You can select from several nationwide, and in some areas, regional dental Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) plans, and high and standard coverage options.  You can also select from several nationwide vision plans.  You may enroll in a dental plan or a vision plan, or both.  Some TRICARE beneficiaries may not be eligible to enroll in both.  Visit www.opm.gov/dental or
www.opm.gov/vision for more information.

You enroll online at www.BENEFEDS.gov.  Please see Section 2, Enrollment, for more information.

If you or one of your family members is enrolled in or covered by one FEDVIP plan, that person cannot be enrolled in or covered as a family member by another FEDVIP plan offering the same type of coverage; e.g., you (or covered family members) cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans.

If you sign up for a dental and/or vision plan during the 2024 Open Season, your coverage will begin on January 1, 2025.  Premium deductions will start with the first full pay period beginning on/after January 1, 2025.  You may use your benefits as soon as your enrollment is confirmed.

Employees automatically pay premiums through payroll deductions using pre-tax dollars. Annuitants automatically pay premiums through annuity deductions using post-tax dollars.  TRICARE enrollees automatically pay premiums through payroll deduction or automatic bank withdrawal (ABW) using post-tax dollars.

Each year, an open season will be held, during which you may enroll or change your dental and/or vision plan enrollment.  This year, open season runs from November 11, 2024 through midnight Eastern time December 9, 2024.  You do not need to re-enroll each open season unless you wish to change plans or plan options; your coverage will continue from the previous year.  In addition to the annual open season, there are certain events that allow you to make specific types of enrollment changes throughout the year.  Please see Section 2, Enrollment, for more information.

Your enrollment or your eligibility to enroll may continue after retirement.  You do not need to be enrolled in FEDVIP for any length of time to continue enrollment into retirement.  Your family members may also be able to continue enrollment after your death.  Please see Section 1, Eligibility, for more information.

If you are a Federal or U.S. Postal Service employee, you are eligible to enroll in FEDVIP, if you are eligible for the Federal Employees Health Benefits (FEHB), the Postal Service Health Benefits (PSHB) Program or the Health Insurance Marketplace (Exchange) and your position is not excluded by law or regulation. Enrollment in the FEHB/PSHB Program or the Health Insurance Marketplace (Exchange) is not required.

Certain temporary, intermittent, and seasonal Federal and U.S. Postal Service employees are now eligible to enroll in FEDVIP. To be eligible, these employees must be expected to work 130 hours per calendar month for at least 90 days. In addition, certain firefighters hired under a temporary appointment and intermittent emergency response personnel are eligible to enroll in FEDVIP. The employing agency must determine and notify these employees of their eligibility. 

You are eligible to enroll if you:

• retired on an immediate annuity under the Civil Service Retirement System (CSRS), the Federal Employees Retirement System (FERS), or another retirement system for employees of the Federal Government;
• retired for disability under CSRS, FERS, or another retirement system for employees of the Federal Government.

Your FEDVIP enrollment will continue into retirement, if you retire on an immediate annuity or for disability under CSRS, FERS or another retirement system for employees of the Government, regardless of the length of time you had FEDVIP coverage as an employee.  There is no requirement to have coverage for 5 years of service prior to retirement in order to continue coverage into retirement, as there is with the FEHB/PSHB Program.

Your FEDVIP coverage will end if you retire on a Minimum Retirement Age (MRA) + 10 retirement and postpone receipt of your annuity.  You may enroll in FEDVIP again when you begin to receive your annuity.

If you are a survivor of a deceased Federal/U.S. Postal Service employee or annuitant and you are receiving an annuity, you may enroll or continue the existing enrollment.

A compensationer is someone receiving monthly compensation from the Department of Labor’s Office of Workers’ Compensation Programs (OWCP) due to an on-the-job injury/illness who is determined by the Secretary of Labor to be unable to return to duty.  You are eligible to enroll in FEDVIP or continue FEDVIP enrollment into compensation status.

An individual who is eligible for FEDVIP dental coverage based on the individual's eligibility to previously be covered under the TRICARE Retiree Dental Program or an individual eligible for FEDVIP vision coverage based on the individual's enrollment in a specified TRICARE health plan. 

Retired members of the uniformed services and National Guard/Reserve components, including “gray-area” retirees under age 60 and their families are eligible for FEDVIP dental coverage. These individuals, if enrolled in a TRICARE health plan, are also eligible for FEDVIP vision coverage. In addition, uniformed services active-duty family members who are enrolled in a TRICARE health plan are eligible for FEDVIP vision coverage.

Except with respect to TRICARE-eligible individuals, family members include your spouse and unmarried dependent children under age 22.  This includes legally adopted children and recognized natural children who meet certain dependency requirements.  This also includes stepchildren and foster children who live with you in a regular parent-child relationship.  Under certain circumstances, you may also continue coverage for a disabled child 22 years of age or older who is incapable of self-support.  FEDVIP rules and FEHB/PSHB rules for family member eligibility are NOT the same. 

For more information on family member eligibility visit the website at
www.opm.gov/healthcare-insurance/dental-vision/ or contact your employing agency or retirement system.

