEDS will automatically remove the dependent on their 22nd birthday unless the employing agency or retirement system notifies BENEFEDS that the dependent should remain on the FEDVIP plan. BENEFEDS refers any questions about approval back to the employing agency or retirement system.

To notify BENEFEDS that the dependent should remain on the FEDVIP plan, the agency benefits officer must:

• email FEDVIPadministration@ltcpartners.com from a federal email address
• include the enrollee's name, dependent name, status of disability (permanent or temporary*), date through which the incapacity is certified, and an HR signature
• not include attachments

Please see BAL 13-208 and Attachment 1 for full ISS details.

After a dependent's 22nd birthday
If a dependent child older than age 22 has been removed from FEDVIP enrollment and the primary enrollee calls stating the child is incapable of self-support, the enrollee may add their child back to their FEDVIP plan(s) if they are within 60 days from the day the child turned age 22.

Within 60 days from the dependent's 22nd birthday:

• The enrollee must contact their employing agency or retirement system to submit the necessary documentation.
• The decision and supporting documentation must be received by BENEFEDS within 60 days from the date the child turned 22.
• Once BENEFEDS receives approval from the employing agency or retirement system, the dependent will be added back to the plan retroactive to the drop date, with no lapse in coverage.

Beyond 60 days from the dependent's 22nd birthday
The enrollee may add their child back to their FEDVIP plan during the next Federal Benefits Open Season and provide supporting documentation.

Uniformed service members
It is the uniformed service member or sponsor's responsibility to determine whether a dependent child is incapable of self-support (ISS).

If the child is unmarried and incapable of self-support due to a mental or physical disability that began before age 21 (non-student) or before age 23 (full-time student) and they are financially dependent on the sponsor for more than 50% of their support, then they are considered an eligible child and may be added to the sponsor's FEDVIP dental and/or vision plan. If the sponsor enrolls in a FEDVIP plan and wants to add their child to their plan, we'll ask for the child's date of birth and what type of eligible child they are for purposes of coverage.

The child's incapable of self-support status must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) prior to enrolling them in FEDVIP. Once ISS eligibility has been established in DEERS, the sponsor does not need to establish eligibility again under FEDVIP.

Once enrolled in FEDVIP, if the child becomes incapable of self-support, they must register the child's incapable of self-support status in DEERS and notify BENEFEDS prior to their 21st birthday (non-student) or 23rd birthday (full-time student), so that the child may continue their coverage.

BENEFEDS reserves the right to validate the family member's eligibility in DEERS.

They do not need to re-enroll. Even though the payroll office will notify BENEFEDS of the change in payroll offices, we do encourage employees to notify BENEFEDS before any change in enrollment, including the new agency name. We cannot process the payroll deduction of their dental and/or vision plan premiums until we receive the updated agency information. If the employee does not see premiums deducted by their new payroll office, they should contact BENEFEDS Customer Service. Note: If we cannot confirm the new agency location, BENEFEDS will begin billing the employee directly. If an agency benefits officer (ABO) is assisting with this process, the employee must complete and submit the Authorization for Disclosure of Information form before BENEFEDS will discuss the case with an ABO.

If a federal civilian is enrolled as an employee and eligible for an immediate annuity, their FEDVIP plan automatically continues when they retire. They do not need to act. There is no five-year coverage requirement for continuing FEDVIP into retirement like there is for the Federal Employees Health Benefits (FEHB) Program.

Retirement is not a qualifying life event. This means you cannot change or cancel your FEDVIP plan during the plan year because of retirement. If you wish to change or cancel, you must wait for the next Federal Benefits Open Season, which typically runs from the second Monday in November through the second Monday in December each year.

Once BENEFEDS has been notified of an employee's retirement from their payroll office, we will work with their annuity system to set up premium deductions from their annuity (the frequency of deductions will change from 24 or 26 per year to only 12). Premium deductions will begin when their annuity is finalized, assuming it is sufficient to cover the premiums. In most cases, changing from payroll deduction to annuity deduction is automatic. But there are some cases that can take an extended period for your annuity to be finalized.

Note: Employees must pay all direct bills until their annuity is finalized. BENEFEDS cannot deduct FEDVIP premiums from their annuity until the U.S. Office of Personnel Management (OPM) processes their retirement (OPM will provide a claim number). While they are receiving interim payments, BENEFEDS will send direct bills to pay for your premiums. Employees must pay any direct bills they receive to keep their coverage active. If they do not pay the direct bills, their coverage may be cancelled.

Active uniformed service members who are retiring are eligible to enroll in FEDVIP dental coverage and (if enrolled in a TRICARE health plan) FEDVIP vision coverage. They're considered newly eligible for the program, and they can enroll 31 days prior to their military retirement date until 60 days following.
Note: To prevent a gap in dental coverage between their active duty or reserve dental plan and their FEDVIP plan, retiring uniformed service members must enroll prior to their retirement date.

If the uniformed service member's family was already enrolled in FEDVIP vision coverage while the uniformed service member was on active duty, the family member is no longer eligible as a primary enrollee upon the uniformed service member's retirement. The retiring uniformed service member or family member must call and notify BENEFEDS of the retirement. The family member's FEDVIP vision coverage will be inactivated. The retiree, as the sponsor, must then enroll in FEDVIP dental and/or vision coverage as a retired uniformed service member and add their eligible family members as dependents to their coverage.

If a federal employee expects to go on leave without pay, they have the option to set up accelerated payments to pay for their premiums. To set up accelerated payments, the employee must select the number of pay dates they'd like to pay for premiums when they enroll. We will then calculate their deduction amount based on this selection and set up the deductions with their pay provider.

No. BENEFEDS can't give information about an enrollee's FEDVIP plans to anyone other than the enrollee, insurance carrier, and payroll/annuity provider unless the enrollee completes and submits an authorization form allowing such disclosure. To give us permission to disclose plan information to a designated person, the enrollee must complete an Authorization for Disclosure of Information form and fax it to 1-833-889-3666 or mail it to BENEFEDS, Attn: HIPAA Privacy Office, P.O. Box 797, Greenland, NH 03840-0797.