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WE STAND FOR GREAT DENTAL COVERAGE. 2018 DENTAL RATES AND BENEFITS.

MESSAGE FROM GEHA

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Dear Federal Employee:

GEHA Connection Dental Federal® plans are designed exclusively for federal employees, retirees and their families. With more than 80 years serving the federal workforce, GEHA has a long-term commitment of providing affordable, high-quality benefits.

GEHA offers two dental plans: Standard Option and High Option. Both plans include comprehensive coverage, including fillings, root canals and other services. There are no waiting periods for most procedures, and no deductible. See our premium rates on page 5.

Our plans go beyond your oral health with these great supplemental benefits* in 2018:

Vision. Through Connection Vision® powered by EyeMed, you and your covered family members each pay only $5 for an annual routine eye exam when you use a qualified EyeMed participating provider.

Hearing. GEHA members save 30 percent to 60 percent off the average retail price of hearing aids through TruHearing.

Life Alert. You and your extended family members enjoy exclusive discounts, including free activation and a 10 percent discount for Life Alert® emergency-response services.

Teeth whitening. GEHA members receive a 20 percent discount off the lowest published price on all Smile Brilliant products – custom-fitted trays, teeth whitening gel and desensitizing gel.

With GEHA you get great out-of-network benefits and have the freedom to see any dentist you choose. For the most cost savings, we encourage you to visit our in-network providers. You can search our network at gehadental.com/finddentist.

Know how much you’ll payYou can estimate costs for many in-network dental procedures with our pricing tool at gehadental.com/pricing.

Choose dental coverage from the one not-for-profit association that puts your needs first. At GEHA, we stand by those who stand for us.

Thank you for your interest in GEHA Connection Dental Federal. If you have questions, please visit gehadental.com or call us at 877.590.GEHA.

In good health,

Julie Browne President & CEO

*GEHA supplemental benefits are neither offered nor guaranteed under contract with the FEHB or FEDVIP programs, but are made available to all enrollees and family members who become members of GEHA.

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WE STAND FOR HEALTHY SMILES.

When you choose a GEHA dental plan, you can be confident that your oral health is in good hands. You get free in-network preventive care, no deductible and the freedom to see any dentist you choose. Now that's something to smile about.

Free in-network preventive care includes exams, X-rays and two annual cleanings.

Large dental network with more than 340,000 provider locations nationwide. Choosing a dentist in the network can reduce your out-of-pocket costs.

Orthodontic care for the whole family is paid at 70 percent of plan allowance for children and adults, with no waiting period for High Option.

Comprehensive coverage for fillings, root canals and more.

Impressive $35,000 per person calendar-year maximum with High Option.

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Find your code, then find your premium. Locate your state or first three digits of your ZIP code, then match your rate code to the premium charts (next page) to see how much you’ll pay.

PREMIUM RATE CODES BY STATE / ZIP CODE (FIRST THREE DIGITS)

AK All 5 IN 463, 464 3 NE All 1 TN Rest of the state 2

AL All 1 IN Rest of the state 1 NH All 4 TX All 2

AR All 1 KS All 2 NJ 080-084 3 UT All 1

AZ All 2 KY 410, 452, 459 2 NJ Rest of the state 5 VA 201, 205, 220-227 4

CA 939-941, 943-952, 954 5 KY Rest of the state 1 NM All 3 VA Rest of the state 2

CA Rest of the state 4 LA All 2 NV All 3 VT All 2

CO All 4 MA All 4 NY 005, 100-119, 124-126 5 WA 980-985 5

CT 064-069 5 MD 205-212, 214, 217 4 NY 063 4 WA 986 3

CT Rest of the state 4 MD 219 3 NY Rest of the state 2 WA Rest of the state 4

DC All 4 MD Rest of the state 2 OH 430-432, 440-443, 450-455, 459 2 WI 540 3

DE All 3 ME 038 4 OH Rest of the state 1 WI Rest of the state 2

FL 330-334 3 ME Rest of the state 3 OK All 2 WV 254 4

FL Rest of the state 2 MI 480-485 3 OR All 3 WV Rest of the state 2

GA 300-303, 305, 311, 399 3 MI Rest of the state 2 PA 173-174 4 WY 834 2

GA Rest of the state 2 MN 550-555, 563 3 PA 183 5 WY Rest of the state 1

HI All 3 MN Rest of the state 2 PA 189-196 3 PR All 1

IA All 1 MO All 2 PA Rest of the state 1 GU All 1

ID All 2 MS All 1 RI All 4 VI All 1

IL 600-608 3 MT All 2 SC All 2

FOInternational + all other areas

not listed1IL Rest of the state 1 NC All 2 SD All 1

IN 460-462, 470, 472 2 ND All 1 TN 422 1

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BIWEEKLY COST

MONTHLY COST (RETIREES)