With respect to TRICARE-eligible individuals, family members include your spouse, unremarried widow, unremarried widower, unmarried child, and certain unmarried persons placed in your legal custody by a court. An unremarried former spouse who meets the U.S. Department of Defense’s 20-20-20 and/or 20-20-15 benefit eligibility requirements may only enroll in a self-only FEDVIP vision plan. Children include legally adopted children, stepchildren, and pre-adoptive children. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity. 

The following persons are not eligible to enroll in FEDVIP, regardless of FEHB/PSHB eligibility or receipt of an annuity or portion of an annuity:

• Deferred annuitants
• Former spouses of employees or annuitants.  Note:  Former spouses of TRICARE-eligible individuals may enroll in a FEDVIP vision plan.
• FEHB/PSHB Temporary Continuation of Coverage (TCC) enrollees
• Anyone receiving an insurable interest annuity who is not also an eligible family member
• Active-duty uniformed service members.  Note:  If you are an active-duty uniformed service member, your dental and vision coverage will be provided by TRICARE.  Your family members will still be eligible to enroll in the TRICARE Dental Plan (TDP). 
• Temporary/seasonal employees who do not meet the 130 hours per calendar month for 90 days.

You must use BENEFEDS to enroll or change enrollment in a FEDVIP plan.  BENEFEDS is a secure enrollment website (www.BENEFEDS.gov) sponsored by OPM.  If you do not have access to a computer, call 1-877-888-FEDS (3337), TTY number 1-877-889-5680 to enroll or change your enrollment. 

If you are currently enrolled in a FEDVIP vision plan and want to switch to BCBS FEP Vision, you must change enrollment through BENEFEDS.  If you do not want to change plans or options, your enrollment will continue automatically.  Please note: your plan's premiums may change for 2025.

Note: You cannot enroll or change enrollment in a FEDVIP plan using the Health Benefits Election Form (SF 2809) or through an agency self-service system, such as Employee Express, PostalEase, EBIS, MyPay, or Employee Personal Page.  However, those sites may provide a link to BENEFEDS.

Self Only: A Self Only enrollment covers only you as the enrolled employee or annuitant.  You may choose a Self Only enrollment even though you have a family; however, your family members will not be covered under FEDVIP.

Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plus one eligible family member whom you specify.  You may choose a Self Plus One enrollment even though you have additional eligible family members, but the additional family members will not be covered under FEDVIP. 

Self and Family: A Self and Family enrollment covers you as the enrolled employee or annuitant and all of your eligible family members.  You must list all eligible family members when enrolling.

If you or one of your family members is enrolled in or covered by one FEDVIP plan, that person cannot be enrolled in or covered as a family member by another FEDVIP plan offering the same type of coverage; e.g., you (or covered family members) cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans.

Open Season

If you are an eligible employee, annuitant, or TRICARE-eligible individual (TEI), you may enroll in a dental and/or vision plan during the November 11, 2024 through midnight Eastern time December 9, 2024, Open Season.  Coverage is effective January 1, 2025.

During future annual open seasons, you may enroll in a plan, or change or cancel your dental and/or vision coverage.  The effective date of these open season enrollments and changes will be set by OPM.  If you want to continue your current enrollment, do nothing.  Your enrollment carries over from year to year, unless you change it.

New hire/Newly eligible

You may enroll within 60 days after you become eligible as:

• a new employee;
• a previously ineligible employee who transferred to a covered position;
• a survivor annuitant if not already covered under FEDVIP; 
• an employee returning to service following a break in service of at least 31 days; or
• a TRICARE-eligible individual

Your enrollment will be effective the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment.

Qualifying Life Event

A qualifying life event (QLE) is an event that allows you to enroll, or if you are already enrolled, allows you to change your enrollment outside of an open season. 

The following chart lists the QLEs and the enrollment actions you may take:

Qualifying Life Event: Marriage
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes

Qualifying Life Event: Acquiring an eligible family member (non-spouse)
From Not Enrolled to Enrolled: No
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Losing a covered family member
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: Yes
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Losing other dental/vision coverage (eligible or covered person)
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Moving out of regional plan's service area
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes

Qualifying Life Event: Going on active military duty, non-pay status (enrollee or spouse)
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: Yes
Change from One Plan to Another: No

Qualifying Life Event: Returning to pay status from active military duty (enrollee or spouse)
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Returning to pay status from Leave without pay (LWOP)
From Not Enrolled to Enrolled: Yes (if enrollment cancelled during LWOP)
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes (if enrollment cancelled during LWOP)

Qualifying Life Event: Annuity/compensation restored
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Transferring to an eligible position*
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: Yes
Change from One Plan to Another: No

*Position must be in a Federal agency that provides dental and/or vision coverage with 50 percent or more employer-paid premium.

The timeframe for requesting a QLE change is from 31 days before to 60 days after the event. There are two exceptions:

• There is no time limit for a change based on moving from a regional plan’s service area. 
• You cannot request a new enrollment based on a QLE before the QLE occurs, except for enrollment because of loss of dental or vision insurance. You must make the change no later than 60 days after the event.

