Plan - Option Rating Region Self-Only Self Plus One Self & Family Self-Only Self Plus One Self & Family
Aetna Dental - High
0 $17.65 $35.31 $52.95 $38.24 $76.51 $114.73
1 $16.03 $32.05 $48.08 $34.73 $69.44 $104.17
2 $17.65 $35.31 $52.95 $38.24 $76.51 $114.73
3 $18.79 $37.58 $56.35 $40.71 $81.42 $122.09
4 $20.73 $41.46 $62.19 $44.92 $89.83 $134.75
5 $22.52 $45.03 $67.54 $48.79 $97.57 $146.34
Delta Dental - High
0 $27.06 $54.11 $81.17 $58.63 $117.24 $175.87
1 $18.13 $36.28 $54.40 $39.28 $78.61 $117.87
2 $19.90 $39.80 $59.71 $43.12 $86.23 $129.37
3 $21.83 $43.68 $65.51 $47.30 $94.64 $141.94
4 $23.24 $46.47 $69.74 $50.35 $100.69 $151.10
5 $27.06 $54.11 $81.17 $58.63 $117.24 $175.87
Delta Dental - Standard
0 $13.33 $26.66 $39.99 $28.88 $57.76 $86.65
1 $9.38 $18.75 $28.13 $20.32 $40.63 $60.95
2 $10.22 $20.46 $30.67 $22.14 $44.33 $66.45
3 $11.03 $22.07 $33.11 $23.90 $47.82 $71.74
4 $11.64 $23.29 $34.93 $25.22 $50.46 $75.68
5 $13.33 $26.66 $39.99
$28.88 $57.76 $86.65
Dominion Dental Services - High
1 $9.58 $19.15 $28.73 $20.76 $41.49 $62.25
2 $9.94 $19.88 $29.80 $21.54 $43.07 $64.57
3 $10.30 $20.60 $30.90 $22.32 $44.63 $66.95
4 $10.69 $21.37 $32.07 $23.16 $46.30 $69.49
5 $14.21 $28.41 $42.62 $30.79 $61.56 $92.34
Dominion Dental Services - Standard
1 $5.66 $11.30 $16.96 $12.26 $24.48 $36.75
2 $5.90 $11.80 $17.69 $12.78 $25.57 $38.33
3 $6.58 $13.15 $19.73 $14.26 $28.49 $42.75
4 $7.30 $14.59 $21.89 $15.82 $31.61 $47.43
5 $8.36 $16.72 $25.08 $18.11 $36.23 $54.34
Emblemhealth FEDVIP Dental Program - High
In and Out-of-Network Benefits 1 $19.20 $38.38 $57.58 $41.60 $83.16 $124.76
Humana Federal Advantage Plan - High
1 $10.63 $21.24 $31.88 $23.03 $46.02 $69.07
2 $11.25 $22.50 $33.75 $24.38 $48.75 $73.13
3 $12.18 $24.38 $36.55 $26.39 $52.82 $79.19
4 $14.78 $29.57 $44.34 $32.02 $64.07 $96.07
5 $15.82 $31.65 $47.46 $34.28 $68.58 $102.83
FEP BlueDental - High
0 $25.60 $51.17 $76.77 $55.47 $110.87 $166.34
1 $17.31 $34.63 $51.94 $37.51 $75.03
$112.54
2 $19.40 $38.77 $58.16 $42.03 $84.00 $126.01
3 $21.12 $42.23 $63.35 $45.76 $91.50 $137.26
4 $22.88 $45.72 $68.59 $49.57 $99.06 $148.61
5 $25.60 $51.17 $76.77 $55.47 $110.87 $166.34
FEP BlueDental - Standard
0 $13.63 $27.26 $40.89 $29.53 $59.06 $88.60
1 $9.16 $18.32 $27.49 $19.85 $39.69 $59.56
2 $10.04 $20.09 $30.13 $21.75 $43.53 $65.28
3 $11.42 $22.83 $34.22 $24.74 $49.47 $74.14
4 $12.33 $24.64 $36.94 $26.72 $53.39 $80.04
5 $13.63 $27.26 $40.89 $29.53 $59.06 $88.60
GEHA Connection Dental Federal - High
0 $17.27 $34.56 $51.84 $37.42 $74.88 $112.32
1 $17.27 $34.56 $51.84 $37.42 $74.88 $112.32
2 $19.00 $37.97 $57.00 $41.17 $82.27 $123.50
3 $21.56 $43.13 $64.68 $46.71 $93.45 $140.14
