| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | |
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1 | Federal Employees Dental and Vision Insurance Program (FEDVIP) Dental Premium Rate Charts | |||||||||||||||||||||||||
2 | Biweekly Premium Rates | Monthly Premium Rates | ||||||||||||||||||||||||
3 | Plan - Option | Rating Region | Self-Only | Self Plus One | Self & Family | Self-Only | Self Plus One | Self & Family | ||||||||||||||||||
4 | Please note: Rating areas for each carrier are not the same for all plans. Please refer to the Dental Rating Chart to determine your specific region. | |||||||||||||||||||||||||
5 | Aetna Dental - High | 0 | $19.41 | $38.81 | $58.22 | $42.06 | $84.09 | $126.14 | ||||||||||||||||||
6 | Aetna Dental - High | 1 | $17.62 | $35.23 | $52.85 | $38.18 | $76.33 | $114.51 | ||||||||||||||||||
7 | Aetna Dental - High | 2 | $19.41 | $38.81 | $58.22 | $42.06 | $84.09 | $126.14 | ||||||||||||||||||
8 | Aetna Dental - High | 3 | $20.64 | $41.28 | $61.92 | $44.72 | $89.44 | $134.16 | ||||||||||||||||||
9 | Aetna Dental - High | 4 | $22.78 | $45.57 | $68.35 | $49.36 | $98.74 | $148.09 | ||||||||||||||||||
10 | Aetna Dental - High | 5 | $24.75 | $49.47 | $74.21 | $53.63 | $107.19 | $160.79 | ||||||||||||||||||
11 | Aetna Dental - Standard | 0 | $11.63 | $23.25 | $34.86 | $25.20 | $50.38 | $75.53 | ||||||||||||||||||
12 | Aetna Dental - Standard | 1 | $10.57 | $21.13 | $31.70 | $22.90 | $45.78 | $68.68 | ||||||||||||||||||
13 | Aetna Dental - Standard | 2 | $11.63 | $23.25 | $34.86 | $25.20 | $50.38 | $75.53 | ||||||||||||||||||
14 | Aetna Dental - Standard | 3 | $12.36 | $24.71 | $37.06 | $26.78 | $53.54 | $80.30 | ||||||||||||||||||
15 | Aetna Dental - Standard | 4 | $13.61 | $27.22 | $40.83 | $29.49 | $58.98 | $88.47 | ||||||||||||||||||
16 | Aetna Dental - Standard | 5 | $14.78 | $29.55 | $44.34 | $32.02 | $64.03 | $96.07 | ||||||||||||||||||
17 | Blue Cross Blue Shield FEP Dental - High | 0 | $18.95 | $37.90 | $56.84 | $41.06 | $82.12 | $123.15 | ||||||||||||||||||
18 | Blue Cross Blue Shield FEP Dental - High | 1 | $18.95 | $37.90 | $56.84 | $41.06 | $82.12 | $123.15 | ||||||||||||||||||
19 | Blue Cross Blue Shield FEP Dental - High | 2 | $21.23 | $42.46 | $63.69 | $46.00 | $92.00 | $138.00 | ||||||||||||||||||
20 | Blue Cross Blue Shield FEP Dental - High | 3 | $23.10 | $46.21 | $69.31 | $50.05 | $100.12 | $150.17 | ||||||||||||||||||
21 | Blue Cross Blue Shield FEP Dental - High | 4 | $25.03 | $50.05 | $75.08 | $54.23 | $108.44 | $162.67 | ||||||||||||||||||
22 | Blue Cross Blue Shield FEP Dental - High | 5 | $28.01 | $56.02 | $84.03 | $60.69 | $121.38 | $182.07 | ||||||||||||||||||
23 | Blue Cross Blue Shield FEP Dental - Standard | 0 | $10.19 | $20.39 | $30.58 | $22.08 | $44.18 | $66.26 | ||||||||||||||||||
24 | Blue Cross Blue Shield FEP Dental - Standard | 1 | $10.19 | $20.39 | $30.58 | $22.08 | $44.18 | $66.26 | ||||||||||||||||||
25 | Blue Cross Blue Shield FEP Dental - Standard | 2 | $11.17 | $22.33 | $33.50 | $24.20 | $48.38 | $72.58 | ||||||||||||||||||