Enrollments and enrollment changes made based on a QLE are effective on the first day of the pay period following the one in which BENEFEDS receives and confirms the enrollment or change. BENEFEDS will send you confirmation of your new coverage effective date.

Once you enroll in a plan, your 60-day window for that type of plan ends, even if 60 calendar days have not yet elapsed. That means once you have enrolled in either a dental or a vision plan, you cannot change or cancel that particular enrollment until the next open season, unless you experience a QLE that allows such a change or cancellation.

VA Exception for Cancellation

Generally, you may cancel your enrollment only during the annual open season. However, if you are a FEDVIP enrollee paying premiums on a post-tax basis, and you, your family member, or TEI family member becomes eligible for VA dental or vision benefits, then you may change your enrollment type or cancel your enrollment within 60 days of receiving notification of VA dental or vision eligibility. This 60-day period may fall outside of open season. VA dental or vision eligibility documentation must be submitted to OPM via the BENEFEDS mailbox
(benefedsportal@opm.gov) within 60 days of notification to support the FEDVIP enrollment change or cancellation. 

Your cancellation is effective at the end of the day before the date OPM sets as the open season effective date. An eligible family member’s coverage also ends upon the effective date of the cancellation. 

If you are a FEDVIP enrollee paying premiums on a pre-tax basis, and you, your family member, or TEI family member becomes eligible for VA dental or vision benefits, then you may not change or cancel your FEDVIP enrollment until the next open season. 

FEDVIP enrollees can verify if they are paying their premiums on a pre- or post-tax basis by contacting BENEFEDS at 1-877-888-FEDS (3337), TTY number 1-877-889-5680. 

Coverage ends for active and retired Federal, U.S. Postal employees, and TRICARE-eligible individuals when:

• you no longer meet the definition of an eligible employee, annuitant, or TRICARE-eligible individual;
• as a Retired Reservist you begin active duty;
• a sponsor or primary enrollee leaves active duty;
• you begin a period of non-pay status or pay that is insufficient to have your FEDVIP premiums withheld and you do not make direct premium payments to BENEFEDS;
• you are making direct premium payments to BENEFEDS and you stop making the payments;
• it is the last day of the pay period for which BENEFEDS received premium following the loss of eligibility;
• you cancel the enrollment during open season.

Coverage for a family member ends when:

• you as the enrollee lose coverage; or
• the family member no longer meets the definition of an eligible family member.

Under FEDVIP, there is no 31-day extension of coverage. The following are also NOT available under the FEDVIP plans:

• Temporary Continuation of Coverage (TCC);
• spouse equity coverage; or
• right to convert to an individual policy (conversion policy).

If you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA), you should consider how coverage under a FEDVIP plan will affect your annual expenses, and thus the amount that you should allot to an FSAFEDS account. Please note that insurance premiums are not eligible expenses for either type of FSA.   

Please review  IRS - Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (www.irs.gov/forms-pubs/about-publication-969) for additional information about carryover and contribution amounts for the upcoming tax year. If you have an HCFSA or LEX HCFSA FSAFEDS account and you have not exhausted your funds by December 31st of the plan year, FSAFEDS can automatically carry over a set maximum amount of unspent funds into another health care or limited expense account for the subsequent year. To be eligible for carryover, you must be employed by an agency that participates in FSAFEDS and actively making allotments from your pay through December 31st. You must also actively re-enroll in a health care or limited expense account during the next open season to be carryover eligible. Your re-enrollment must meet the minimum contribution amount for the plan year. If you do not re-enroll, or if you are not employed by an agency that participates in FSAFEDS and actively making allotments from your pay through December 31st, your funds will not be carried over. 

Because of the tax benefits an FSA provides, the IRS requires that you forfeit any money for which you did not incur an eligible expense and file a claim in the time permitted. This is known as the “Use-it-or-Lose-it” rule. Carefully consider the amount you will elect. 

Current FSAFEDS participants must re-enroll to participate in the program next year.

See www.fsafeds.gov or call 1-877-FSAFEDS (372-3337) or TTY: 1-866-353-8058. Note: FSAFEDS is not open to retired employees or to TRICARE eligible individuals. 

If you enroll or are enrolled in a high deductible health plan with a health savings account (HSA) or health reimbursement arrangement (HRA), you may use your HSA or HRA to pay for qualified dental/vision costs not covered by your FEHB/PSHB and/or FEDVIP plans. 

Two ID cards are issued for each member, regardless of coverage option.  Existing members' ID cards are still valid.  If additional cards are needed, you may request them through our website, www.bcbsfepvision.com, or call us at 1-888-550-BLUE (2583) or TTY: 1-800-523-2847.  All eligible dependents listed on your enrollment share your identification number.  You do not need an ID card for each member of your family.  You can print a temporary ID card online in our member portal at www.bcbsfepvision.com/portal, view it in our mobile app or contact customer service to verify your eligibility in the plan.

We list in-network plan providers in the provider directory, which is updated frequently.  The most current list can be found on our website at www.bcbsfepvision.com.  It is your responsibility to ensure that the provider chosen is an active participant in the program, at the time you receive services.  The BCBS FEP Vision network is specific to routine vision care and is different from the network for your medical plan.

