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Final regulations set for federal dental coverage

Washington—Federal employees cannot be denied dental coverage because of a pre-existing condition, the U.S. Office of Personnel Management said in final regulations governing the enhanced benefits established by 2004 legislation.

"Neither enrollment nor benefits coverage is denied due to a pre-existing dental condition," said the OPM regulations issued Aug. 26. "However, since the dental program was established in order to provide benefits for dental services for teeth and their surrounding tissues, a carrier may determine that coverage does not extend to replacements for teeth missing before the effective date of enrollment in the program." Although there are no pre-existing condition limitations, there may be specific plan exclusions or limitations.

The voluntary coverage is available to federal employees, family members and retirees worldwide. Under the 2004 law, the government does not subsidize dental coverage, but employees may pay premiums with pre-tax dollars. During the 2008 open season, which will run from Nov. 10 to Dec. 8, employees may select dental and other health coverage. The OPM first offered dental coverage in the 2006 open season.

The final rule also allows for cancellation of enrollment in a dental plan when an enrollee or spouse is called to active military service. Dental plans under the Federal Employees Dental and Vision Insurance Program will include underserved areas in their service areas and provide benefits to enrollees in underserved areas, the OPM said. In areas not meeting OPM "access standards," enrollees may receive services from non-network providers.

Dental coverage is offered by Aetna Life Insurance Company, Government Employees Health Association, Inc., MetLife Inc., United Concordia Companies, Inc., Group Health, Inc., CompBenefits, and Triple-S, Inc. Some plans are available only in specific areas and others nationwide. All plan brochures are available for downloading from the FEDVIP Web site.

Dental carriers conduct their own disputed claims process and are required to use an independent third party to conduct a final analysis of any dispute, upon appeal, the regulations say. "This process was established to ensure an independent evaluation is conducted but at minimal cost to program enrollees."

There is a waiting period of up to 24 months for orthodontia services but no waiting periods for other covered dental services.