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HIP HMO Preferred Gold Plan

The EmblemHealth FEDVIP Dental Program

At EmblemHealth, we believe your dental health is key to your overall health. Did you know preventive dental visits like routine exams and cleanings not only help to maintain your oral health, but your overall health as well? These services can diagnose tooth decay before it progresses into a more invasive and expensive treatment, prevent tooth loss, assess gum disease, screen for oral cancer, and keep your smile bright. Infection and inflammation in the mouth can increase the risk of developing medical conditions like diabetes, heart disease, stroke, respiratory diseases, and even cancer. Brushing and flossing daily, regular dental check-ups, and good oral healthcare are important to help maintain your general health.

That’s why we offer benefit plan options designed to support your dental and vision care through the Federal Employees Dental and Vision Insurance Program (FEDVIP).

The EmblemHealth FEDVIP Dental Program is a program available only to eligible federal employees who live in the following counties in New York, New Jersey, Pennsylvania, and Connecticut:

  • New York State: All counties.
  • New Jersey: Bergen, Essex, Hudson, Middlesex, Monmouth, Morris, Passaic, Somerset, Sussex, and Union.
  • Pennsylvania: Monroe and Pike.
  • Connecticut: Fairfield, Litchfield, and New Haven.

As a FEDVIP member, you can choose from any of our thousands of network dentists. Plus, it’s easy to receive the dental care you need because you don’t need any referrals with this plan.

Our FEDVIP program stands out because it offers:

  • Low-cost sharing with two enrollment options:
  • High Option. Utilizes Preferred Premier Network for in-network services.
  • Standard Option. Utilizes Preferred Network for in-network services.
  • Coverage that supports your dental needs. Our plan includes 100% in-network dental coverage for preventive dental services and complex procedures.
  • Lots of choices. Choose from a network of dentists and specialists in New York, New Jersey, Connecticut, and Pennsylvania

We’re committed to creating healthier futures for our members and our community. For easy access to information about your dental benefits, claim status, benefits eligibility, and more, simply visit my.emblemhealth.com and register for your member account.

Quick Links

BENEFEDS Enrollment: 
877-888-3337 (TTY: 711)
Contact BENEFEDS to enroll.

Member Services:
877-842-3625 (TTY: 711)
from 8 a.m. to 6 p.m., seven days a week.

Benefits at a Glance

What the plan costs and covers.

Preventive and Diagnostic Services

Covers services meant to maintain good dental health, including exams, x-rays, cleanings, sealants, and fluoride treatments. This plan covers: two routine exams, one limited emergency exam, and two cleanings per covered person, payable in a calendar year.

Paid in full in-network.

No deductible applies to in- and out-of-network services. 

Intermediate Services

Covers fillings, extractions, denture/crown/bridge repairs, root canals, periodontal surgeries, emergency treatments, oral surgery, anesthesia/IV sedation, and specialist consultations.

Paid in full in-network.

Deductible applies to out-of-network benefits only.

Under the Standard Option (Preferred plan) you may be responsible for a material upgrade fee for certain services.

Major Services

Covers crowns, inlays, onlays, fixed bridgework, and dentures.

Covers surgical placement of implants.

Paid in full in-network.

Deductible applies to out-of-network benefits only.

Under the Standard Option (Preferred plan) you may be responsible for a material upgrade fee for certain services.

High option: $4,500 annual maximum
Standard option: $3,000 annual maximum

Calendar Year Deductible

Applies to out-of-network intermediate and major services only.

Out-of-network: $50 individual/$150 family

Maximum Benefit Payout

Annual maximum per covered member (not including orthodontia)

Lifetime orthodontia maximum per covered member. (Orthodontia benefits are effective at the time coverage begins. Children and adults are covered for orthodontia.)

No annual maximum.

High option: $4,000
Standard option: $3,000

Out-of-Network Reimbursement

The member pays the difference between EmblemHealth's Preferred plan allowance and the provider’s charge.  

The Preferred plan allowance is the amount EmblemHealth pays dentists who participate in the EmblemHealth Preferred Network for covered services. 

Predetermination of Benefits is recommended for major services. EmblemHealth will give you an estimate of what dental services and materials will be paid for before you start treatment. Ask your dentist to submit a Treatment Plan.

2026 EmblemHealth FEDVIP Dental Program

It’s easy to receive care when you have our FEDVIP Dental plan. You’ll be able to choose from any of our thousands of network dentists and specialists in New York, New Jersey, Pennsylvania, and Connecticut without ever needing a referral or filling out paperwork.

You’ll even receive reimbursement for covered services performed by out-of-network dentists based on the Preferred plan’s in-network allowance, once you meet the plan’s applicable deductible. Should you choose to receive care from out-of-network dentists, just submit a claim to us. We’ll send you a check for the amount we cover. Please be aware, however, that since we don’t have a payment contract with out-of-network dentists, the amount we pay you may not be the full amount the dentist charged.

Need to see a dentist?

To find a dentist in your plan’s network, use our Find Care tool. The map and directions feature can help you find a dentist’s office when you click on their name in our directory. 

Choosing the FEDVIP Dental Program

It’s easy to enroll in the EmblemHealth FEDVIP Dental plan — just register and sign in at BENEFEDS.gov and select the EmblemHealth FEDVIP Dental option. You can also call BENEFEDS for assistance at 877-888-3337  TTY: (711) or internationally at 571-730-5942 from 9 a.m. to 7 p.m. ET, Monday through Friday.

Make sure to include the EmblemHealth FEDVIP Dental Program enrollment codes as shown on the Enrollment Codes and Rates section of this page.

If you’re already in the EmblemHealth FEDVIP Dental Program, you don’t need to do anything. Your coverage will continue automatically.    

 

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