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Your new plan is NOT responsible for providing coverage until the effective date of your enrollment change which for most employees is the first day of the first full pay period in January. If you need medical services before the effective date of your Open Season enrollment, you should contact your old plan. Please remember, while the new enrollments are not effective until the first full pay period in January, the new plan benefits are effective January 1. Your old plan, therefore will provide coverage according to the new contract. These expenses will count toward your prior year's deductible.
If you are an annuitant, you should contact your new plan. Your Open Season enrollment is effective January 1.
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The Notice of the Office of Personnel Management's Privacy Practices (NPP) is a document that describes how OPM may use and give out-- "disclose"--individually identifiable health information -your personal health information.
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The agency you are leaving will file a report in your Official Personnel Folder of all the health benefits and Thrift Savings Plan changes you made using Employee Express. You can get a copy from your Human Resources Office.
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FEHB law does not permit the Program to offer a Self Plus One category. Pursuant to section 8905 of title 5, United States Code, “An employee [or annuitant] may enroll in an approved health benefits plan under section 8903 or 8903(a) of this title either as an individual or for self and family.” The law does not allow a Self Plus One option. Congress would need to change the law to permit this type of enrollment plan.
OPM’s Office of Actuaries has done cost and premium projections on the impact of changing from a two-tiered structure to a multi-tiered structure in the current FEHB Program. While it might not be readily apparent, because a large number of older two-person families participate in the FEHB Program, the cost of providing health insurance for this older two person group is often nearly twice as high as it is to cover younger members with large families. The self plus one premium would be based on the health cost of this group. For this reason, it is not clear that adding additional enrollment options to the FEHB Program would result in any significant benefit to those who ask for the change. In fact, they might be worse off.
The objective of a group insurance policy like FEHB is to promote the beneficial aspects of risk-sharing. The Program shares the risk among a large group of enrollees, from those who are sick and high-risk to those who are healthy and low-risk. By spreading the risk, FEHB enrollees as a whole can get better coverage and lower premiums. We believe that balancing charges across large demographic groups provides the best value, stability, and equity over the life of program enrollment opportunities.
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During the FEHB Open Season, you may: enroll in any health benefit plan for which you are eligible; change from one plan, option, or type of enrollment to another;. cancel your enrollment; Change your pre-tax waiver status.
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Yes. You will receive a separate Notice of Privacy Practices from your FEHB plan, as well as any providers that you see -including physicians and hospitals.
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If you are enrolled in the FEHB Program but are employed outside the Executive Branch, or your pay is not issued by an agency of the Executive Branch, you may be eligible if your employer agrees to adopt our plan and offer participation in premium conversion.� All non-Executive branch agencies were contacted by OPM with instructions on how to become part of the plan.
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When children reach age 26, they are eligible to enroll in Temporary Continuation of Coverage (TCC) or convert to an individual policy. It is the responsibility of you or your child to know when he/she is no longer eligible for coverage and to apply for TCC or a conversion policy in a timely manner. Your employing office is not obligated to inform you of your child’s eligibility for TCC and conversion rights when he/she is no longer eligible for coverage.
TCC:
If a child loses coverage under your enrollment because he/she reaches age 26, he/she is eligible for TCC. You must contact your Human Resources Office within 60 days of your child’s 26th birthday to inform them that your child is turning age 26. Your Human Resources Office will give you information about enrolling your child in TCC or converting your child to an individual policy. Your child has 60 days to request enrollment for TCC from the later of (1) his/her 26th birthday or (2) the date of the TCC notice from the Human Resources Office. For more information about TCC, please review the TCC coverage pamphlet at
www.opm.gov/insure/health/eligibility/tcc.
Conversion:
If a child loses coverage under your enrollment because he/she reaches age 26, he/she is entitled to convert to an individual policy offered by the carrier of your plan. Your child is not required to provide evidence of insurability. To apply for conversion, you or your child must make a written request to the carrier of your plan. You or your child must apply for conversion within 31 days after his/her 26th birthday. For more information about conversion, please visit
http://www.opm.gov/insure/health/reference/handbook/FEHB15.asp#31.
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Enrollees may choose from Self Only coverage or Self and Family coverage. Other coverage types -- such as Medicare enrolled and/or Medicare eligible -- are not available. Data shows that there is not a significant difference in the cost to the FEHB Program between employees and enrollees covered by both Medicare and an FEHB plan. The cost to employees or Medicare-eligible enrollees would not reduce substantially be creating a separate Medicare category. Interestingly, your enrollees often benefit from older enrollees' Medicare enrollment. This is because substantial savings can be realized from an aggressive coordination of benefits program between the plan and Medicare; the savings are applied to all enrollees' rates.
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If you are a current Federal employee, you should contact your Human Resources Office and ask them to find out on what date and carrier report number your enrollment information was forwarded to your new health insurance carrier. With this information, your new carrier will be able to locate your enrollment data and forward ID cards to you.
