Compare GEHA dental plans No in-network deductibles and no waiting periods 1 for most services . Compare plans at geha.com/CompareDental
High What the plan pays in- or out-of-network 2
Standard What the plan pays in-network 2
Standard What the plan pays out-of-network 2
2022 plan year benefit
Benefit description
Two exams, two cleanings bitewing X-rays per calendar year
3 and two sets of
100%
100%
75%
Class A – Basic
80%
55%
50%
Class B – Intermediate
Fillings, extractions and periodontal maintenance
Root canals, crowns, bridges, dentures, periodontal surgery 4
50%
35%
30%
Class C – Major
• 70% • $3,500
• 70% • $2,500
• 70% • $2,000
Class D – Orthodontic
Adults and children orthodontic
lifetime maximum • No waiting period
lifetime maximum
lifetime maximum
• 12-month
• 12-month
waiting period
waiting period
$2,500 per person
$2,000 per person
Calendar year maximum Applies only to Class A, B and C services
Unlimited per person
Out-of-network deductible for Class B and C services is $0 for High, $25 Standard Self Only, $50 Standard Self Plus One and $75 Standard Self and Family.
1 There is no waiting period for Class A, B or C services. There is a 12-month waiting period for Class D orthodontic services on the Standard plan only. 2 If your out-of-network dentist charges more than GEHA’s agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance. 3 High plan members with certain health conditions can be eligible for a third cleaning in a calendar year if considered medically necessary. 4 Implants are limited to $2,500 per person per year in- or out-of-network on High. For Standard, implants are limited to $2,500 per person per year in-network, or $2,000 per person per year out-of-network. This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental
04 2022 GEHA DENTAL PLANS
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