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Brochure contents
Cover Page
Introduction
Table of Contents
Changes for 2022
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 and Features
Summary of Benefits
Stop Health Care Fraud!
Rate Information
Rates
Blue Cross Blue Shield FEP Dental Brochure - 2022
Section 4 Your Costs for Covered Services
Section 4 Your Cost For Covered Services
Deductible
Coinsurance
Annual Benefit Maximum
Lifetime Benefit Maximum
In-Network Services
Out-of-Network Services
Calendar Year
Emergency Services
In-Progress Treatment