In some cases, due to local regulations or business practices, the doctor may be independent of the retail location.  You should confirm that both the doctor and the retail location are participating prior to seeking services.

We negotiate rates with vision care providers to help save you money. BCBS FEP Vision in-network providers are referred to as participating providers and are contracted through Davis Vision. When scheduling an appointment, you should identify yourself as a member of the FEDVIP BCBS FEP Vision plan. The provider is then responsible for verifying eligibility and submitting the claim by contacting BCBS FEP Vision either by telephone or via the web. If you use a participating provider to obtain covered care, benefits are paid at the in-network level. You are responsible for amounts over the plan allowance, lens copays, and optional lens and treatment copays.

BCBS FEP Vision also offers several in-network online options such as: contactsdirect.com, 1800contacts.com, befitting.com, glasses.com, lenscrafters.com, targetoptical.com, visionworks.com and warbyparker.com.  Check our website at www.bcbsfepvision.com for additional options.

Under Standard Option, you must stay in-network for covered services.  If you receive care from a non-participating provider, we will not pay for any services unless you reside in a limited access area.  Please see Section 4, Your Cost For Covered Services.

Under High Option, you may obtain care from any licensed eye care provider. If the provider you use is not part of our network, benefits will be considered out-of-network. Because these providers are out of the BCBS FEP Vision network, we will reimburse you up to the maximum reimbursement amount allowed by the plan (see fee schedule allowances as described in Section 4, Your Cost For Covered Services). You are responsible to pay the out-of-network provider and then submit a claim along with an itemized receipt to receive your reimbursement (see Section 8, Claims Filing and Disputed Claims Processes, for information).

Under Standard Option, you must stay in-network for covered services.  If you receive care from a non-participating provider, we will not pay for any services unless you reside in a limited access area.  Please see Section 4, Your Cost For Covered Services.

Pre-authorization is only required for:

• Medically necessary contact lenses in the treatment of certain eye health conditions and is obtained by the participating provider.
• The treatment of low vision and is obtained by the participating provider.
• The child benefit for children 13 and under if their prescription changes.
• The condition benefit for members with certain conditions (diabetes, hypertension, kidney disease, dementia, pregnancy, HNCRT (Head and Neck Cancer Patients with Radiation Therapy) if their prescription changes.

When you visit a provider who participates with both your FEHB/PSHB plan and your FEDVIP plan, and the FEHB/PSHB plan provides routine vision care and services, the FEHB/PSHB plan will pay benefits first. The FEDVIP plan allowance will be the prevailing charge in these cases.  You are responsible for the difference between the FEHB/PHSB and FEDVIP benefit payments and the FEDVIP plan allowance. We are responsible for facilitating the process with the primary FEHB/PSHB payor.

We do not coordinate benefits with non-FEHB/non-PSHB health plans.

If you live in an area that does not have adequate access to an BCBS FEP Vision network provider and you receive covered services from an out-of-network provider, we will pay up to 100% of our plan allowance listed below.  You are responsible for any difference between the amount billed and our payment.  To determine if you are in a limited access area call us at 1-888-550-BLUE (2583) or TTY: 1-800-523-2847.  

Members who reside in areas not meeting access standards* can visit an out-of-network provider, pay billed charges and then be reimbursed based on the plan allowance.

*NOTE: Access Standards
Urban and suburban Zip Codes: at least 90% of FEDVIP eligibles in a network access area (Zip Code plus 15 driving-miles) must have access to a vision care preferred provider.
Rural Zip Codes: at least 80% of FEDVIP eligibles in a network access area (Zip Code plus 35 driving-miles) must have access to a vision care preferred provider.

Plan Allowance: The maximum benefit payment for services provided in areas not meeting the access standards are shown in the chart below. You are responsible for charges billed over the amounts shown.

Services/Material: Vision Care Exam
High Option: We pay up to $50
Standard Option: We pay up to $50

Services/Material: Single Vision Lenses
High Option: We pay up to $72
Standard Option: We pay up to $72

Services/Material: Bifocal Lenses
High Option: We pay up to $109
Standard Option: We pay up to $109

Services/Material: Trifocal Lenses
High Option: We pay up to $136
Standard Option: We pay up to $136

Services/Material: Lenticular Lenses
High Option: We pay up to $136
Standard Option: We pay up to $136

Services/Material: Contact Lenses
High Option: We pay up to $150
Standard Option: We pay up to $140

Services/Material: Medically Necessary Contact Lenses
High Option: We pay up to $600
Standard Option: We pay up to $600

Services/Material: Frames
High Option: We pay up to $200
Standard Option: We pay up to $140

A co-payment is a fixed amount of money you pay to the provider when you receive services.

Example: The BCBS FEP Vision High Option and Standard Option plans have a $0 copay for a vision care exam. However, Standard Option has a $10 copay for lenses. This copay does not apply to High Option. Please refer to Section 5 for further details.

When you visit a BCBS FEP Vision network doctor, your vision care exam is covered in full and prescription glasses or contacts are covered after any co-payments.  If you visit an in-network independent provider, you will also receive 20% off any out-of-pocket costs over your frame allowance and a savings of 15% on any balance over your conventional contact allowance.  To receive covered benefits, you must stay in-network if you are enrolled in Standard Option. 

