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Frequently Asked Questions Insurance

Disputed Claims

  • No, retiree pay premiums on a post tax basis.
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  • No, unlike FEHB, employees may not opt out of premium conversion for FEDVIP. If employees do not wish to have premium conversion for FEDVIP, they should not enroll.
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  • You must apply within 60 days of:
    • the date your marriage ended, or
    • the date the employing office notified you that your qualifying court order (or your former spouse's election) entitled you to coverage, whichever is later.
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  • This means that the person (a designated beneficiary or person entitled under the order of precedence) advised OFEGLI, in writing, that he/she does not want the money he/she is entitled to receive. A disclaimer by default means that the person doesn't ever file a claim form to claim the benefits. If someone entitled to benefits disclaims them, he/she cannot tell OFEGLI who should get the disclaimed benefits. Rather, OFEGLI must treat those benefits as if the person disclaiming had died before the Insured. If the person disclaiming was a designated beneficiary, OFEGLI would pay the disclaimed share equally to the remaining beneficiaries. If there are no remaining beneficiaries or the person disclaiming was not a designated beneficiary, OFEGLI will pay the proceeds according to the next step in the order of precedence. Perhaps a few examples will help.
    Mary designated John and Susan for 50% each. Mary dies. John disclaims his share. It does not matter that John wanted his mother, Laura, to receive the benefits. OFEGLI will pay 100% to Susan.
    Here's another example.
    Raul is single, childless, and did not designate a beneficiary. Raul dies. His parents are entitled to the benefits based on the order of precedence. His father disclaims his share of the benefits. OFEGLI will pay 100% to his mother.
    And here's a final example.
    Cyndi is married with one child. She did not designate a beneficiary. Cyndi dies. Her husband is entitled to the benefits based on the order of precedence. He disclaims the benefits. OFEGLI moves to the next step in the order of precedence and pays 100% to Cyndi's child.
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  • As a result of health care reform, beginning January 1, 2011, children of Federal enrollees will be covered by their parent’s FEHB Self and Family enrollment until their 26th birthday (plus a 31-day temporary extension of coverage), even if the child previously lost coverage because he/she turned 22.
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  • The effective date of the Open Season change is the first day of the first full pay period in January. For annuitants this date will always be January 1.
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  • During the annual Open Season, OPM sends Open Season material to all those enrolled in the FEHBP plus those who have suspended their enrollments to enroll in a Medicare-sponsored plan approved by the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA) and to enroll in TRICARE.
    • OPM provides Open Season Express, an operator supported toll-free telephone service for retirees to call to request brochures, health benefits satisfaction surveys, and make enrollment changes using telephone technology. The phone number is 1 (800) 332-9798.
    • OPM also provides an interactive Open Season website at retireefehb.opm.gov/.
    • There are other events that allow retirees or their survivors to make enrollment changes -- such as a move out of the service area of an HMO, enrollment in Medicare, or a change in marital status. These events are given in the FEHB Handbook. During the year, annuitants should call OPM on the toll-free number 1-888-767-6738, TDD for the hearing impaired 1-800-878-5707, or send email to retire@opm.gov. Annuitants in the Washington DC local calling area should dial (202) 606-0500, or (202) 606-0551 for the hearing impaired.
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  • You must request a waiver of the five-year requirement from OPM. The steps you must take are given in the FEHB Handbook at Waiver of 5-Year Enrollment Requirement - Waiver of 5-Year Enrollment Requirement. If your agency has buyout authority, you may not need to write to the OPM. If you think you might qualify for a waiver of the 5-year coverage requirement, contact your Human Resources Office for information. If you meet the requirements, your agency will attach a memorandum to your retirement application stating that you meet the requirements for waiver by the OPM.
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  • Federal and U.S. Postal Service employees eligible for FEHB coverage (whether or not enrolled) and annuitants/survivor annuitants/compensationers (regardless of FEHB eligibility) are eligible to enroll.
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  • When you retire, you are entitled to the full government contribution.
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