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Frequently Asked Questions Insurance

Premium Conversion

  • Mary J. is a single parent with one child who will turn age 26 at the end of March. She wants to maintain her Self and Family coverage until that time. The loss of an eligible child is a QLE, and changing her coverage from Self and Family to Self Only is on account of and consistent with that QLE. At the end of March, Mary changes her coverage to Self Only. Michael M., a federal employee, has Self Only coverage and so does his wife, who is employed in the private sector. In June, she gives birth to their first child. Michael wants to cancel his FEHB coverage, saying that his wife has picked up family coverage that includes him and their new child. Michael's request is on account of and consistent with his QLE. Monique K. begins an approved period of leave without pay (LWOP) to attend school. She elects to keep her FEHB coverage, and incur an obligation to her employing agency. She may not change her FEHB coverage, but may change her premium conversion election. Agencies must determine acceptable documentation for a qualifying life event (QLE). Acceptable documentation includes birth and death certificates, marriage licenses, divorce papers, etc. When your QLE is one where documentation is not readily available the IRS has indicated that your certification of coverage under another health plan is sufficient.
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  • FEHB premiums deducted from the pay of a participating employee are deducted BEFORE FICA and Federal income taxes. When an employee waives participation in premium conversion, FEHB premiums will continue to be deducted from the pay after FICA and Federal income taxes. In all cases, deductions for CSRS or FERS will continue to be made first.
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  • We ensure that the plans provide the benefits described in the FEHB Program brochures. The health plans often make Preferred Provider Agreements and other arrangements with providers which are contractual arrangements between the carriers and the providers. Because of the discounts that a plan realizes through its contracts with PPO providers, the plan is able to reimburse a higher percentage of the negotiated PPO allowance when PPO providers are utilized. It would not be cost effective for the plan to reimburse at the higher level when the provider is not giving a discount. Furthermore, much of the benefit you receive from using PPO providers comes from the PPO provider's agreement not to bill you for more than the negotiated PPO allowance. Non-PPO providers are under no such obligation. In some areas of the country, it is much more difficult for a plan to arrange PPO contracts for all types of services. In areas where there are no PPO providers, you can still receive your plan's regular benefits, as opposed to the incentivized PPO benefit.
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  • No. Federal retirement, thrift savings and life insurance benefits are not affected by participation in premium conversion.
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  • If you are employed in the Executive Branch of the Federal Government, are participating in the FEHB Program, and your pay is issued by an Executive Branch agency, you are eligible to have your FEHB premiums paid under the premium conversion plan.
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  • The Judiciary Branch, U.S. Postal Service, and some smaller Executive Branch agencies with independent compensation-setting authority, have already implemented their own FEHB premium conversion plans; the employees of these entities will not participate in our premium conversion plan. At the present time, annuitants and compensationers whose FEHB premiums are deducted from annuities and benefits are not eligible to participate in premium conversion. There are special rules for reemployed annuitants.
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