If you are enrolled in Standard Option, you must stay in-network for covered services.  If you receive care from a non-participating provider, we will not pay for any services unless you reside in a limited access area. Please see details described in (Section 3, How to Obtain Care) for information on limited access areas.

If you are enrolled in High Option, you’ll get more out of your coverage and pay lower out-of-pocket costs when you see a BCBS FEP Vision network provider.  Plus, there are no claim forms to submit when you see an in-network provider. When you visit an out-of-network provider, you will be reimbursed according to the schedule shown in the chart below.  Only items listed in the chart below are reimbursable.  You will be responsible for charges billed over the amounts shown.

Services/Material:  Vision Care Exam 
We Pay: Up to $30
Services/Material:  Single Vision Lenses
We Pay: Up to $25
Services/Material:  Bifocal Lenses
We Pay: Up to $35
Services/Material:  Trifocal Lenses
We Pay: Up to $45
Services/Material:  Lenticular Lenses
We Pay: Up to $45
Services/Material:  Elective Contact Lenses
We Pay: Up to $75
Services/Material:  Medically Necessary Contact Lenses
We Pay: Up to $225
Services/Material:  Frames
We Pay: Up to $30

Vision Care Exam: covered in full once every calendar year. 

• Includes dilation, if professionally indicated
• Includes refraction only if vision health exam is billed to medical; an EOB from medical insurance is required.

BCBS FEP Vision doctors provide a comprehensive exam that focuses on your eye health and overall wellness

In-Network: Nothing

Out-of-Network: Expenses in excess of the fee schedule allowance of $30

In-Network: Nothing

Out-of-Network: All charges

Retinal Imaging

In-Network: $29 copay

Out-of-Network: All charges

In-Network: $29 copay

Out-of-Network: All charges

Lenses: one pair every calendar year.

Lenses include choice of glass or plastic lenses, all lens powers (single vision, bifocal, trifocal, lenticular), fashion and gradient tinting, ultraviolet protective coating, oversized and glass-grey #3 prescription sunglass lenses.

Note: All lenses include scratch-resistant coating with no additional copayment. There may be an additional charge at in-network national and online retailers.

Note: You may choose prescription glasses or contacts.

In-Network: Nothing

Out-of-Network: Expenses in excess of fee schedule allowance of:

$25 single vision

$35 bifocal

$45 trifocal

$45 lenticular

In-Network: $10 copay

Out-of-Network: All charges

Optional Lenses and Treatments

In-Network Only

In-Network Only

Anti-Reflective (AR) Coatings - Standard/Premium/Ultra/Ultimate

$20/$33/$45/$70

$35/$48/$60/$85

Blended Segment Lenses

$20

$20

Blue Light Filtering Lenses

$15

$15

Digital single vision & computer lenses

$30

$30

Edge Polish

$22

$22

Hi-Index Lenses (1.67/1.74)

$55/$120

$55/$120

High Luster Edge Polish

$70

$70

Intermediate Vision Lenses

$30

$30

Mirror Coating

$86

$86

Photochromic Glass Lenses

$20

$20

Plastic Photosensitive Lenses (Transitions®)

No-Copay

$65

Polarized Lenses

$75

$75

Polycarbonate Lenses

No-Copay

No-Copay

Premium Scratch Resistant

$30

$30

Progressives Lenses - Standard/Premium/Ultra/Ultimate

$0/$40/$90/$125

$50/$90/$140/$175

Rimless Drill

$66

$66

Roll & Polish

$16

$16

Roll Edge

$24

$24

Scratch Protection Plan

$0

$0

Scratch Resistant Coating

$0

$0

Scratch Resistant Premium

$30

$30

Slab Off

$186

$186

Specialty Lens (myodisc/double sided grind) and Lenticular)

$206

$206

Tinted Lenses

No-Copay

No-Copay

Trivex Lenses

$50

$50

Ultraviolet Protective Coating

No-Copay

No-Copay

Frames: covered once every calendar year.

Receive an additional $50 towards your frame allowance at all MyEyeDr. locations. 

*Note: Additional discounts are available from in-network independent providers.  In-network national and online retailers do not offer the discount. 

Note: “Collection” frames, including newly introduced Green Eco sustainable Collection, with retail values up to $195 are available at no cost at most in-network independent providers. Retail chain providers typically do not display the “Collection,” but are required to maintain a comparable selection of frames that are covered in full.

In-Network:

Collection Frames: Nothing

Nothing for frames up to $200 frame allowance.  Additionally, a 20% discount applies to any amount over $200*

$250 frame allowance at all MyEyeDr. locations.  The additional 20% discount does not apply.

Out-of-Network: Expenses in excess of fee schedule allowance of $30

In-Network:

Collection Frames: Nothing

Nothing for frames up to $140 frame allowance.  Additionally, a 20% discount applies to any amount over $140*

$190 frame allowance at all MyEyeDr. locations.  Additional 20% discount does not apply.

Out-of-Network: All charges

Contact Lenses: covered once every calendar year – in lieu of eyeglasses.