26 | Blue Cross Blue Shield FEP Dental - Standard | 3 | $12.69 | $25.38 | $38.07 | $27.50 | $54.99 | $82.49 | ||||||||||||||||||
27 | Blue Cross Blue Shield FEP Dental - Standard | 4 | $13.70 | $27.40 | $41.10 | $29.68 | $59.37 | $89.05 | ||||||||||||||||||
28 | Blue Cross Blue Shield FEP Dental - Standard | 5 | $15.12 | $30.24 | $45.37 | $32.76 | $65.52 | $98.30 | ||||||||||||||||||
29 | Delta Dental's Federal Employees Dental Program - High | 0 | $27.14 | $54.28 | $81.42 | $58.80 | $117.61 | $176.41 | ||||||||||||||||||
30 | Delta Dental's Federal Employees Dental Program - High | 1 | $18.20 | $36.39 | $54.59 | $39.43 | $78.85 | $118.28 | ||||||||||||||||||
31 | Delta Dental's Federal Employees Dental Program - High | 2 | $19.95 | $39.90 | $59.85 | $43.23 | $86.45 | $129.68 | ||||||||||||||||||
32 | Delta Dental's Federal Employees Dental Program - High | 3 | $21.89 | $43.78 | $65.68 | $47.43 | $94.86 | $142.31 | ||||||||||||||||||
33 | Delta Dental's Federal Employees Dental Program - High | 4 | $23.29 | $46.59 | $69.88 | $50.46 | $100.95 | $151.41 | ||||||||||||||||||
34 | Delta Dental's Federal Employees Dental Program - High | 5 | $27.14 | $54.28 | $81.42 | $58.80 | $117.61 | $176.41 | ||||||||||||||||||
35 | Delta Dental's Federal Employees Dental Program - Standard | 0 | $14.10 | $28.20 | $42.30 | $30.55 | $61.10 | $91.65 | ||||||||||||||||||
36 | Delta Dental's Federal Employees Dental Program - Standard | 1 | $9.94 | $19.89 | $29.83 | $21.54 | $43.10 | $64.63 | ||||||||||||||||||
37 | Delta Dental's Federal Employees Dental Program - Standard | 2 | $10.83 | $21.65 | $32.48 | $23.47 | $46.91 | $70.37 | ||||||||||||||||||
38 | Delta Dental's Federal Employees Dental Program - Standard | 3 | $11.67 | $23.33 | $35.00 | $25.29 | $50.55 | $75.83 | ||||||||||||||||||
39 | Delta Dental's Federal Employees Dental Program - Standard | 4 | $12.31 | $24.62 | $36.92 | $26.67 | $53.34 | $79.99 | ||||||||||||||||||
40 | Delta Dental's Federal Employees Dental Program - Standard | 5 | $14.10 | $28.20 | $42.30 | $30.55 | $61.10 | $91.65 | ||||||||||||||||||
41 | Dominion National - High | 1 | $8.98 | $17.95 | $26.93 | $19.46 | $38.89 | $58.35 | ||||||||||||||||||
42 | Dominion National - High | 2 | $9.95 | $19.90 | $29.85 | $21.56 | $43.12 | $64.68 | ||||||||||||||||||
43 | Dominion National - High | 3 | $13.22 | $26.44 | $39.66 | $28.64 | $57.29 | $85.93 | ||||||||||||||||||
44 | Dominion National - Standard | 1 | $5.34 | $10.67 | $16.01 | $11.57 | $23.12 | $34.69 | ||||||||||||||||||
45 | Dominion National - Standard | 2 | $6.81 | $13.62 | $20.43 | $14.76 | $29.51 | $44.27 | ||||||||||||||||||
46 | Dominion National - Standard | 3 | $7.82 | $15.64 | $23.47 | $16.94 | $33.89 | $50.85 | ||||||||||||||||||
47 | EmblemHealth Dental - High | 1 | $29.64 | $59.21 | $88.84 | $64.22 | $128.29 | $192.49 | ||||||||||||||||||
48 | EmblemHealth Dental - Standard | 1 | $21.16 | $42.29 | $63.46 | $45.85 | $91.63 | $137.50 | ||||||||||||||||||
49 | GEHA Connection Dental Federal - High | 0 | $26.67 | $53.34 | $79.95 | $57.79 | $115.57 | $173.23 | ||||||||||||||||||