PREMIUM

PREMIUM RATE SCHEDULE*

HIGH OPTION STANDARD OPTION

Self Only Self Plus One Self and Family Self Only Self Plus One Self and Family

1 $16.23 $32.47 $48.70 $9.24 $18.48 $27.72

2 $17.84 $35.68 $53.55 $10.14 $20.28 $30.41

3 $20.25 $40.51 $60.75 $11.52 $23.01 $34.51

4 $21.86 $43.73 $65.61 $12.43 $24.84 $37.25

5 $24.26 $48.55 $72.87 $13.78 $27.56 $41.34

PREMIUM

PREMIUM RATE SCHEDULE*

HIGH OPTION STANDARD OPTION

Self Only Self Plus One Self and Family Self Only Self Plus One Self and Family

1 $35.17 $70.35 $105.52 $20.02 $40.04 $60.06

2 $38.65 $77.31 $116.03 $21.97 $43.94 $65.89

3 $43.88 $87.77 $131.63 $24.96 $49.86 $74.77

4 $47.36 $94.75 $142.16 $26.93 $53.82 $80.71

5 $52.56 $105.19 $157.89 $29.86 $59.71 $89.57

* Rates based on member's primary state of residence.

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Find your plan below to see what’s covered.

It’s easy.Enroll today.

To sign up for a plan online, visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal.

You can also call Benefeds toll-free at 877.888.3337 / TTY: 877.889.5680.

BENEFIT

All classes of service are included in both High Option and Standard Option as part of the plan. This is a brief description of services covered under the GEHA Connection Dental Federal plan. Do NOT rely on

this chart alone. All benefits are subject to the definitions, limitations and exclusions set forth in the dental brochure.

2018 PLAN YEAR WAITINGPERIOD

CALENDAR YEAR

DEDUCTIBLE

HIGH OPTION BENEFITPlan pays the following

percentage of the plan allowance:

STANDARD OPTION BENEFITPlan pays the following

percentage of the plan allowance:

In-network Out-of-network* In-network Out-of-network*

Basic–Class A†

Exams, Cleanings**, X-rays None None 100% 100% 100% 100%

Intermediate–Class B†

Fillings, Extractions and Periodontal maintenance

None None 80% 80% 55% 55%

Major–Class C†

Root canals, Crowns, Bridges, Dentures, Periodontal surgery and Implants***

None None 50% 50% 35% 35%

Orthodontic–Class D††

No waiting period for High Option. Orthodontic services after a 12-month waiting period for Standard Option for children and adults.

High Option

Standard Option

None 70% 70% 70% 70%None 12

Months

Calendar year maximum $35,000 / person $2,500 / person

* Member pays any difference between the plan allowance and the billed amount.

** Plans cover two cleanings per calendar year.

*** Implants are limited to $2,500 per covered person per year, included in the calendar year maximum.

† Class A, B, and C Covered Services are limited to a combined Calendar Year Maximum Benefit of $35,000 for High Option and $2,500 for Standard Option, per covered person.

†† Limited to a lifetime maximum of $2,500 under High and Standard Option, per covered person.

Limitations and exclusions – This plan has certain limits on dental coverage in order to keep plan rates affordable for you and your dependents. A complete list of plan limitations and exclusions may be found in the GEHA Connection Dental Federal Plan Brochure.

As with all FEDVIP plans, dental benefits available from your FEHB carrier will be considered before we calculate benefits paid by GEHA.

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Affordable and reliable ... it’s what you’d expect from GEHA.

When you choose an in-network dentist, your preventive care is free. That means you get two exams and cleanings a year, and a set of X-rays is included. Children qualify for free

fluoride treatments and tooth sealants.

Pre-determination estimate Before you receive treatment, estimate how much your care will cost. You or your provider can send in an itemized proposed treatment plan, and we will send you and your dentist an estimate of how the services will be covered.

Choosing a dentist You have your choice of providers. However, for many services, your out-of-pocket costs may be lower when you visit in-network providers. Network providers will not bill you more than the plan’s maximum allowable charge for covered services.

Know before you go GEHA’s Dental Procedure Pricing Tool helps you understand and compare treatment costs so you can make better decisions about your dental care. Learn more at gehadental.com/pricing.

Our coverage doesn’t stop at your dentist’s office. All GEHA Connection Dental Federal members receive additional year-round benefits and exclusive discounts.