*Note:  Additional discounts are available from in-network independent providers.  In-network national and online retailers do not offer the discount.

**Note: Pre-authorization is required.

In-Network:

Expenses in excess of a $150 allowance.  Additionally, a 15% discount applies to any amount over $150.*

The evaluation, fitting and follow-up care is covered in full for Non-Specialty contact lenses.  For Specialty lenses (including, but not limited to, toric, multifocal and gas permeable lenses), you receive $60 toward the contact lens evaluation and fitting, plus a 15% discount off the balance over $60*.  Participating providers will bill you for anything over the $60 less the discount so you do not have to file a claim. 

Expenses in excess of $600 for medically necessary contact lenses.**

Out-of-Network:  Expenses in excess of fee schedule allowance of:

$75 elective contact lenses

$225 medically necessary contact lenses

In-Network:

Expenses in excess of a $140 allowance. Additionally, a 15% discount applies to any amount over $140.*

The evaluation, fitting and follow-up care is covered with a $55 copay for non-specialty contacts, plus a 15% discount off the balance

Participating providers will bill you for anything over the $55, less the discount, so you do not have to file a claim.

Expenses in excess of $600 for medically necessary contact lenses.**

Out-of-Network: All charges

BCBS FEP Vision “Collection” frames and all eyeglass lenses manufactured in BCBS FEP Vision laboratories are guaranteed for one year from the original date of dispensing.  Warranty limitations may apply to provider or retailer supplied frames and/or eyeglass lenses.  Please ask your provider for details of the warranty that is available to you.

Benefit applies to children 13 years of age and under.

In-Network Only – High Option and Standard Option

One additional vision care exam is covered in full every calendar year.

If the child's prescription changes, one additional pair of lenses is covered in full for High Option members; there is a $10 copay for Standard Option members. Also, one additional pair of frames is covered if the child's prescription changes, with Collection frames covered in full and non-Collection frames subject to the allowance, plus a 20% discount on any amount over the allowance.

The prescription must have changed at least a 0.5 diopter or the seg height changed at least a 5.0 millimeter, or lens type changed,   e.g. (from single vision to bifocal).  Pre-authorization is required.

This benefit provides additional coverage to members who have been diagnosed with the following conditions:  diabetes, hypertension, kidney disease, dementia, pregnancy, HNCRT (Head and Neck Cancer Patients with Radiation Therapy).

In-Network Only - High Option and Standard Option

One additional vision care exam is covered in full every calendar year.

If the prescription changes, one additional pair of lenses is covered in full for High Option members; there is a $10 copay for Standard Option members.

The prescription must have changed at least 0.5 diopter or the seg height changed at least a 5.0 millimeter, or lens type changed, e.g. (from single vision to bifocal).  Pre-authorization is required.

Low Vision: Low vision is a significant loss of vision but not total blindness. Ophthalmologists and optometrists specializing in low vision care can evaluate and prescribe optical devices, and provide training and instruction to maximize the remaining usable vision for our members with low vision. After pre-authorization by BCBS FEP Vision, covered low vision services (both in- and out-of-network) will include one comprehensive low vision evaluation every five years, with a maximum charge of $300; maximum low vision aid allowance of $600 with a lifetime maximum of $1,200 for items such as high-power spectacles, magnifiers and telescopes; and follow-up care – four visits in any five-year period, with a maximum charge of $100 each visit.  Digital devices such as iPads, cell phones, etc. are not covered.  Participating providers will obtain the necessary pre-authorization for these services. 

.

Medically Necessary Contact Lenses: Contact lenses may be determined to be medically necessary and appropriate in the treatment of patients affected by certain conditions. Clinical documentation may be requested from your doctor to support the medically necessary contact lenses. Contact lenses may be determined to be medically necessary in the treatment of specific eye conditions such as:

Keratoconus

High Ametropia

Anisometropia

Aphakia

Aniridia

Moderate to Severe Dry Eye Disease

Irregular Astigmatism

Having the diagnosis of a particular eye condition does not guarantee that the contact lenses would be determined to be medically necessary per the criteria outlined in the clinical guidelines. 

Save with Blue365® Discounts

BCBS FEP Vision presents Blue365, a program that provides easy access to premier health and wellness products and services to help members build a path to live a healthy life. With Blue365, members get access to over 90 handpicked discounts from leading brands and there is no limit to how many deals a member can redeem. Many deals are available and new ones are constantly being added, including:  

• Fitness – Get the support you need to achieve your fitness goals with deals on wearable devices, apparel, home gym equipment, virtual workout classes and in-person gym access.
• Healthy Eyes and Ears – Between replacing hearing aids and correcting your vision, caring for your eyes and ears can get expensive quickly. Blue365 provides up to 60% off hearing aids, discounts on LASIK surgery and more.
• Home and Family – Your home and family can influence your mental, physical, emotional, and financial well-being. Blue365 offers discounts on premium vitamins and supplements, pet insurance, fertility services, products for new parents, financial offers, family health and more.
• Nutrition – Blue365 offers a variety of deals that help you eat right. Choose from meal kit subscriptions, chef-prepared entrees, weight management plans and more.
• Personal Care – A little self-care can go a long way toward improving your mental health. Blue365 offers exclusive discounts on skin care products, oral care products, tooth-whitening kits, mindfulness subscriptions and much more.
• Travel – Sometimes a vacation is all you need to escape stress and reset. Blue365 makes family getaways more affordable with discounted access to lodging, car rentals and vacation packages.

