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Insurance FAQs

Disputed Claims

  • Each year,  Open Season runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December. This year Open Season is November 10, 2014 - December 8, 2014
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  • If you are a Federal RETIREE or compensationer: OPM's Retirement Office is the only office with access to your FEGLI life insurance records.  Your FEGLI records are not available online.  You can contact Retirement at 1-888-767-6738 or retire@opm.gov. You can request a Verification of Life Insurance (VOLI) to be mailed to you.  The VOLI will include information on your life insurance coverage.   Retirement's phone lines are open Monday through Friday 7:40 am to 5:00 pm eastern time. The phone lines can get extremely busy so we recommend calling early in the morning or late in the evening when the lines are less busy. Have your retirement claim number (CSA/CSF) or social security number handy.  If you wish to change your FEGLI life insurance beneficiaries, complete this form and mail it to OPM's Retirement Office at the address on page 3: www.opm.gov/forms/pdf_fill/sf2823.pdf If you are a Federal EMPLOYEE: Contact your human resources office.  The office that maintains your Official Personnel Folder (OPF) or its equivalent is the only office with access to your FEGLI life insurance records. If you do not know what office that is or how to contact them, check with your supervisor.  You can also look on a copy of your most recent Standard Form 50, Notification of Personnel Action, to determine the coverage you currently have:
    1. In Block 27 on that form, there is a 2-character code that represents your current coverage and a definition of the code. 
    2. You can look up the codes and their translation at http://archive.opm.gov/insure/life/reference/handbook/sf50tbl.asp 
    3. You can then use the FEGLI Calculator to determine the current value of your FEGLI by inputting your current age, salary and type(s) of FEGLI coverage. 
    If you wish to change your FEGLI life insurance beneficiaries, complete this form and submit it to your human resources office: www.opm.gov/forms/pdf_fill/sf2823.pdf
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  • When you die, the Office of Federal Employees' Group Life Insurance (OFEGLI) will pay life insurance benefits in a particular order, set by law:
    • If you assigned ownership of your life insurance, OFEGLI will pay benefits in the following order of precedence: First, to the beneficiary(ies) designated by your assignee(s), if any;  Second, if there is no such beneficiary, to your assignee(s).
    • If you did not assign ownership and there is a valid court order on file, OFEGLI will pay benefits in accordance with that court order.
    • If you did not assign ownership and there is no valid court order on file, OFEGLI will pay benefits in the following order of precedence:
      • First, to the beneficiary(ies) you designated;
      • Second, if there is no such beneficiary, to your widow or widower;
      • Third, if none of the above, to your child or children, with the share of any deceased child distributed among descendants of that child (a court will usually have to appoint a guardian to receive payment for a minor child);
      • Fourth, if none of the above, to your parents in equal shares or the entire amount to your surviving parent;
      • Fifth, if none of the above, to the executor or administrator of your estate;
      • Sixth, if none of the above, to your other next of kin as determined under the laws of the State where you lived.
    To designate new beneficiaries, submit a Designation of Beneficiary to your human resources office (or to OPM's Retirement Office if you are retired). If you would like to know who is listed in your current Designation of Beneficiary, follow these instructions
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  • Original Medicare has four parts:
    Part A (Hospital Insurance) helps pay for:
    • inpatient hospital care
    • critical access hospitals
    • skilled nursing facility care
    • some home health care
    • hospice care
    Part B (Medical Insurance) helps pay for:
    • doctors' services
    • ambulance services
    • outpatient hospital care
    • x-rays and laboratory tests
    • durable medical equipment and supplies
    • home health care (if you don't have Part A)
    • certain preventive care
    • limited ambulance transportation
    • other outpatient services
    • some other medical services Part A doesn't cover, such as physical and occupational therapy
    Part C (Medicare Advantage): If you join a Medicare Advantage Plan you generally get all your Medicare benefits, which may include prescription drugs, through one of the following types of plans:
    • Medicare HMOs – You must get your care from primary care doctors, specialists, or hospitals on the HMO's list of network providers, except in an emergency.
