Insurance FAQs

Dental plans provide a comprehensive range of services, including the following:

• Class A (Basic) services, which include oral examinations, prophylaxis, diagnostic evaluations, sealants and x-rays.
• Class B (Intermediate) services, which include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions, and denture adjustments.
• Class C (Major) services, which include endodontic services such as root canals, periodontal services such as gingivectomy, major restorative services such as crowns, oral surgery, bridges and prosthodontic services such as complete dentures.
• Class D (Orthodontic) services with up to a 24-month waiting period.

Premium conversion may slightly reduce the Social Security benefit you will receive upon retirement. The extent of the impact depends upon several factors:

• the retirement system that you participate in;
• whether your salary exceeds the Social Security wage base; and
• the number of years left until your retirement.

The FEHB Program runs on a calendar year basis - from January through December. The carriers' provider contracts, however, which are between the provider and the carrier, are spread throughout the year, as are the carriers' policies with other employers.

The "Federal Employees Health Benefits Children's Equity Act of 2000" requires mandatory Self and Family enrollment coverage for FEHB-eligible employees who do not comply with a court or administrative order to provide health insurance coverage for their child(ren). You should send a copy of the court order to your ex-spouse's Human Resources Office. They will ensure that your ex-spouse has an FEHB Self and Family enrollment that provides coverage for the children. If your ex-spouse does not have a Self and Family enrollment, his Human Resources Office will enroll him in the Self and Family option of his current FEHB plan. If his current plan is an HMO and the child(ren) don't live within the service area of this plan, they will enroll him in the Basic Option of the Blue Cross and Blue Shield Service Benefit Plan. Please be sure to include your home address in your notification so that the Human Resources Office can make this determination. The Human Resources Office will send you a copy of the SF 2809, Health Benefits Election Form. They will also send a copy to the FEHB plan so the plan can update their records and send ID cards to you. The Human Resources Office will flag your ex-spouse's health insurance records to prevent him from making a change to a Self Only enrollment for as long as the court order requires him to provide health insurance coverage to your child(ren) or until the youngest child reaches age 26, whichever occurs first.

FEHB and FEDVIP are separate programs. While some FEHB plans offer dental or vision benefits as part of their benefit package, only those carriers under contract to OPM are FEDVIP plans. FEDVIP plans offer comprehensive dental and vision benefits. FEDVIP is not part of the FEHB program, and it is different from any supplementary dental and vision product your FEHB plan may offer.

Medicare beneficiaries may enroll in Original Medicare (Parts A and B) or choose to get their benefits from an array of Medicare Advantage Plans (Part C) plan options. Depending on where you live, Part C options may include Medicare Advantage Plans that are approved by Medicare but run by private companies. Medicare Advantage plans offer Medicare Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), private fee-for-service plans (PFFS), Medicare Special Needs Plans, and Medicare Medical Savings Account (MSA) plans. The Medicare Prescription Drug, Improvement and Modernization Act (MMA) established a voluntary outpatient prescription drug benefit, Medicare Part D, effective January 1, 2006. Medicare enrollees are able to receive prescription drug coverage by enrolling in a Medicare Part D plan. Medicare Advantage Plans (Medicare Part C) may also offer prescription drug coverage that follows the same rules as the Medicare Part D coverage. Other Medicare plans include Medicare Cost Plans, demonstration/pilot programs, and PACE (Programs of All-inclusive Care for the Elderly).

No, your FEHB plan will still be the primary payor for your vision and dental care up to the limits of its coverage.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal law that provides far-reaching health insurance reforms and medical privacy protections for all Americans. Title I of HIPAA offers important, though limited, Federal protections that improve the availability and continuity of health coverage for workers and their families. Under certain conditions, this law guarantees the availability of new health coverage with no exclusions for pre-existing conditions for individuals who lose employment-based health coverage due to changes in employment or family status. The Departments of the Treasury, Labor, and Health and Human Services are jointly responsible for Federal rules concerning health insurance portability and accessibility requirements. However, since HIPAA gives enforcement authority to the individual states and allows states to impose more generous protections than those under HIPAA, a key source of information for individuals is your State Insurance Commissioner.

Only you and the children born to or adopted by you and your former spouse (the Federal employee or annuitant) are covered under a Self and Family enrollment. Your child must be under age 26 or be incapable of self-support because of a mental or physical disability that existed before age 26. Your children cannot be covered under more than one FEHB enrollment. If the employee or annuitant covers the children under his/her FEHB enrollment, your Spouse Equity enrollment should be for Self Only coverage.

An eligible individual may choose one of the following enrollment options:

1. Self Only, which covers only the enrolled employee or annuitant;
2. Self Plus One, which covers the enrolled employee or annuitant plus one eligible family member specified by the enrollee; or
3. Self and Family, which covers the enrolled employee or annuitant and all eligible family members.

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.

A. Yes, you will be able to reenroll in the future because you are canceling your enrollment to be covered by another FEHB enrollment.

Living Benefits payments received on or after January 1, 1997, are not subject to Federal income tax. However, some states have laws, regulations, or rulings concerning the taxability of Living Benefits (also called accelerated death benefits). You should consult a tax advisor or your State's tax department for specific information concerning State income tax laws. Qualified payments from viatical settlement firms received on or after January 1, 1997 are also not subject to Federal income tax provided the companies meet certain tax exemption qualifications. If you are considering assigning your insurance to a viatical settlement firm, you should consult a tax advisor to determine if you and the viatical settlement firm meet the tax exemption qualification standards.

Your premiums will not change. The enrollment will be changed to your name and changed to a self only enrollment if there are no other eligible family members.

You may not need to write to the Office of Personnel Management. If you think you might qualify for a waiver of the 5-year coverage requirement, contact your Human Resources Office for information. If you meet the requirements, your agency will attach a memorandum to your retirement application stating that you meet the requirements for waiver by the Office of Personnel Management.

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.

Valium is a brand name drug whose generic counterpart is Diazepam. On the other hand, Amoxicillin is a generic drug of the brand drug Trimox.

No. If an annuitant, survivor, or former spouse suspends Self and Family coverage, the coverage of all family members is suspended as well.

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.