50 | GEHA Connection Dental Federal - High | 1 | $17.93 | $35.84 | $53.77 | $38.85 | $77.65 | $116.50 | ||||||||||||||||||
51 | GEHA Connection Dental Federal - High | 2 | $20.15 | $40.28 | $60.44 | $43.66 | $87.27 | $130.95 | ||||||||||||||||||
52 | GEHA Connection Dental Federal - High | 3 | $21.98 | $43.96 | $65.95 | $47.62 | $95.25 | $142.89 | ||||||||||||||||||
53 | GEHA Connection Dental Federal - High | 4 | $24.61 | $49.20 | $73.81 | $53.32 | $106.60 | $159.92 | ||||||||||||||||||
54 | GEHA Connection Dental Federal - High | 5 | $26.67 | $53.34 | $79.95 | $57.79 | $115.57 | $173.23 | ||||||||||||||||||
55 | GEHA Connection Dental Federal - Standard | 0 | $14.99 | $29.98 | $44.98 | $32.48 | $64.96 | $97.46 | ||||||||||||||||||
56 | GEHA Connection Dental Federal - Standard | 1 | $10.14 | $20.28 | $30.40 | $21.97 | $43.94 | $65.87 | ||||||||||||||||||
57 | GEHA Connection Dental Federal - Standard | 2 | $11.36 | $22.71 | $33.99 | $24.61 | $49.21 | $73.65 | ||||||||||||||||||
58 | GEHA Connection Dental Federal - Standard | 3 | $12.44 | $24.83 | $37.26 | $26.95 | $53.80 | $80.73 | ||||||||||||||||||
59 | GEHA Connection Dental Federal - Standard | 4 | $13.88 | $27.74 | $41.60 | $30.07 | $60.10 | $90.13 | ||||||||||||||||||
60 | GEHA Connection Dental Federal - Standard | 5 | $14.99 | $29.98 | $44.98 | $32.48 | $64.96 | $97.46 | ||||||||||||||||||
61 | HealthPartners Dental Plan - High | 1 | $25.54 | $51.07 | $76.61 | $55.34 | $110.65 | $165.99 | ||||||||||||||||||
62 | HealthPartners Dental Plan - High | 2 | $26.82 | $53.64 | $80.46 | $58.11 | $116.22 | $174.33 | ||||||||||||||||||
63 | HealthPartners Dental Plan - Standard | 1 | $18.39 | $36.79 | $55.18 | $39.85 | $79.71 | $119.56 | ||||||||||||||||||
64 | HealthPartners Dental Plan - Standard | 2 | $20.99 | $41.98 | $62.98 | $45.48 | $90.96 | $136.46 | ||||||||||||||||||
65 | Humana Dental - High | 1 | $21.11 | $42.22 | $63.34 | $45.74 | $91.48 | $137.24 | ||||||||||||||||||
66 | Humana Dental - High | 2 | $23.20 | $46.40 | $69.60 | $50.27 | $100.53 | $150.80 | ||||||||||||||||||
67 | Humana Dental - High | 3 | $24.34 | $48.68 | $73.03 | $52.74 | $105.47 | $158.23 | ||||||||||||||||||
68 | Humana Dental - High | 4 | $26.03 | $52.05 | $78.08 | $56.40 | $112.78 | $169.17 | ||||||||||||||||||
69 | Humana Dental - High | 5 | $31.30 | $62.61 | $93.91 | $67.82 | $135.66 | $203.47 | ||||||||||||||||||
70 | Humana Dental - Standard | 1 | $11.19 | $22.39 | $33.58 | $24.25 | $48.51 | $72.76 | ||||||||||||||||||
71 | Humana Dental - Standard | 2 | $12.06 | $24.11 | $36.17 | $26.13 | $52.24 | $78.37 | ||||||||||||||||||
72 | Humana Dental - Standard | 3 | $13.01 | $26.02 | $39.02 | $28.19 | $56.38 | $84.54 | ||||||||||||||||||
73 | Humana Dental - Standard | 4 | $14.28 | $28.56 | $42.85 | $30.94 | $61.88 | $92.84 | ||||||||||||||||||
74 | Humana Dental - Standard | 5 | $16.38 | $32.76 | $49.13 | $35.49 | $70.98 | $106.45 | ||||||||||||||||||
75 | The MetLife Federal Dental Plan - High | 0 | $25.90 | $51.80 | $77.69 | $56.12 | $112.23 | $168.33 | ||||||||||||||||||