Each week, Blue365 members can receive great health and wellness deals via email. With Blue365, there is no paperwork to fill out. Just visit http://www.bcbsfepvision.com/additional-discounts and select Visit Blue365 deals to learn more about the various Blue365 vendors and discounts. BCBS FEP Vision does not recommend, endorse, warrant, or guarantee any specific Blue365 vendor or item. Vendors and the program are subject to change at any time.

Laser Vision Correction: BCBS FEP Vision members can realize substantial discounts on laser correction procedures using the QualSight Network. For more details visit our website at https://bcbsfepvision.com/lasik/.

Your Hearing Network: BCBS FEP Vision members have access to a hearing health care program through Your Hearing Network (YHN). For more details visit our website at https://bcbsfepvision.com/additional-discounts/.

Vision Cost Estimator Tool
Description: The vision cost estimator tool is a web-based, educational know-before-you-go resource that enables users to estimate their approximate out-of-pocket costs when visiting an in-network eye care provider, reducing financial surprises and demonstrating in-network value. The tool also provides descriptions on topics such as retinal imaging, eyewear preferences, the benefits of various lenses and other add-ons, and much more. Try our cost estimator tool by visiting https://bcbsfepvision.com/costestimator.

Vision Simulator
Description: Experience vision issues with the Vision Simulator:  See through the eyes of someone affected by glaucoma, cataract, diabetic retinopathy, presbyopia, glare, and macular degeneration, and experience the impact these common conditions have on sight. How would your daily activities be impacted? What moments would you lose? Whose faces would you miss?  Try our vision simulator by visiting https://bcbsfepvision.com/visionsimulator.

Virtual Frame Try-on
Description: Our frame try-on tool allows you to try our Exclusive Collection frames from the convenience of your phone, tablet, or computer.  Use your webcam to see what the frames look like on you or you can select a model.  Try our virtual frame try-on tool by visiting https://bcbsfepvision.com/frametryon.

AskBlue BCBS FEP Vision Plan Finder
Description: Need help choosing between High Option and Standard Option?  AskBlue makes it easy.  In just 10 minutes, you can answer some simple questions and get recommended a plan based on your needs.                                                                           

Try AskBlue by visiting https://askblue.bcbsfepvision.com

Member Portal
Description: Visit our member portal at www.bcbsfepvision.com/portal to, view your benefits, locate an in-network provider, check the status of your claims, request claim forms, and request a duplicate or replacement ID card.  Additional features include:

• Online EOBs – You can view, download, and print your Explanation of Benefits (EOB) forms.                                                Simply log on to www.bcbsfepvision.com/portal, enter your credentials, and from there you can search claims and select the “EOB” link next to each claim to access your EOB. You can also access EOBs via the bcbsfepvision mobile app.
• Check eligibility – You can verify all the eligible members on your account.
• Submit an out-of-network claim – If you choose to see an out-of-network provider you can submit your claim online in the member portal or via the bcbsfepvision mobile app.
• Shop online retailers – You can access our online retail partners' websites by clicking on the retailer's name.

BCBS FEP Vision Mobile Application
Description: BCBS FEP Vision’s mobile application is available for download for both iOS and Android mobile phones. The application provides members with 24/7 access to helpful features, tools and information related to BCBS FEP Vision benefits.  They can log in with their username and password to access personal eye care information such as benefits, out-of-pocket costs, and wellness information. They can also view claims and approval status, view/share Explanations of Benefits (EOBs), view/share member ID cards, locate in-network providers and shop online retailers.

Social Media
Description:  Follow us @fepblue on Facebook, Instagram, YouTube and LinkedIn for the latest information happening at BCBS FEP Vision.

Virtual Experience
Description: We’re thrilled to offer a unique, one-of-a-kind virtual experience!  Don’t miss this engaging, entertaining and educational experience for you to explore more about our vision care plans.  View this virtual experience on your computer or mobile device by going to https://bcbsfepvision.com/experience/.

For professional care you receive overseas, we provide benefits as indicated below.  You are responsible for any difference between our payment and the amount billed, in addition to any copayment amounts.  You must also pay any charges for non-covered services.

We do not maintain a network of providers outside the United States and Puerto Rico.  You may visit any international provider of your choice and be reimbursed up to the amount listed under "International Plan Allowances" below.

International providers are under no obligation to file claims on behalf of our members.  You may need to pay for the services at the time you receive them and then submit a claim along with an itemized receipt to us for reimbursement.  Claim forms are available at www.bcbsfepvision.com  or via email at fepmemberhelp@davisvision.com.  To file a claim for covered vision care services received outside the United States and Puerto Rico, send completed claim forms and itemized receipts to:

Blue Cross Blue Shield FEP Vision
PO Box 507
Troy, NY 12181

Or you may fax your claim to 518-220-6555.  Please contact us at fepmemberhelp@davisvision.com to let us know you would like to submit your claim via email.  We will respond with instructions on how to securely submit your claim. 

