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Insurance FAQs

Health

  • 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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  • 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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  • Annuitants sometimes need a new copy of “Your Federal Retirement Benefits” to show their retirement income to their mortgage lender, bank, underwriter, state income tax office, or low-income housing provider.  To request a new copy of “Your Federal Retirement Benefits”, or to receive a verification of your annuity, contact OPM’s Retirement Office at 1-888-767-6738 or retire@opm.gov.  The phone lines are open from 7:30 am to 7:45 pm (Eastern Standard Time). It is a busy phone number so we encourage you to call early in the morning or after 5:00 pm when the phone lines are less busy.
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  • They can apply to suspend their coverage at any time. Annuitants can call OPM's Retirement Information Office at 1-888-767-6738 to obtain a suspension form. Callers within the local Washington, DC calling area must call 202-606-0500. Former spouses can get the form from the employing office or retirement system maintaining their enrollment. Eligible individuals must submit a completed suspension form and provide all necessary documentation to show eligibility for TRICARE or CHAMPVA during the period beginning 31 days before and ending 31 days after the date they designate as using TRICARE or CHAMPVA instead of FEHB coverage.
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  • Employee Express is an innovative automated system that Federal employees use to make their personnel and payroll transactions electronically.
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  • No. Employees may not suspend their coverage. However, they can cancel their coverage to use CHAMPVA, TRICARE or TRICARE-for-Life. Employees who do not participate in premium conversion may cancel their enrollment at any time. For employees who participate in premium conversion, eligibility for CHAMPVA or TRICARE is not a qualifying life event that would allow them to cancel their FEHB enrollment. These employees may cancel during any annual FEHB Open Season. If an employee who canceled FEHB coverage to use CHAMPVA, TRICARE or TRICARE-for-Life decides to return to FEHB coverage, the employee can do so during a future Open Season. If the employee loses CHAMPVA, TRICARE or TRICARE-for-Life coverage involuntarily, the employee can immediately reenroll in the FEHB Program.
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  • A qualifying life event (QLE) is a term defined by OPM to describe events deemed acceptable by the IRS that may allow participants in cafeteria plans (including premium conversion) to change their participation election for premium conversion outside of an open season. With two exceptions, the rules for changing FEHB enrollment outside of Open Season do not change. Most of the time, people make changes to their FEHB enrollment on account of and consistent with a qualifying life event. The opportunities for you to enroll or change enrollment described in 5 CFR Part 890, and described in the FEHB Employee Health Benefits Election Form (SF 2809) will continue to be allowed under premium conversion except:
    • you may not cancel your enrollment at any time
    • you may not change from Self and Family to Self Only at any time.
      You will still be allowed to make these changes to your enrollment if the change is on account of and consistent with a qualifying life event. The IRS has additional events that will allow you to change your participation (election) in premium conversion. Read on for more information.
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  • If you are the surviving spouse and you receive a survivor annuity, you can continue the deceased's Self and Family enrollment for all eligible family members. The enrollment will be changed to your name and premiums withheld from your survivor annuity. If you are the only person eligible for coverage, the enrollment will be changed to Self Only. After the change, the carrier will send you a new identification card.
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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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  • 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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  • 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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  • When you retire, you are entitled to the full government contribution.
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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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  • Yes, if you are eligible for this TRICARE program, you can suspend your FEHB coverage.
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  • If the documentation showing your eligibility for TRICARE is received within the period beginning 31 days before and ending 31 days after the date you designate as the day you want to use TRICARE or CHAMPVA instead of FEHB coverage, the suspension becomes effective at the end of the day before the day you designated. Otherwise, the suspension becomes effective at the end of the month in which we receive your documentation.
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  • The employing office bills you for each pay period (generally each month) you are covered.
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  • You can change most "discretionary" personnel and payroll transactions, including your:
    • Financial allotments
    • Savings bonds
    • Health benefits
    • Thrift Savings Plan (TSP)
    • Direct deposit
    • Federal and state tax withholdings
    • Your home address
    • Combined Federal Campaign (CFC)
    • Your Employee Express PIN
    • New! -- You can also get a copy of your Leave and Earnings Statement for the current pay period and two previous pay periods.
    (You can't change your life insurance on Employee Express.) Contact your Human Resources Office to find out what other services your agency may provide through Employee Express.
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  • Yes. There are a few things an employee should consider. First, to be eligible to continue FEHB coverage after retirement, a retiring employee must be enrolled or covered under the FEHB Program for the five years of service immediately before retirement, or, if less than five years, for all service since the first opportunity to enroll. Employees can count their coverage under TRICARE toward meeting this requirement. However, the employee must be enrolled in an FEHB health plan on the date of retirement to continue coverage. Second, if the employee dies when the cancellation is in effect, any surviving spouse will not be eligible to continue FEHB health benefits coverage.
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  • During the fall of each year, you will receive a copy of the Medicare & You handbook. It is also available by calling 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048, or at www.medicare.gov/publications/pubs/pdf/10050.pdf . The Medicare & You handbook has information on Medicare Parts A & B; Medicare Advantage Plans (Part C); Medicare Prescription Drug Coverage (Part D); Help for People with Limited Income and Resources; and Joining and Switching Plans. The Medicare website (www.medicare.gov) contains the handbook and other information about Medicare. If you do not have a personal computer, your local library or senior center may be able to help you access this website. You should contact your retirement system before making any change to your coverage, especially if you are considering suspending your FEHB coverage to enroll in a Medicare Advantage Plan. If you are a CSRS or FERS annuitant, you may call OPM's Retirement Information Office at 1-88USOPMRET (1-888-767-6738) or 202-606-0500 from the metropolitan Washington area, or you may write to:
    Office of Personnel Management Retirement Operations Center P.O. Box 45 Boyers, PA 16017-0045
    Other useful publications, such as the Guide to Health Insurance for People with Medicare, are also available at the Medicare number (1-800-633-4227) or from your State Health Insurance Assistance Program (SHIP) counseling office. The SHIP counselors in your state are also available by telephone or sometimes as a walk-in resource if you would like more personalized attention. You can find SHIP counseling office telephone numbers in the Medicare & You handbook or on the Medicare website at www.medicare.gov/contacts/static/allStateContacts.asp. Your FEHB plan brochure provides specific information on how its benefits are coordinated with Medicare. Some HMOs participating in the FEHB are structured to provide more comprehensive coverage if you enroll in both their HMO and their Medicare Advantage plan.
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Total Count: 488, Number of Pages: 25, Page: 2
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