76 | The MetLife Federal Dental Plan - High | 1 | $18.45 | $36.89 | $55.34 | $39.98 | $79.93 | $119.90 | ||||||||||||||||||
77 | The MetLife Federal Dental Plan - High | 2 | $19.46 | $38.92 | $58.38 | $42.16 | $84.33 | $126.49 | ||||||||||||||||||
78 | The MetLife Federal Dental Plan - High | 3 | $21.61 | $43.22 | $64.84 | $46.82 | $93.64 | $140.49 | ||||||||||||||||||
79 | The MetLife Federal Dental Plan - High | 4 | $23.50 | $47.01 | $70.51 | $50.92 | $101.86 | $152.77 | ||||||||||||||||||
80 | The MetLife Federal Dental Plan - High | 5 | $25.90 | $51.80 | $77.69 | $56.12 | $112.23 | $168.33 | ||||||||||||||||||
81 | The MetLife Federal Dental Plan - Standard | 0 | $14.07 | $28.14 | $42.21 | $30.49 | $60.97 | $91.46 | ||||||||||||||||||
82 | The MetLife Federal Dental Plan - Standard | 1 | $10.48 | $20.95 | $31.43 | $22.71 | $45.39 | $68.10 | ||||||||||||||||||
83 | The MetLife Federal Dental Plan - Standard | 2 | $11.13 | $22.25 | $33.38 | $24.12 | $48.21 | $72.32 | ||||||||||||||||||
84 | The MetLife Federal Dental Plan - Standard | 3 | $12.16 | $24.32 | $36.47 | $26.35 | $52.69 | $79.02 | ||||||||||||||||||
85 | The MetLife Federal Dental Plan - Standard | 4 | $13.41 | $26.82 | $40.23 | $29.06 | $58.11 | $87.17 | ||||||||||||||||||
86 | The MetLife Federal Dental Plan - Standard | 5 | $14.07 | $28.14 | $42.21 | $30.49 | $60.97 | $91.46 | ||||||||||||||||||
87 | Triple-S Salud - High | 1 | $5.91 | $11.81 | $15.43 | $12.81 | $25.59 | $33.43 | ||||||||||||||||||
88 | United Concordia Dental - High | 0 | $26.27 | $52.53 | $78.78 | $56.92 | $113.82 | $170.69 | ||||||||||||||||||
89 | United Concordia Dental - High | 1 | $17.62 | $35.23 | $52.83 | $38.18 | $76.33 | $114.47 | ||||||||||||||||||
90 | United Concordia Dental - High | 2 | $19.77 | $39.53 | $59.30 | $42.84 | $85.65 | $128.48 | ||||||||||||||||||
91 | United Concordia Dental - High | 3 | $21.95 | $43.87 | $65.83 | $47.56 | $95.05 | $142.63 | ||||||||||||||||||
92 | United Concordia Dental - High | 4 | $24.11 | $48.20 | $72.31 | $52.24 | $104.43 | $156.67 | ||||||||||||||||||
93 | United Concordia Dental - High | 5 | $26.27 | $52.53 | $78.78 | $56.92 | $113.82 | $170.69 | ||||||||||||||||||
94 | United Concordia Dental - Standard | 0 | $15.05 | $30.09 | $45.15 | $32.61 | $65.20 | $97.83 | ||||||||||||||||||
95 | United Concordia Dental - Standard | 1 | $10.14 | $20.28 | $30.42 | $21.97 | $43.94 | $65.91 | ||||||||||||||||||
96 | United Concordia Dental - Standard | 2 | $11.39 | $22.74 | $34.12 | $24.68 | $49.27 | $73.93 | ||||||||||||||||||
97 | United Concordia Dental - Standard | 3 | $12.61 | $25.22 | $37.82 | $27.32 | $54.64 | $81.94 | ||||||||||||||||||
98 | United Concordia Dental - Standard | 4 | $13.83 | $27.66 | $41.49 | $29.97 | $59.93 | $89.90 | ||||||||||||||||||
99 | United Concordia Dental - Standard | 5 | $15.05 | $30.09 | $45.15 | $32.61 | $65.20 | $97.83 | ||||||||||||||||||
100 | UnitedHealthcare Dental Plan - High | 0 | $30.72 | $61.43 | $92.15 | $66.56 | $133.10 | $199.66 | ||||||||||||||||||