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Insurance FAQs

Disputed Claims

  • Yes.
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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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  • We have published a final regulation that allows current FEHB annuitants and former spouses who are eligible for these programs to suspend their FEHB coverage and premium payments. The regulation allows these individuals to reenroll in the FEHB Program during the Open Season, or immediately if they are involuntarily disenrolled from the non-FEHB coverage.
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  • You will be able to enroll through BENEFEDS at www.BENEFEDS.com during Open Season. Those without access to a computer will be able to enroll by phone at 1-877-888-FEDS (3337), TTY 1-877-889-5680.
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  • No. FEGLI life insurance open seasons are extremely rare.  Outside of an open season, eligible employees can enroll in FEGLI by taking a physical exam or with a Qualifying Life Event. The form to request FEGLI by taking a physical exam is available the SF 2822.  The form is completed partly by you, partly by your agency, and partly by your healthcare provider.  If OFEGLI approves your request, you are automatically enrolled in Basic. If you want Optional insurance as well as Basic, you can enroll in Option A and/or Option B within 60 days from the date of OFEGLI's approval. You cannot enroll in Option C by getting a physical. With a FEGLI Qualifying Life Event, you can enroll in FEGLI Basic, Option A, up to five multiples of Option B, and/or up to five multiples of Option C.  Qualifying Life Events are marriage, divorce, death of spouse, or acquisition of an eligible child. To enroll or increase your FEGLI coverage based on a life event, submit an SF 2817 to your human resources office within 60 days after the life event.
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  • 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).
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  • No. Under the Federal Employees Dental and Vision Insurance Program (FEDVIP), there is no extension of coverage, temporary continuation of coverage (TCC), spouse equity coverage, or right to convert to an individual policy (conversion policy).
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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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  • You are no longer an eligible family member when your divorce or annulment becomes final. You get a 31-day extension of your health benefits plans coverage after that date. You may convert to an individual contract offered by your health benefits plan, if you don't qualify for or don't want FEHB coverage through Spouse Equity or TCC.
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  • If you are on a deferred retirement annuity, you are not eligible for FEDVIP. If you are retiring with title to an MRA+10 annuity and you postpone receiving your annuity, you are eligible for FEDVIP only when you begin to receive that annuity. You would not be eligible for FEDVIP during the time between your separation from duty and before actual receipt of your annuity.
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  • When you return to work after a break in service of less than 180 days, your human resources office will automatically enroll you in the same coverage that you had before you left your prior position. You will have to qualify to elect other coverage (Open Season, physical exam or life event). When you return to work after a break in service of 180 days or more, your human resources office will automatically enroll you in Basic and the same Optional insurance that you had in your prior position. You will have this coverage the first day you are in pay and duty status. Any previous waiver of insurance is automatically cancelled. Unless you file a new waiver, Basic insurance becomes effective your first day in pay and duty status in a position in which you are eligible for coverage. You may elect more insurance (if you don't already have the maximum) within 31 days of returning to service in an eligible position, regardless of the coverage you had during previous employment. If you do not make a new election, you will automatically get back whatever Optional insurance you had immediately before your separation. Any coverage that you had previously waived will be waived again.
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  • 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.
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  • When a drug patent expires other companies may produce a generic version of the brand name drug. A generic medication, also approved by the FDA, is basically a copy of the brand name drug and is marketed under its chemical name. A generic drug may have a different color or shape than its brand name counterpart, but it must have the same active ingredients, strength, and dosage form (i.e., pill, liquid, or injection), and provide the same effectiveness and safety as its brand name counterpart.
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  • Vision plans feature comprehensive eye examinations and coverage for lenses, frames and contact lenses. Other benefits such as discounts on LASIK surgery may also be available.
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  • As long as your spouse has a Self and Family enrollment and you are still married to your spouse, you will be covered under the enrollment. Your eligibility for coverage under your spouse's Self and Family enrollment will cease after a divorce or annulment. You may, however, be eligible for FEHB coverage under either the Spouse Equity provisions or the Temporary Continuation of Coverage provisions of the law. You would be enrolled in your own right and would pay both the Government and employee shares of the premium yourself.
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  • No. Option C coverage only provides coverage for your spouse and eligible children. Mothers, fathers, brothers, sisters and other family members are not covered under Option C. There are no exceptions to this, regardless of the health status of your family member and whether he or she qualifies as your dependent.
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  • The National Defense Authorization Act for 2001 (Act) extended TRICARE pharmacy coverage to uniformed services Medicare eligible retirees, spouses, and survivors on April 1, 2001. Now uniformed services beneficiaries can get comprehensive prescription drug coverage through TRICARE's retail, mail order, or military treatment facility pharmacies. The Act also reinstated eligibility for TRICARE medical benefits for these beneficiaries on October 1, 2001. Beneficiaries with Medicare Parts A and B are now eligible to use TRICARE coverage for physician, hospital, surgical, and pharmaceutical services.
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  • You should consult an attorney concerning such legal issues as appointing a guardian for your minor child. If you should die while your child is still a minor and he/she is entitled to your life insurance benefits, the Office of Federal Employees' Group Life Insurance (OFEGLI) will not pay benefits to your minor child. If the benefits payable are $10,000 or less, OFEGLI may pay the benefits to a surviving parent when the parent assures OFEGLI, in writing, that he/she will use the funds for the sole benefit of the child. If benefits exceed $10,000, payment depends on whether the State where the child lives requires a guardian. If the State requires a guardian, a court-appointed guardian can file a claim for death benefits on behalf of your minor child. In those cases, guardianship must be established before payment can be made. Natural parentage is not automatic guardianship. The guardian must have the authority granted by the court to collect money on behalf of the child. OFEGLI would then make payment to the guardian who would have to answer to the court regarding how/when he/she spent the money, depending on the details of the guardianship granted by the court. In those States that do not require the court appointment of a guardian, OFEGLI will pay the benefits to the person responsible for the care of the child when he/she assures OFEGLI, in writing, that he/she will use the funds for the sole benefit of the child. If there is not a guardian and one won't be appointed and the State requires one and the proceeds are greater than $10,000, OFEGLI will open an interest-bearing account payable to the minor upon reaching the legal age.
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  • The date of the court order itself is not relevant. But the date the agency or retirement system (as applicable) received the court order is relevant. If someone submitted a court order before July 22, 1998, it is not valid and the Office of Federal Employees' Group Life Insurance (OFEGLI) cannot honor it.
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  • No. When you lose FEHB coverage other than by cancellation (including cancellation by nonpayment of premiums) you have a 31-day temporary extension of coverage, at no cost. This coverage is provided in the same enrollment category so you may convert to an individual contract with your current health benefits plan. Please review the Temporary Continuation of Coverage (TCC) pamphlet. www.opm.gov/insure/health/eligibility/tcc
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Total Count: 711, Number of Pages: 36, Page: 6
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