Click here to skip navigation
An official website of the United States Government.

Insurance FAQs

Health

  • If you are an annuitant or an employee who waived premium conversion, you can change from a Self and Family enrollment to a Self Only enrollment at any time. If you are an employee, your youngest child turning age 26 is a qualifying life event (QLE) permitting you to change your FEHB enrollment outside of Open Season.  With this QLE, you can change from Self and Family to Self Only coverage.  You do not need to wait until the next Open Season to make this change; however, you need to request the change to Self Only coverage within 60 days of your child turning 26.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • A formulary is a list of both generic and brand name drugs that are preferred by your health plan. Often, many drugs on the market produce the same results equally well. Health plans will choose formulary drugs that are just as safe and effective as the alternatives but cost less. A team of pharmacists and physicians meet to review the formulary and make changes as necessary.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • As long as you have a Self and Family enrollment and one of the family members is entitled to a survivor annuity, the children are eligible for FEHB coverage until they reach age 26 or until no survivor is eligible for a survivor annuity. Children age 26 or over are eligible to continue FEHB coverage if they are incapable of self-support because of a mental or physical disability that existed before age 26. 
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • You can find the Guide to Federal Benefits (RI 70-5) that lists the premiums for TCC at http://www.opm.gov/insure/health/planinfo/guides/index.asp.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • If your FEHB is retroactively reinstated for 6 additional months, FEHB will become the primary payer and TRICARE the secondary payer during the additional 6 month coverage period. Thus, any payments made by TRICARE during that 6-month period could be reconciled with the FEHB carrier and any benefit adjustments could cause a difference in the amounts that you owe. Factors such as covered vs. non-covered services, network vs. out-of-network providers, deductibles, copayments, coinsurance, Health Maintenance Organization (HMO) geographic considerations, and catastrophic coverage applications may alter your total out-of-pocket expenses. Some additional issues for you to consider are:
    • If your FEHB plan covers services that TRICARE does not, having FEHB coverage could work to your advantage.
    • If TRICARE covers services that FEHB does not, TRICARE as the secondary payer should not adversely work against you since TRICARE would pay its normal benefits in the absence of benefits from the FEHB carrier.
    • If your FEHB plan becomes primary and you used TRICARE providers that were out of your FEHB plan's network, you need to determine if you would be better off with just the TRICARE coverage paying benefits alone or would you be better off having FEHB pay as primary and TRICARE as secondary for the out-of-network services.
    • You need to determine if shifting deductibles, copayments, and coinsurance from TRICARE to FEHB as the primary carrier enhances or decreases your overall benefits.
    • You need to determine how the geographic restriction of having an HMO Plan as primary payer affects the benefits received for you and your family members and how it affects payment from TRICARE as the secondary payer.
    • You need to determine if requesting retroactive FEHB for 6 additional months would enable you to meet your catastrophic protection benefits, thus, potentially enhancing your overall payment receipts.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
    • Self Only                                                                                                                                                      
    • Self and Family
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • 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.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • The former spouses that the regulation applies to are those of civilian Federal employees and annuitants as defined under the Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615). The regulation does not apply to "unremarried former spouses" under TRICARE law (title 10 USC). See also the chapter on former spouses in the FEHB Handbook.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • 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.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • 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. 
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • Medicare has two new provisions: Part C (Medicare Advantage) and Part D (Medicare Prescription Drug Coverage). Part C: You can enroll in a Medicare Advantage plan to get your Medicare benefits. Medicare Advantage is the term used to describe the various private health plan choices available to Medicare beneficiaries. Part D: There is a monthly premium for Part D coverage. Most Federal employees do not need to enroll in the Medicare drug program, since all Federal Employees Health Benefits Program plans will have prescription drug benefits that are at least equal to the standard Medicare prescription drug coverage. Still, you may want to be aware of the benefits Medicare is offering, so you can help others make informed decisions. If you have limited savings and a low income, you may be eligible for Medicare's Low-Income Benefits. For people with limited income and resources, extra help in paying for a Medicare prescription drug plan is available. Information regarding this program is available through the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.ssa.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
    How well did this answer your question? Submit
    Submitting rating...
    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.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • Your grandchild may be eligible for FEHB coverage if he/she meets the eligibility requirements for foster children. These requirements are:
    • the child must be under age 26 (if the child is over age 26, he/she must be incapable of self support due to a disability that existed before age 26);
    • the child must currently live with you;
    • the parent-child relationship must be with you, not the child's biological parent;
    • you must currently be the primary source of financial support for the child; and
    • you must expect to raise the child to adulthood.
    For your grandchild to be covered under your FEHB enrollment, you must sign a certification stating that your grandchild meets all the requirements and that you will notify your employing office if the child moves out of the home or stops being financially dependent on you. You submit this certification to your employing office for their determination that your grandchild meets these requirements. Your employing office will then notify your FEHB plan that your grandchild should be added to your enrollment.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • As long as the annuitant was enrolled in Self and Family coverage when he/she suspended FEHB coverage and made arrangements to leave a survivor annuity, the survivor annuitant can reenroll in the FEHB Program under the same conditions as an annuitant.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • Yes, Qualifying Life Events (QLE).
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • Be careful. Such a cancellation would be permanent. Annuitants cannot re-enroll in the program except under very limited circumstances, such as to enroll in a Medicare-sponsored health plan, as described below, or TRICARE. Another exception is if your spouse is also a Federal employee and you cancel to be covered by your spouse's FEHB plan. Further, neither you nor your family members would be eligible for continued coverage nor would you be able to convert your coverage to a private non-group policy. Do not drop out of the program unless you are sure of being able to re-enroll.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • The TCC provisions allow children who no longer qualify as an eligible child (e.g., child reaches age 26, foster child no longer lives with the employee, foster child is no longer financially dependent on the employee) to continue their FEHB coverage for up to 36 months. The child is enrolled in his/her own right and pays both the employee’s and the Government's share of the premium, plus an additional 2% administrative cost. You should notify your employing office within 60 days after the child no longer qualifies for coverage as a family member. A child who loses FEHB coverage for any reason other than by cancellation has a 31-day temporary extension of coverage, at no cost, for the purpose of converting to a non-group contract with his/her current health benefits plan. To convert the child's coverage to a non-group plan, you or your child must apply directly to the health benefits plan within 31 days after the child's eligibility ends. For further information on health benefits, contact your personnel office.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • If you disagree with the plan’s decision on your claim, the Federal Employees Health Benefits (FEHB) Program provides for an appeal process.  Check your plan’s FEHB brochure to see if the service is covered, limited, or excluded. Review and follow the directions in the disputed claims section (Section 8) of the brochure. This section will tell you how to ask the plan to reconsider your claim. You must explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered.   If the plan again denies the claim, read the plan's decision letter carefully. Then, check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of the brochure will tell you how to write to the U.S. Office of Personnel Management to ask us to review the claim.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
  • 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.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.
    • Change in family status
    • Change in employment status
    • You or a family member lose FEHB or other health insurance coverage                                                                
    • For more information, see SF 2809 for the Tables of Permissible Changes in Enrollment                                                                                                                                                                           
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    An error occurred while trying to submit your feedback.
    Please try again later.


Total Count: 481, Number of Pages: 25, Page: 9
Control Panel