-
Only you and the children born to or adopted by you and your former spouse (the Federal employee or annuitant) are covered under a Self and Family enrollment. Your child must be under age 26 or be incapable of self-support because of a mental or physical disability that existed before age 26.
Your children cannot be covered under more than one FEHB enrollment. If the employee or annuitant covers the children under his/her FEHB enrollment, your Spouse Equity enrollment should be for Self Only coverage.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
A. Yes, you will be able to reenroll in the future because you are canceling your enrollment to be covered by another FEHB enrollment.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Your premiums will not change. The enrollment will be changed to your name and changed to a self only enrollment if there are no other eligible family members.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
You may not need to write to the Office of Personnel Management. 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 Office of Personnel Management.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Valium is a brand name drug whose generic counterpart is Diazepam. On the other hand, Amoxicillin is a generic drug of the brand drug Trimox.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Yes. Spouses of federal annuitants are covered under a family enrollment in the Federal Employees Health Benefits (FEHB) Program during the divorce process and during a legal separation. Spouses of annuitants lose eligibility for FEHB coverage when the divorce is final. Former spouses of annuitants can apply for coverage in the FEHB Program under the
Spouse Equity or
Temporary Continuation of Coverage provisions of the FEHB law. Former spouses of annuitants must contact the annuitant’s retirement system within 60 days after the divorce to apply.
For more information on divorce after retirement, please visit
http://www.opm.gov/insure/health/faq/divorce.asp.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
No. If an annuitant, survivor, or former spouse suspends Self and Family coverage, the coverage of all family members is suspended as well.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
No. The termination is not considered a break in the continuous enrollment necessary for continuing FEHB coverage during retirement. If you decide not to continue your coverage, your enrollment is terminated, not canceled. To avoid a gap in your coverage after you return to work, you must reinstate your enrollment on or before the last day of your TRICARE coverage. See our questions and answers on
Return from Military Service.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Open Season changes for most Federal employees are effective the first day of the first full pay period that begins in January. Generally, mid-year changes are effective on the first day of the pay period which begins after your enrollment is received by your Human Resources Office.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Temporary Continuation of Coverage (TCC) is available to: (1) employees who lose their FEHB Program coverage because they leave their Federal jobs, (2) children who lose their FEHB Program family member status because they reach age 26, and (3) former spouses who lose their FEHB Program family member status because of divorce or annulment. TCC allows former employees to continue their FEHB Program coverage for up to 18 months, and former family members (children and former spouses) to continue FEHB Program coverage for up to 36 months. For more information about TCC, please review the TCC pamphlet at
www.opm.gov/insure/health/eligibility/tcc/index.asp.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Your agency should contact you or your dependent and give you an opportunity to select another plan. If they were unable to reach you and you learned after the enrollment time frame that your plan discontinued, they must use SF 2810 to reinstate your old enrollment code. This is for enrollment history purposes only, and cannot be sent to your old carrier since the plan is discontinued. Your agency should give you an opportunity to select another plan, and process the change retroactive to the date after your enrollment under your former plan terminated. When selecting another plan, please remember you are responsible for determining if any providers used participate in your new plan's network.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
If you remarry before age 55, your health benefits enrollment will end on the last day of the month preceding the month in which you remarry. However, if you were married for 30 years or more to the deceased employee or annuitant, your health benefits enrollment will continue. If you are enrolled in Self and Family coverage when your annuity ends, the enrollment will continue for any eligible children as long as one of them is entitled to receive a survivor annuity (but you will not be covered).
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
If the State in which you reside recognizes common-law marriages, yes.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
“Changes to Federal Benefits Eligibility Due to Health Reform” are now available on OPM’s website at
http://www.opm.gov/insure/health/aca/index.asp. These FAQs provide your employees with important information about child eligibility and Federal Benefits under the Affordable Care Act.
FastFacts offering a basic understanding of the Affordable Care Act and child eligibility under the Federal Benefits Health Benefits (FEHB) Program are now available on our website at
http://www.opm.gov/insure/fastfacts/reform.pdf. The
FastFacts is a two-page document designed to be easily posted to a bulletin board as well as distributed electronically.
These and additional resources about health care reform are available on our website at
www.opm.gov/insure/health/reform.