    • Medicare PPO Plans – In most plans your share of plan costs is less when you use in-network primary care doctors, specialists and hospitals. Using out-of-network providers costs you more.
    • Medicare Special Needs Plans – These plans generally limit enrollment to people in certain long-term care facilities (like nursing homes); people eligible for both Medicare and Medicaid; or those with certain chronic or disabling conditions.
    • Medicare Private Fee-for-Service Plans – In these plans, you may go to any Medicare-approved primary care doctor, specialist, or hospital that will accept the terms of the private plan's payment.
    • Medicare Medical Savings Account (MSA) Plans - These plans include a high deductible plan that will not begin to pay benefits until the high annual deductible is met. They also include a medical savings account into which Medicare will deposit money for you to use to pay your health care costs. Medical Savings Account Plans do not cover prescription drugs.
    Part D (Medicare Prescription Drug Coverage) Under this program, private companies provide Medicare Prescription Drug Coverage and you pay a monthly premium. Federal retirees already have excellent access to health benefits coverage for drugs through participation in the FEHB Program. However, if you choose to enroll in Part D, Medicare benefits for drugs will be primary (will pay first) in most cases for FEHB enrollees. (Medicare C plans that include prescription drugs will also be primary to FEHB benefits.) It will almost always be to your advantage to keep your current FEHB coverage without any changes. The exception is for those with limited incomes and resources who may qualify for Medicare's extra help with prescription drug costs. Contact your benefits administrator or your FEHB Program insurer for information about your FEHB coverage before making any changes. It is important to note that FEHB Program prescription drug coverage is an integral part of your total health benefits package. You cannot suspend or cancel FEHB Program prescription drug coverage without losing your FEHB plan coverage in its entirety (in other words, losing coverage) for hospital and medical services which would mean you might have significantly higher costs for those services. Because all FEHB Program plans have as good or better coverage than Medicare, they are considered to offer creditable coverage. So, if you decide not to join a Medicare drug plan now, but change your mind later and you are still enrolled in FEHB, you can do so without paying a late enrollment penalty. As long as you have FEHB Program coverage you may enroll in a Medicare prescription drug plan from November 15 to December 31st of each year at the regular monthly premium rate. However, if you lose your FEHB Program coverage and want to join a Medicare prescription drug program, you must join within 63 days of losing your FEHB coverage or your monthly premium will include a late enrollment penalty. The late enrollment penalty will change each year but will be included in your premium each year for as long as you maintain the coverage.
    Medicare does not cover:
    • your monthly Part B premium or Part C or Part D premiums
    • deductibles, coinsurance or copayments when you get health care services
    • outpatient prescription drugs (with only a few exceptions) unless you enroll in a Part C plan which provides drug coverage or a Part D plan
    • routine or yearly physical exams
    • custodial care (help with bathing, dressing, toileting, and eating) at home or in a nursing home
    • dental care and dentures (with only a few exceptions)
    • routine foot care
    • hearing aids
    • routine eye care
    • health care you get while traveling outside of the United States (except under limited circumstances)
    • cosmetic surgery
    • some vaccinations
    • orthopedic shoes
    Complete Medicare benefits information can be found in the Centers for Medicare and Medicaid Services publication, Medicare & You handbook which can be found on the Medicare website (www.medicare.gov).
