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Frequently Asked Questions Insurance

My FEHB enrollment terminated after 18 months. What factors should I consider in deciding if I should request the 6 additional months of FEHB coverage allowed by current law?

If your FEHB is retroactively reinstated for 6 additional months, FEHB will become the primary payer and TRICARE the secondary payer during the additional 6 month coverage period. Thus, any payments made by TRICARE during that 6-month period could be reconciled with the FEHB carrier and any benefit adjustments could cause a difference in the amounts that you owe. Factors such as covered vs. non-covered services, network vs. out-of-network providers, deductibles, copayments, coinsurance, Health Maintenance Organization (HMO) geographic considerations, and catastrophic coverage applications may alter your total out-of-pocket expenses. Some additional issues for you to consider are:

  • If your FEHB plan covers services that TRICARE does not, having FEHB coverage could work to your advantage.
  • If TRICARE covers services that FEHB does not, TRICARE as the secondary payer should not adversely work against you since TRICARE would pay its normal benefits in the absence of benefits from the FEHB carrier.
  • If your FEHB plan becomes primary and you used TRICARE providers that were out of your FEHB plan's network, you need to determine if you would be better off with just the TRICARE coverage paying benefits alone or would you be better off having FEHB pay as primary and TRICARE as secondary for the out-of-network services.
  • You need to determine if shifting deductibles, copayments, and coinsurance from TRICARE to FEHB as the primary carrier enhances or decreases your overall benefits.
  • You need to determine how the geographic restriction of having an HMO Plan as primary payer affects the benefits received for you and your family members and how it affects payment from TRICARE as the secondary payer.
  • You need to determine if requesting retroactive FEHB for 6 additional months would enable you to meet your catastrophic protection benefits, thus, potentially enhancing your overall payment receipts.

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