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Insurance FAQs

Health

  • 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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  • When you retire, you are entitled to the full government contribution.
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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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  • No. The law defines family members as a spouse and children under age 26. Public Law 104-199, Defense of Marriage Act, states, " the word 'marriage' means only a legal union between one man and one woman as husband and wife, and the word 'spouse' refers only to a person of the opposite sex who is a husband or a wife."
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  • If you do not want to continue your FEHB enrollment, you must notify your employing office in writing that you wish to terminate your coverage. If you do not take action to terminate the coverage, your enrollment will continue for up to 24 months while you are on military duty.
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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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  • 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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  • The employing office has 14 days to notify you of your TCC rights and send you an election form. You must return the election form and a certified copy of your divorce decree within 60 days from your divorce date or 65 days after the date of the employing office notice, whichever is later. Your coverage will be effective the day after your 31-day extension of coverage as a family member ends.
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  • Yes, if you are eligible for this TRICARE program, you can suspend your FEHB coverage.
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  • Problems arising from oral discussions are very difficult to settle later because they are impossible to prove or disprove. In contractual situations such as under the FEHB Program, oral statements can never be regarded as official and, so, we state in the brochures that oral statements made by any representative of a carrier cannot modify the benefits described in the brochure.
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  • Information about the new TRICARE-For-Life program can be obtained by calling 1-888-DOD LIFE (1-888-363-5433) or by going to the TRICARE website at www.tricare.osd.mil.
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  • Generally, your coverage continues for 36 months from the date of your divorce or annulment, as long as you pay your premiums on time. After your TCC enrollment ends:
    • you get a 31-day extension of coverage, and
    • you may convert to an individual contract offered by your health benefits plan,
    unless you lose coverage because you canceled your enrollment or didn't pay your premiums.
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  • The Help Desk:
    • Tells you what transactions you can do (link to question #4) and how to do them using Employee Express;
    • Gives numbers for the Employee Express phone system;
    • Gives locations for touch screens (kiosks) and contacts for Human Resources Offices;
    • Gives the Employee Express email address;
    • Issues new PINs
    • Automatically sends a verification letter to you for health benefits changes you make in Employee Express. (For paperwork on other changes, contact your Human Resources Office.)
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  • Pay-As-You-Go Under the Pay-As-You-Go option, you pay your share of the FEHB premium directly to your employing agency while on LWOP. These payments will generally be made with after-tax monies, since there is no pay from which to make deductions.   Catch-Up Most employees who have a period of LWOP choose to pay their FEHB premiums via the Catch-up option. Under this option, the agency remits your share of the FEHB premium to OPM while you are on LWOP. You incur an obligation to your employing agency and are required to repay it upon your return to pay status. The repayment of the amount owed will be treated on a pre-tax basis, if it's deducted from pay and you participate in premium conversion at the time the deduction is made. If you choose to repay the amount owed to your agency directly out-of-pocket your taxable income is not reduced. Prepay Your agency may (but is not required to) offer you the option to prepay your FEHB premium from salary before you go on a period of LWOP. The amount of FEHB premiums you prepay in advance may either be deducted from your pay or paid directly "out-of-pocket" to your agency. Payments made "out-of-pocket" do not reduce taxable income. The amount of FEHB premiums that you prepay will be treated on a pre-tax basis, if it is deducted from your pay and you participate in premium conversion. IRS rules limit the amount you may prepay on a pre-tax basis. If your period of LWOP will span two tax years, the amount that you may prepay on a pre-tax basis may not exceed the amount of FEHB premiums due for the remainder of the current tax year. If you wish to prepay the amounts due for the subsequent tax year as well, the deductions must be made after-tax. You may use the "Pay-As-You-Go" or Catch-up options for amounts due in the subsequent tax year. Example Sam A. participates in premium conversion and had $100 per month in FEHB premiums deducted from his pay. He will go on LWOP for three months beginning on October 31, 2002 and opts to continue his FEHB coverage. Mr. A. uses the pre-pay option to pay from his salary the $300 in FEHB premium payments that will be due while he is on LWOP. Mr. A. will receive pre-tax treatment for only $200 of his FEHB premium prepayment- the amount he will owe for the months of November and December 2002. The remaining $100 prepaid – the amount due for January 2003 – must be given after-tax treatment.
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  • Most health maintenance organizations (HMO) restrict enrollment to an area where its doctors and hospitals are accessible. Although some HMOs do not have restrictions on where you live or work, please recognize that if you later find it is inconvenient to get to a plan provider, you may have to wait until the next Open Season to change plans.
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  • While you may count the time you are covered under transitional TRICARE toward meeting the 5 year/initial opportunity requirement to continue your FEHB into retirement, you must be covered under FEHB on the day you retire. If you plan to retire during your transitional TRICARE period, you must reinstate your FEHB before your retirement date. Your Human Resources Office can assist you.
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  • You should obtain, complete and return a waiver/election form to your employing office. You may waive participation in premium conversion (or elect to participate, if you previously waived) during the annual FEHB Open Season. Also, you may have the opportunity to waive participation in premium conversion if you've experienced a Qualifying life event (QLE). Refer to the QLE section for more information. FEHB Open Season During the FEHB Open Season, you will have an opportunity to elect or waive your participation in premium conversion. An Open Season election to participate or waive participation in premium conversion must be received by your employing agency no later than the last day of the Open Season to be considered timely filed. The effective date of your election will be the same as the effective date of an FEHB enrollment election: the first payroll period that begins on or after January 1st. If your agency accepts and processes a late Open Season enrollment election, it must also accept a late election to participate or waive participation in premium conversion. Because elections begin with pay periods, when you change participation in premium conversion (begin or waive participation) during the FEHB Open Season, there will likely be at least one payroll paid date in the subsequent calendar year in which your FEHB deductions reflect the previous election. Example Mark G. had previously waived participation in premium conversion. He opted to participate again in premium conversion during the November 2002 Open Season. Mr. G. is paid on a biweekly basis, with the following payroll periods: Payroll Begin Date End Date Pay Date Pre-Tax/ After-tax 01 12/15/02 12/28/02 1/8/03 after-tax 02 12/29/02 1/11/03 1/22/03 after-tax 03 1/12/03 1/25/03 2/5/03 pre-tax Mr. Marks' payroll office would treat his FEHB deductions on an after-tax basis through the end of payroll period 02.
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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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  • 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 die, the Waiver of Immediate Reinstatement of FEHB automatically terminates. If you postponed reinstatement of a Self and Family enrollment, and your survivors are eligible for a survivor annuity, their FEHB coverage will begin the day after your death.
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Total Count: 376, Number of Pages: 19, Page: 2