4 $23.28 $46.55 $69.85 $50.44 $100.86 $151.34
5 $25.83 $51.70 $77.59 $55.97 $112.02 $168.11
GEHA Connection Dental Federal - Standard
0 $10.06 $20.12 $30.17 $21.80 $43.59 $65.37
1 $10.06 $20.12 $30.17 $21.80 $43.59 $65.37
2 $11.04 $22.08 $33.11
$23.92 $47.84 $71.74
3 $12.55 $25.05 $37.58 $27.19 $54.28 $81.42
4 $13.54 $27.06 $40.58 $29.34 $58.63 $87.92
5 $15.02 $30.02 $45.04 $32.54 $65.04 $97.59
2020 Biweekly Premium Rates 2020 Monthly Premium Rates
2020 Federal Employees Dental and Vision Insurance Program (FEDVIP) Dental Premium Rate Charts
Please note: Rating areas for each carrier are not the same for all plans. Please referto the Dental Rating Chart to determine your specific region.
In and Out-of-Network Benefits
In and Out-of-Network Benefits
In and Out-of-Network Benefits
In-Network Benefits Only Except for Emergency
Services
In-Network Benefits Only Except for Emergency
Services
In and Out-of-Network Benefits
In-Network Benefits Only Except for Emergency
Services
In and Out-of-Network Benefits
In and Out-of-Network Benefits
In and Out-of-Network Benefits
Plan - Option Rating Region Self-Only Self Plus One Self & Family Self-Only Self Plus One Self & Family
2020 Biweekly Premium Rates 2020 Monthly Premium Rates
2020 Federal Employees Dental and Vision Insurance Program (FEDVIP) Dental Premium Rate Charts
Please note: Rating areas for each carrier are not the same for all plans. Please referto the Dental Rating Chart to determine your specific region.
MetLife Federal Dental Plan - High
0 $28.25 $56.50 $84.75 $61.21 $122.42 $183.63
1 $19.10 $38.19 $57.29 $41.38 $82.75 $124.13
2 $21.39 $42.79 $64.18 $46.35 $92.71 $139.06
3 $23.31 $46.62 $69.92 $50.51 $101.01 $151.49
4 $25.24 $50.48 $75.73 $54.69 $109.37 $164.08
5 $28.25 $56.50 $84.75 $61.21 $122.42 $183.63
MetLife Federal Dental Plan - Standard
0 $15.12 $30.23 $45.35 $32.76 $65.50 $98.26
1 $10.30 $20.59 $30.89 $22.32 $44.61 $66.93
2 $11.17 $22.33 $33.50 $24.20 $48.38 $72.58
3 $12.39 $24.78 $37.17 $26.85 $53.69 $80.54
4 $13.75 $27.51 $41.26 $29.79 $59.61 $89.40
5 $15.12 $30.23 $45.35 $32.76 $65.50 $98.26
Triple S PPO - High
In-Network Benefits Only Except for Services
Rendered by Orthodontists
1 $4.58 $9.16 $12.01 $9.92 $19.85 $26.02
United Concordia Dental - High
0 $23.04 $46.06 $69.08 $49.92 $99.80 $149.67
1 $15.44 $30.87 $46.28 $33.45 $66.89 $100.27
2 $17.32 $34.68 $52.00 $37.53 $75.14 $112.67
3 $19.24 $38.45 $57.70 $41.69 $83.31 $125.02
4 $21.13 $42.27 $63.41 $45.78 $91.59 $137.39
5 $23.04 $46.06
$69.08 $49.92 $99.80 $149.67
In and Out-of-Network Benefits
In and Out-of-Network Benefits
In and Out-of-Network Benefits