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  • If the insured person was a Federal RETIREE or compensationer: You must report the death to OPM's Retirement Office. You can use this tool or you can call Retirement at 1-888-767-6738. If you believe the retiree was enrolled in FEGLI Life Insurance and that you are a beneficiary, you can download a claim form and mail it to OFEGLI, an office of MetLife. MetLife determines who is entitled to FEGLI Life Insurance proceeds, for what amount, and processes all claims.  OPM has no role in this process. Due to privacy restrictions, OPM cannot release information about whether the retiree was enrolled in FEGLI Life Insurance, the amount of life insurance, or the names of the beneficiaries. MetLife will mail a claim form to each beneficiary. All inquiries about life insurance claims must be directed to MetLife. If the insured person was a Federal EMPLOYEE: You must report the death to the employee's human resources office. If you believe the employee was enrolled in FEGLI Life Insurance and that you are a beneficiary, you can download a claim form and mail it to OFEGLI, an office of MetLife. MetLife determines who is entitled to FEGLI Life Insurance proceeds, for what amount, and processes all claims. OPM has no role in this process. Due to privacy restrictions, the employee's human resources office cannot release information about whether the employee was enrolled in FEGLI Life Insurance, the amount of life insurance, or the names of the beneficiaries. MetLife will mail a claim form to each beneficiary. All inquiries about life insurance claims must be directed to MetLife. If the insured person was FAMILY MEMBER covered under FEGLI Option C: FEGLI Option C covers the lives of the employee/retiree's spouse and eligible children under age 22. If you have Option C coverage and an eligible family member dies, complete this form and submit it to the location indicated on page 1.
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  • If you are entitled to Part A without paying the premiums, you should take it, even if you are still working. This may help cover some of the costs that your FEHB plan may not cover, such as deductibles, coinsurance, and charges that exceed the plan's allowable charges. There are other advantages to Part A, such as (if you also enroll in Part B,) being eligible to enroll in a Medicare Advantage Plan.
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  • Outside of Open Season, you can make changes due to certain events, called qualifying life events (QLEs) The most common QLEs for changing enrollment type or plan are: marriage, acquiring a child, moving away from the area served by your Health Maintenance Organization (HMO), losing health insurance coverage, or changing employment status.
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  • If you are an employee, you can cancel or reduce your FEGLI life insurance at any time by submitting this form to your human resources office. If you want to reduce life insurance, sign only for the coverage you want to KEEP.   If you want to cancel all life insurance, sign in Box 5. Exception: if you have assigned your life insurance by transferring ownership to another person or to a company, then you cannot cancel or reduce your Basic, Option A, or Option B coverage.
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  • You must contact BENEFEDS in order to change your name and/or address: www.benefeds.com or 1-877-888-3337, TTY 1-977-889-5680.
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  • When you enroll in a Medicare Advantage plan, you may not need FEHB coverage because the Medicare Advantage plan will provide you with many of the same benefits. You should review the Medicare Advantage Plan benefits carefully before making a decision to suspend or cancel FEHB coverage. You should contact your retirement system to discuss suspension and reenrollment.
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  • Yes, you may change your FEHB enrollment to any available plan or option at any time beginning 30 days before you become eligible for Medicare. You may use this enrollment change opportunity only once. You may also change your enrollment during the annual Open Season, or because of another event that permits enrollment changes (such as a change in family status).
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  • If you are a retiree, you can cancel or reduce your FEGLI life insurance at any time. There is no form; you must mail a signed letter to OPM's Retirement Office at: U.S. Office of Personnel Management Retirement Operations Center P.O. Box 45 Boyers, PA 16017-0045 The cancellation or reduction must be in writing and have an original signature by the insured retiree.  Be sure to include your retirement claim number (CSA) or Social Security Number (SSN) and specify what action you want taken.  Please note that you cannot increase your coverage after retirement or reinstate coverage that you cancel.
