Workers to Get Their Pick of Dental, Vision Plans

By Stephen Barr
Thursday, September 21, 2006

The new dental and vision benefit program for federal employees and retirees tries to fill a gap in their health-care coverage by offering a mix of national and regional plans that vary in cost and enrollment options.

The program's design should make the federal premiums competitive with plans offered in the private sector, officials at the Office of Personnel Management think. By law, the government cannot provide a subsidy for the new benefits, but enrollees who stay in dental and vision networks will have lower costs.

The OPM officials kicked off the new dental-vision program yesterday after announcing premium increases for the federal employees health insurance program. Federal employees and retirees will have to do some homework to determine which dental and vision options best fit their needs, of course. But OPM briefing materials provided a snapshot of the program's design and the options offered by 10 vendors.

As with their health insurance, federal employees will be able to pay their dental-vision premiums on a pretax basis through a payroll deduction. Retirees may have their premiums withheld from their monthly pension checks, but the Internal Revenue Code does not provide a tax break for retirees.

When enrolling, federal employees and retirees will select one of three options: self-only coverage; self plus one, for the enrollee and a family member; and self and family, for eligible family members (such as unmarried, dependent children under 22).

In the Washington area, biweekly dental premiums range from $9.64 for the MetLife self-only standard option to $51.20 for the Government Employees Hospital Association's high-benefit family option.

Biweekly premiums for vision benefits will range from $2.63 for self-only coverage through the Spectera standard option to $16.21 for family coverage under the Vision Services Plan high option.

The only service that will not be available to enrollees right away is orthodontia.

One of the 10 vendors, MetLife, will offer two dental options, high and standard. The high option, the OPM said, will provide the highest per-person maximum benefit of any nationwide provider -- $3,000 per person annually. Orthodontia will be covered after a two-year waiting period, with a $1,500-per-person lifetime maximum under the standard option.

Another vendor, CompBenefits, a dental-health maintenance organization, will provide coverage in the District, Virginia, West Virginia and most of Maryland. There are fixed co-payments for each service, regardless of the amount of the charge. The plan has no benefit maximum, but it does not offer an out-of-network benefit in most areas. It also has no lifetime maximum for orthodontia.

In general, dental plans will cover basic services, such as exams, sealants and X-rays; restorative procedures, such as fillings, crowns and periodontal scaling; and some major services, such as root canals and complete dentures.

Visions plans will provide eye exams and coverage for lens, frames and contact lens. Other benefits, such as discounts on Lasik surgery, also may be available.

OPM officials said employees will be able to enroll for the dental-vision programs through a Web site or by calling a toll-free number and speak to a program representative.

Some federal employee health insurance plans cover some dental and vision services. That will serve as the first payer for services, and the new dental-vision program will be secondary. Dental and vision enrollees will be asked to provide information on their medical insurance plan to help coordinate benefits.

To help reduce out-of-pocket costs, employees also will be able to use their flexible spending accounts, which require annual renewal, for any services that insurance doesn't pay for.

Federal employees and retirees will be able to enroll in the new program from Nov. 13 to Dec. 11. Coverage starts Dec. 31.

Innovation Deadline

The deadline to apply for the $100,000 Innovations in American Government award has been extended to Tuesday to give applicants more time to prepare and file their material, program spokesman Carl Fillichio said.

Applications and information on the award, given annually to creative, effective government programs, may be found at http://www.innovationsaward.harvard.edu . The original deadline was Sept. 12.

The award is administered by the Ash Institute for Democratic Governance and Innovation at Harvard's John F. Kennedy School of Government in partnership with the nonprofit Council for Excellence in Government.

Stephen Barr's e-mail address isbarrs@washpost.com.