If you have specific questions, please contact your agency’s benefits officer. If you do not know who this person is, please go to
http://apps.opm.gov/abo/ where you will find a list of agencies and their Headquarters Benefits Officers.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
No. If you request the additional coverage, you will be reinstated into the same plan. However, if the plan you were in no longer exists, your agency must allow you to select another plan. Your change would be retroactive to your reinstatement date. As in the above question, remember that you are responsible for determining if providers used during the additional 6-month period participate in your new plan's network.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Yes. Generic drugs are less expensive than brand name products, and so the amount you pay as part of your prescription drug cost-sharing is less than what you pay for brand names. In addition, most plans charge you a lower copay if you use generic drugs.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
Your Human Resources Office will compile your health benefits records and forward them to OPM along with your retirement application and other records. OPM will review your health benefits records to determine if you are eligible to continue your FEHB enrollment into retirement. If you are eligible, OPM will process a transfer-in action and forward you a copy of this action for your records.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
A Plan offering a Point of Service product (POS) has features of both a Health Maintenance Organization (HMO) and a managed Fee-for-Service (FFS) plan. A few years ago, we began permitting plans to offer POS products as part of their benefits packages. Think of it as a hybrid of the two types of plans. In an HMO, the POS product lets you choose to use providers that are not part of the network of providers affiliated with the plan. There is a cost associated with choosing non-plan providers, usually in the form of substantial deductibles and coinsurances that are higher than the copayment you would normally pay for using a plan provider. You will also need to file a claim for reimbursement, like in a FFS plan. The plan wants you to use its network of providers, but it recognizes the desire of some enrollees to see a provider of their choosing on some occasions. In the case of a POS product of a managed Fee-for-Service (FFS) plan, the opposite is true. The plan's normal benefits include deductibles and coinsurance. But in some locations, the plan has set up a network of providers similar to that you would find in an HMO. The plan encourages you to use these providers, usually by waiving the deductibles and applying a copayment that is smaller than the normal coinsurance. Normally, there would not be any paperwork when you use a network provider. Check the FEHB Guide on this website to see where the FFS plan offers a POS product, and what you must do to elect to participate in the plan's POS product.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
The small reduction in Social Security benefits is greatly outweighed by the much larger tax savings. In each case we tested, the increase in take-home pay far exceeded the minor loss in monthly Social Security benefits.
Here is a simple formula you can use to estimate the difference in your Social Security benefit:
- Take the number of years you will participate in premium conversion (from now until your estimated retirement) and divide by 35.
- Multiply this by your current annual FEHB premium
- Multiply the result of Step 2 by the marginal SSA rate (15% for most Federal employees)
The result is the annual loss of Social Security benefits.
(# of Years of Premium Conversion /35) X Annual FEHB Premium X marginal SSA rate = Annual Loss
Example
You participate in FERS. We assume that you've had a full career of FICA contributions, with an ending salary (today) of $50,000 and projected retirement at age 66 in January 2016. Your estimated Social Security benefit equals $1,414 per month.
You begin participating in premium conversion and reduce your taxable income by $2,000, the amount of your FEHB premium. By changing your salary to $48,000, your monthly Social Security benefit is now $1,403, an $11.00 per month difference in today's dollars.
15/35= .4286 X 2000 = 857 X .15 = 128/12 = 10.71 or 11
Compare that to the estimated $67 increase in take home pay per month.
For more specific information on how the Social Security benefit is calculated, refer to
www.ssa.gov.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.
-
The premiums for the FEHB plan you are currently enrolled in are in the brochure you will receive from your plan during the annual Federal Benefits Open Season. The
Guide to Federal Benefits is a comparison of the plans and their benefits and premiums. There are a variety of Guides targeted to specific groups of enrollees.
The average premium is recalculated every year.
Per FEHB law, the government will pay the lesser of: 75% of the carrier’s total premium, or 72% of the average premium. The enrollee is responsible for the difference between the government contribution and the total premium.
If the average premium increases, the maximum government contribution also increases.
The total premium is the same for all enrollees, but the Government contribution is based on your employment. Some agencies, such as the Postal Service, contribute additional money towards the total premium. As a result, the share you must pay will depend upon your employment status. All Guides are available
on this website or through your Human Resources Office.
Thank you for your feedback!
An error occurred while trying to submit your feedback.
Please try again later.