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Frequently Asked Questions Insurance

Health

  • No, you will pay the same premium as you paid while you were an employee. However, annuitants are paid on a monthly basis so you will pay them at the monthly rate. You may see an increase if you are employed by an agency, such as the Post Office, that contributes additional money towards the total premium. Retirees receive the same government contribution as most Federal employees.
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  • You must apply for Temporary Continuation of Coverage (TCC) with your agency Human Resources Office within 60 days from the date you separate from Federal service. TCC coverage becomes effective the day after the qualifying event. After your 31-day extension of your group coverage ends, you pay the full premium (the enrollee and Government contribution) plus a 2 percent administrative fee. For more information, contact your agency's Human Resources Office and review the TCC pamplet at www.opm.gov/insure/health/eligibility/tcc.
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  • Spouse equity is a provision of the law that allows the former spouse of a Federal employee or annuitant to enroll in FEHB if he or she meets certain requirements.
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  • Once Medicare becomes the primary payer, you may find that a lower cost FEHB plan is adequate for your needs, especially if you are currently enrolled in a plan's high option. Also, some plans waive deductibles, coinsurance, and copayments when Medicare is primary.
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  • Your spouse is eligible for coverage while you are in the process of getting divorced and even while you are legally separated. Your spouse loses eligibility for coverage as a family member when your divorce is final. Your spouse can apply for coverage in the FEHB Program under the Spouse Equity or Temporary Continuation of Coverage provisions of the FEHB law. Your spouse should contact your HR office to apply.
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  • If you provide documentation to your retirement system that you are suspending your FEHB coverage to enroll in a Medicare Advantage plan, you may reenroll in FEHB if you later lose or cancel your Medicare Advantage plan coverage. However, you must wait until the next Open Season to reenroll in FEHB, unless you involuntarily lose your coverage under the Medicare Advantage plan (including because the plan is discontinued or because you move outside its service area). In this case, you may reenroll from 31 days before to 60 days after you lose the Medicare Advantage plan coverage, and your reenrollment in FEHB will be effective the day after the Medicare Advantage plan coverage ends (or ended).
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  • During the annual FEHB Open Season, you may enroll, cancel an enrollment, change plans or options, and waive or begin participation in premium conversion. If you waived participation in premium conversion, you can change from self- and-family enrollment to a Self Only enrollment or cancel your enrollment at any time. You can make other changes during Open Season or due to certain events. Your Human Resources Office can give you more information about these events.
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  • If the union agrees to adopt our plan, premium conversion may apply to Federal employees on LWOP to work for a union.
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  • A. In order for you to continue your health benefits enrollment into retirement, you must: (1) be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement; and (2) have been continuously enrolled (or covered as a family member) in any Federal Employees Health Benefits (FEHB) Program plan(s) (not necessarily the same plan) for the five years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.
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  • No, you do not have to be enrolled in a family plan for the five years before you retire to meet the five-year requirement. As a retiree, you can enroll in a family plan during the Open Season or when an event occurs that permits a change to the family plan.
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