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  • Increasing life insurance:  FEGLI life insurance open seasons are extremely rare and none are currently scheduled.  Your agency and OPM's website will announce when there is a life insurance open season coming up.  The most recent FEGLI open seasons were held in 2004 and 1999. Outside of an open season, eligible employees can enroll or increase their coverage by taking a physical exam or with a Qualifying Life Event. For more information about the physical exam, please see SF 2822. FEGLI life events are marriage, divorce, death of spouse, or acquisition of an eligible child.  With a life event, you can enroll or increase coverage in Basic, Option A, up to five multiples of Option B, and/or up to five multiples of Option C.  You must submit an SF 2817 to your human resources office within 60 days after the life event. Reducing or cancelling life insurance: You can reduce or cancel your FEGLI life insurance at any time, without waiting for an open season.   If you are an employee, submit an SF 2817 to your human resources office, signing only for the coverage you want to keep.   If you are retired, there is no form; you must write a signed letter to OPM's Retirement Office stating clearly the reduction or cancellation you want to make.  Be sure to include your signature, annuity number (CSA/CSF) or social security number, and your phone number.  Send the letter to:
    • Office of Personnel Management 
    • Retirement Operations Center 
    • P.O. Box 45 
    • Boyers, PA 16017-0045
    Please note that you cannot enroll, increase coverage, or restore cancelled coverage after you have retired. Changing beneficiaries: You can change beneficiaries at any time, without waiting for an open season.  Submit an SF 2823 to your human resources office, or to OPM's Retirement Office if you have retired.  The address for OPM's Retirement Office is on page 3 of the form.
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  • You need to complete the SF 2809 if you change your enrollment from Self and Family to Self Only or vice versa. For example, if you have Self and Family coverage and you plan to keep Self and Family coverage, you do not need to complete any forms. You must let the health plan know the date of the divorce so that your ex-spouse can be removed from your enrollment. If you have Self and Family coverage and you now plan on enrolling in Self Only coverage, you must notify your Human Resources Office. You will have to complete an SF 2809.
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  • The Office of Federal Employees' Group Life Insurance (OFEGLI) is an administrative unit of Metropolitan Life Insurance Company that pays claims for the Federal Employees' Group Life Insurance (FEGLI) Program. If OFEGLI is paying the beneficiary less than $5,000, the beneficiary will receive a check. If OFEGLI is paying the beneficiary $5,000 or more, the beneficiary will have a choice of two ways to receive the payment.
    • A check
    • A MetLife Total Control Account or (TCA), an interest bearing account set up in the beneficiary's name, with Metropolitan Life Insurance Company (MetLife)
    If the beneficiary is receiving $5,000 or more and does not make a decision on how to receive payment, a MetLife Total Control Account will be set up in the beneficiary' s name. For more information, see the FEGLI Handbook chapter on claims.
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  • To continue your health benefits enrollment into retirement, you must: (1) have retired on an immediate annuity (that is, an annuity which begins to accrue no later than one month after the date of your final separation); and (2) have been continuously enrolled (or covered as a family member) in any FEHB Program plan (not necessarily the same plan) for the five years of service immediately preceding retirement, or if less than five years, for all service since your first opportunity to enroll.
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  • Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for emergency care outside of the United States which Medicare doesn't provide. Some FEHB plans also provide coverage for dental and vision care. Medicare covers some orthopedic and prosthetic devices, durable medical equipment, home health care, limited chiropractic services, and some medical supplies, which some FEHB plans may not cover or only partially cover (check your plan brochure for details).
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  • Your life insurance coverage continues for up to 12 months in a LWOP or nonpay status. You do not have to pay any premiums while you are on LWOP unless you are receiving benefits from the Department of Labor, Office of Workers' Compensation Programs. The life insurance ends at the end of the 12 months with a 31-day extension of coverage and a right to convert to an individual policy.
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  • Yes, it is true. As part of the Basic life insurance, employees who are under age 45 get an Extra Benefit at no additional cost. The Extra Benefit doubles the amount of the life insurance payable if you are age 35 or younger. Beginning on your 36th birthday, the Extra Benefit decreases 10% each year until, at age 45, there is no Extra Benefit.
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  • During the first 12 months of LWOP, your FEGLI coverage continues. If you die during the first 12 months, OFEGLI uses the salary at the time of death to compute the benefit. For example:
    Stan had Basic insurance only. He went on LWOP February 1, 2003. His salary at that time was $18,449. In September 2003, he got a within-grade increasing his salary to $20,849.00. He died November 15, 2003. Since he died during the first 12 months of LWOP, life insurance is payable. The basic salary used to compute the benefit is $20,849.00.
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Total Count: 717, Number of Pages: 36, Page: 1
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