Contact us at: www.bcbsfepvision.com, via email at fepmemberhelp@davisvision.com or at 1-518-220-6569, TTY: 1-800-523-2847.

You may need to pay the provider in-full at the time of service and you will be reimbursed up to the amounts shown below:

Services/Material:  Vision Care Exam 
High Option: We pay up to $60
Standard Option: We pay up to $60

Services/Material:  Single Vision Lenses
High Option: We pay up to $72
Standard Option: We pay up to $72

Services/Material:  Bifocal Lenses
High Option: We pay up to $109
Standard Option: We pay up to $109

Services/Material:  Trifocal Lenses
High Option: We pay up to $136
Standard Option: We pay up to $136

Services/Material:  Lenticular Lenses
High Option: We pay up to $136
Standard Option: We pay up to $136

Services/Material: Contact Lenses
High Option: We pay up to $150
Standard Option: We pay up to $140

Services/Material:  Medically Necessary Contact Lenses
High Option: We pay up to $600
Standard Option: We pay up to $600

Services/Material:  Frames
High Option: We pay up to $200
Standard Option: We pay up to $140

If your vision care provider is participating in our network, they will file the claim for you, and we will send payment directly to the vision care provider.

If you live in a limited access area, overseas or if you obtain services from a non-participating provider (High Option only), you are responsible for filing the claim.  You can submit your out-of-network claim electronically using the mobile app, member portal on our website, or you can obtain claim forms on the website at

www.bcbsfepvision.com or by calling 1-888-550-BLUE (2583) or TTY: 1-800-523-2847.

You can also submit an out-of-network claim form along with copies of the provider’s bills by mail to:

Blue Cross Blue Shield FEP Vision
PO Box 507
Troy, NY 12181

Out-of-network claims (High Option only), international claims, and claims incurred in limited access areas must be submitted to and received by BCBS FEP Vision within 12 months of the date of service for reimbursement.

Follow this disputed claims process if you disagree with our decision on your claim or request for services.  The FEDVIP law does not provide a role for OPM to review disputed claims.

Disputed Claim Steps:

1. Ask us in writing to reconsider our initial decision. You must:

a) Write to us within 6 months from the date of our decision; and
b) Send your request to us at the address shown below; and
c) Include a statement about why you believe our initial decision was wrong, based on specific benefit provisions in this brochure; and
d) Include copies of documents that support your claim, such as doctor's letters, and Explanation of Benefits (EOB) forms.

Blue Cross Blue Shield FEP Vision
PO Box 507
Troy, NY 12181

FAX: 1-800-403-1783
Email: fepmemberhelp@davisvision.com

2. We have 30 days from the date we receive your request to:

a) Pay the claim or
b) Write to you and maintain our denial or
c) Ask you or your provider for more information.

You or your provider must send the information so that we receive it within 60 days of our request. We will then decide within 30 more days. If we do not receive the information within 60 days, we will decide within 30 days of the date the information was due. We will base our decision on the information we already have. We will write to you with our decision.

3. If the dispute is not resolved through the reconsideration process, you may request a review of the denial.  We will make a decision within 35 days of the date we receive your request in writing.

4. If you do not agree with our final decision, you may request an independent third party, mutually agreed upon by us and OPM, review the decision.  The decision of the independent third party is binding on us and is the final administrative review of your claim.  This decision is not subject to judicial review.

Federal retirees (who retired on an immediate annuity), and survivors (of those who retired on an immediate annuity or died in service) receiving an annuity.  This also includes those receiving compensation from the Department of Labor’s Office of Workers’ Compensation Programs, who are called compensationers.  Annuitants are sometimes called retirees.

Covered services or payment for covered services to which enrollees and covered family members are entitled to the extent provided by this brochure.

The Federal employee, annuitant, or TRICARE-eligible individual enrolled in this plan.

The maximum benefit payment for services received.  Please refer to Section 4, Your Cost for Covered Services, for the maximum benefit payment for services received in limited access areas or out-of-network and Section 6, International Services and Supplies, for services received outside the United States or Puerto Rico.

This is the procedure used by BCBS FEP Vision to pre-approve services and the amount that BCBS FEP Vision will cover.

Generally, a sponsor means the individual who is eligible for medical or dental benefits under 10 U.S.C. chapter 55 based on their direct affiliation with the uniformed services (including military members of the National Guard and Reserves).

Under circumstances where a sponsor is not an enrollee, a TEI family member may accept responsibility to self-certify as an enrollee and enroll TEI family members.

TEI family members include a sponsor’s spouse, unremarried widow, unremarried widower, unmarried child, and certain unmarried persons placed in a sponsor’s legal custody by a court. Children include legally adopted children, stepchildren, and pre- adoptive children. Children and dependent unmarried persons must be under age 21 if they are not a student, and under age 23 if they are a full-time student or incapable of self-support because of a mental or physical incapacity.

Blue Cross Blue Shield FEP Vision.