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Insurance FAQs

Disputed Claims

  • If your agency does not pay your premiums, you must pay the employee's share of the premium during the first 12 months of coverage (just as any other employee on leave without pay). You must pay both the employee and government shares, plus an administrative charge of 2 percent of the total premium, for up to 12 additional months that you continue your coverage while on military duty.
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  • You will be covered only for emergency care. Unless your HMO has a "reciprocity" agreement with a plan in your new area that allows you to get routine care, you must travel back to your HMO for care, or change plans. You can change plans anytime after moving; contact your retirement system.
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  • Yes.
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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 can reenroll in the FEHB Program for any reason during a future Open Season. If you are involuntarily disenrolled from TRICARE or CHAMPVA, you are eligible to immediately reenroll in the FEHB Program. Your request to reenroll must be received within the period beginning 31 days before and ending 60 days after your TRICARE or CHAMPVA coverage ends. Otherwise, you must wait until Open Season.
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  • Call the OPM-Macon Help Desk at 478-757-3030, choose the PIN option, and request a new PIN. The Help Desk will mail your new PIN the next day. Since the Help Desk will mail your new PIN to the address your agency has on file, make sure that your Human Resources Office has your current address. We suggest you change your PIN to something easy to remember and be sure to keep your PIN in a safe place. You won't be able to use Employee Express until you get your new PIN.
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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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  • 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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  • 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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  • You must inform your Human Resources Office that you want to revoke your waiver during your final pay period. Your Human Resources Office will then reinstate your FEHB so that you will have an enrollment to continue under TCC or convert. If your leave and earnings statement for your final pay period does not show a withholding for an FEHB premium, contact your Human Resources Office immediately.
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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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  • Yes, and this works differently than when a survivor disclaims benefits. You can name someone as a beneficiary and someone else if that first person disclaims the benefits. It's a form of contingent beneficiary. As the insured, you CAN specify who should receive the disclaimed benefits (the beneficiary cannot specify who should receive disclaimed benefits). For example, you could word your designation like this:
    Mary Jones, 100%, unless she disclaims.  Otherwise to Johnson Wallace, 100%.
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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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  • If the State in which you reside recognizes common-law marriages, yes.
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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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  • 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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  • If you die, the Waiver of Immediate Reinstatement of FEHB automatically terminates. If you postponed reinstatement of a Self and Family enrollment, and your survivors are eligible for a survivor annuity, their FEHB coverage will begin the day after your death.
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  • A. Yes, you will be able to reenroll in the future because you are canceling your enrollment to be covered by another FEHB enrollment.
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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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  • 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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Total Count: 712, Number of Pages: 36, Page: 6
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