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At GEHA, we never stop striving to help members live healthier. With GEHA Connection Dental Federal, you get these year-round benefits that will keep you and your family smiling.

Exclusive member benefits that work as hard as you do.

Smile Brilliant Whiten your teeth with a custom-made system from the comfort of home. All GEHA members will receive a 20 percent discount off the lowest published price on all Smile Brilliant products – custom-fitted trays, teeth whitening gel and desensitizing gel.

Smile Brilliant’s lab-direct system replicates the results dentists have been providing for years, with both in-office treatments and custom-fitted teeth whitening trays, at a 70 percent discount. Your Smile Brilliant kit is mailed directly to your home.

Make your upper and lower dental impressions – a simple process that takes about 10 minutes – and mail them back to the lab in the postage-prepaid envelope provided. Your handcrafted, customized trays are mailed back within eight business days.

A 100 percent refund is guaranteed within the first 45 days if you are not completely satisfied. Learn more at smilebrilliant.com/geha.

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Connection Hearing powered by TruHearing

GEHA members get exclusive access to low prices on TruHearing® hearing aids through our Connection Hearing® program. Most members see savings

of 30 to 60 percent off their hearing devices, an average of more than $1,800 per pair. Best of all, this benefit can be shared with extended family members.

TruHearing offers more than 100 options selected from the newest models from top companies such as Starkey, Phonak, ReSound, Oticon and Widex. TruHearing has a 95 percent customer satisfaction rating and more than 5,600 provider locations.

Here’s how it works. It starts with a phone call to TruHearing. A consultant will answer all

your questions, check your GEHA enrollment and set up an appointment with an affiliated audiologist or hearing instrument specialist near you.

At your appointment, you’ll receive a comprehensive hearing exam. Your audiologist or specialist will recommend hearing aids that fit your level of hearing loss, budget and lifestyle needs. Your choice will be ordered from TruHearing.

When your hearing aids arrive, your audiologist or specialist will have them programmed and customized. After that, you’ll receive full support from TruHearing, including a 45-day trial period, a three-year warranty, 48 free batteries per device, and professional follow-up visits to ensure your satisfaction. Learn more at gehadental.com/hearing.

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Life Alert Emergency Response

You can’t put a price on round-the-clock peace of mind, but all GEHA members and their extended

family (including adult children, parents and grandparents) can receive discounted emergency response services from Life Alert®, a leader in responsive emergency care.

Life Alert protects all family members in a home health emergency.

Using Life Alert can help seniors remain independent because they’re never alone, even if they’re living alone.

Every 11 minutes, Life Alert responds to calls that range from medical emergencies to falls, fires, home invasions and emergencies away from home.

Life Alert provides access to emergency help, 24/7, even if you can’t reach a phone.

GEHA members receive free activation plus a 10 percent monthly discount. To find out how easy it is to take advantage of this benefit, go to gehadental.com/lifealert.

Connection Vision powered by EyeMed

For GEHA members, Connection Vision® coverage is included for no

extra premium. You and covered family members can get annual eye exams for only a $5 copay when you visit an EyeMed provider. For eye exams at out-of-network providers, EyeMed will reimburse you up to $45 per covered member.

Benefits include: Access to thousands of network

providers, including LensCrafters, Pearle Vision, Sears Optical, Target Optical, JCPenney Optical and private practitioners.

Preferred pricing with fixed discounts for lenses, lens options, frames and conventional contact lenses at participating EyeMed providers.

No limit on the number of discounted glasses or contacts purchased each year.

Savings on surgical procedures, including LASIK, at participating locations.

Learn more at gehadental.com/vision.

© 2017 Government Employees Health Association, Inc. All rights reserved.

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We stand for clarity.When you sign up for a GEHA dental plan, you get the power to verify whether a service is covered – and estimate how much it will cost. To check your coverage and access our dental pricing tool, visit gehadental.com/pricing.

Save even more by staying in-network. GEHA Connection Dental Federal allows you to use any dentist you choose. GEHA will pay the same level of benefits for all qualified providers. You can save even more money by using an in-network dentist, because network providers will not bill GEHA members for costs above their agreed-upon fees. And with more than 340,000 provider locations nationwide, you have lots of great choices.

P.O. Box 2336Independence, MO 64051-2336

PRESORTEDSTANDARD

U.S. POSTAGE

PAID GEHA

Enroll at benefeds.com. You can also call Benefeds toll-free at 877.888.3337 / TTY: 877.889.5680.

For plan questions, call GEHA: 877.590.GEHA / gehadental.com