If you are an annuitant, call your plan. If they tell you they haven't gotten the paperwork yet from your retirement system, you may contact your retirement system. If you are a Civil Service Retirement System (CSRS) annuitant or a Federal Employees Retirement System (FERS) annuitant, contact OPM at
retire@opm.gov.
Before contacting your retirement system, have your annuity information ready, for instance, your name, civil service annuity number (beginning with CSA or CSF), phone number and address, and information about your plan, such as the carrier enrollment code.
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You receive a salary and then your contribution to pay for FEHB coverage is withheld (post-tax). You pay tax on the salary received -- the amount before the health insurance premium is withheld. Thus, you pay tax on a larger amount of income.
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The Office of Personnel Management (OPM) did some calculations comparing the increase in take home pay to the loss of Social Security benefits at various income and Federal income tax levels. The results presented below show how many years of additional Social Security benefits it would take to make up for the take home pay you will lose by not participating in premium conversion. The calculations were simplified; they don't account for the fact that your take home pay will increase now, but you probably won't be receiving your Social Security benefits until many years from now.
The amount of your FEHB premium does not affect the calculations.
Salary
Income Tax Rate*
Years of Social Security Benefits To Recover Lost Pay
To $6,400
0%
p
15%
11
28%
17
$6,401 to $32,100
0%
10
15%
31
28%
49
$32,100+
0%
22
15%
66
28%
104
*Marginal Federal rate. If you don't know yours call your Payroll Office.
As you can see if you don't have to pay any Federal income tax, you lose the primary benefit of premium conversion.
But some individuals might still want to participate because their Social Security and Medicare taxes will be lower. You also can see that at very low earnings levels ($6,400 or less) the decision is less clear cut. OPM's statistics indicate there are less than 100 employees in this category.
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The Open Season dates are set by Federal regulation 5 C.F.R. § 890.301(f), available at http://law.justia.com/us/cfr/title05/5-2.0.1.1.32.3.143.1.html. Each year OPM provides an Open Season from the Monday of the second full workweek in November through the Monday of the second full workweek in December.
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Public Law 107-14 provides beneficiaries over age 65 of the Department of Veterans Affairs (VA) with coverage secondary to Medicare under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). CHAMPVA provides similarly attractive benefits to VA eligible beneficiaries as those benefits provided to uniformed services beneficiaries under the TRICARE or new TRICARE-for-Life programs.
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By regulation, an employee who does not change the enrollment during the Open Season is considered to have canceled the plan in which enrolled. The cancellation is effective the day before the first day of the first full pay period in January. The plan is responsible for providing coverage only through midnight of that date. If you're not sure of the date, you should contact your Human Resources Office and not the plan for the effective date.
You should be aware that you are not entitled to a 31-day extension of coverage because the action is considered a cancellation and not a termination. You cannot reenroll in the FEHB Program until the next open season. Also, this is considered a break in coverage. The 5-year requirement to continue your enrollment into retirement will begin when you reenroll in the FEHB Program. If you are within five years of retirement, you will have to work additional time to be eligible to continue your enrollment into retirement.
If you are an annuitant, you are deemed to have enrolled in the standard option of the Blue Cross and Blue Shield (BCBS) Service Benefit Plan. OPM deems annuitants into the standard option of BCBS by default (and by law) if they do not make a plan selection. If annuitants cancel their FEHB enrollment, they can never reenroll.
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Your Health Plan is required to provide coverage until Open Season enrollments are effective. Since Open Season enrollments generally become effective the first day of the first pay period in January, your Plan will provide coverage until that date.
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No, premiums that are paid under TCC are not eligible for premium conversion. Although we realize that you may make the premium payments on behalf of your child, the TCC policyholder is the child.
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Most FEHB fee-for-service plans offer Preferred Provider Organization (PPO) arrangements. When selecting your health care practitioner, your use of PPO providers whenever possible will help reduce your out-of-pocket expenses. In addition, PPO providers will generally file your claims for you. Read your plan's FEHB brochure carefully to find out about other incentives. Contact your plan to obtain the names of PPO providers in your area. You should also visit your plan's website (identified on the front of the plan's brochure and available by link from this website). Many plans provide up-to-date lists of PPO providers on their website.
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Some health plans offer dental and vision benefits separate from the officially offered benefits stated in their FEHB brochures. Such separate benefits are described on the "Non-FEHB Benefits" page in FEHB brochures.
The plans solely determine what is covered and what is excluded and you must pay any premium associated with these benefits directly to the health or dental plan. There is no government contribution toward the premium on non-FEHB benefits.
Also, some health plans offer a separate dental plan that does not require you to be a member of their health plan. And, occasionally, an agency's employee organization offers dental and vision benefits to the agency's employees. Check with your Human Resources Office.
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To verify your current health benefits plan, 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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