Insurance FAQs

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.

A Living Benefit payment is a lump sum payment to those who are terminally ill and have a documented medical prognosis showing a life expectancy of no more than nine months. You are eligible to elect a Living Benefit if you are an employee, annuitant, or compensationer and you are enrolled in the FEGLI Program. Employees can choose a full or partial (a multiple of $1,000) Living Benefit. Annuitants and compensationers can elect only a full Living Benefit. A Living Benefit is equal to the Basic Life insurance amount, plus any extra benefit for persons under age 45, that would be in effect nine months after the date of the Office of Federal Employees' Group Life Insurance (OFEGLI) receives a completed claim for Living Benefits form. If you have assigned your life insurance, you cannot elect a Living Benefit. Living Benefit payments are reduced by a nominal amount (4.9%) to make up for lost earnings to the Life Insurance Fund because of the early payment of benefits. The election of Living Benefits has no effect on the amount of any Optional life insurance. You will continue to pay premiums for any Optional insurance you have. You must contact OFEGLI at 1-800-633-4542 to obtain the form to elect Living Benefits (Form FE-8). This form is not available from your human resources office or the Office of Personnel Management (OPM).

There are a number of factors for you to consider if you are employed part-time. Although you will not be eligible for the full government contribution, your entire employee contribution will be pre-tax if you participate in premium conversion. That larger reduction in taxable income might offset the lower government contribution. If you are a part-time reemployed annuitant, we suggest that you consult your agency or a qualified tax advisor to review your individual situation.

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.

Yes. The amount of your FEGLI automatically increases when your salary goes up, whenever your annual pay is increased by an amount sufficient to raise the pay to the next $1,000 bracket.

The formulary for your health plan provides a list of medications that a team of health care specialists have approved. Your doctor will write a prescription based on your medical needs, but the formulary provides him with recommendations from the pharmacist and physician team. An effective formulary system provides a medication safety feature. When drugs and administration methods are systematically included (or deleted) in a controlled drug formulary, there are a number of benefits. For instance, each new drug added undergoes a peer review process that uncovers any safety concerns with the drug. Also, when drugs are systematically added to the formulary, there is adequate time to educate the staff before the drug is used. An organized formulary also ensures that the number and variety of drugs is kept to an effective minimum. There are approximately 13,000 prescription drugs on the market today and several drugs can often be used to treat the same condition. A formulary, based on safety and cost considerations, helps to limit the drugs recommended by your plan's health care professionals.

No, retiree pay premiums on a post tax basis.

The 24-month period begins the day you are separated, furloughed, or placed on leave of absence to serve on military duty. This applies even if part of your military service is covered by paid leave immediately followed by furlough or other leave without pay.

Federal and U.S. Postal Service employees eligible for FEHB coverage (whether or not enrolled) and annuitants/survivor annuitants/compensationers (regardless of FEHB eligibility) are eligible to enroll.

Yes.

Annuitants sometimes need a new copy of “Your Federal Retirement Benefits” to show their retirement income to their mortgage lender, bank, underwriter, state income tax office, or low-income housing provider.  To request a new copy of “Your Federal Retirement Benefits”, or to receive a verification of your annuity, contact OPM’s Retirement Office at 1-888-767-6738 or retire@opm.gov.  The phone lines are open from 7:30 am to 7:45 pm (Eastern Standard Time). It is a busy phone number so we encourage you to call early in the morning or after 5:00 pm when the phone lines are less busy.

As a result of health care reform, beginning January 1, 2011, children of Federal enrollees will be covered by their parent’s FEHB Self and Family enrollment until their 26th birthday (plus a 31-day temporary extension of coverage), even if the child previously lost coverage because he/she turned 22.

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.

The cost of Basic insurance is shared between you and the Government. You pay two-thirds and the Government pays one-third. Your age does not affect the cost of Basic insurance. You pay $0.1500 per $1,000 biweekly or $0.3250 monthly. If you are a Postal employee, the U.S. Postal Service pays the entire cost of your Basic life insurance. You pay the full cost of all Optional insurance. The cost depends on your age and the amount of insurance you have. (You can see the premiums for Optional insurance by clicking here.) Your agency will withhold the premiums from your pay.

No, you do not have to be enrolled in a family plan for the five years before you retire to meet the five-year requirement. As a retiree, you can enroll in a family plan during the Open Season or when an event occurs that permits a change to the family plan.

Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children.  Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self support because of a mental or physical disability that existed before age 26 is also an eligible family member. Your employing office will look at the child’s relationship to you as the enrollee to determine whether the child is a covered family member. You cannot cover other relatives, such as your mother, even if they are otherwise considered your dependents. An employee’s agency makes enrollment eligibility decisions in accordance with the law and regulations.  Ask your Human Resources Office for help in deciding whether your circumstances meet the requirements.

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.

No.  By law, annuitants are not eligible for FSAFEDS.  For more information, please refer to the FSAFEDS Summary of Benefits.

Yes, if you experience one of the following Qualifying Life Events: You are enrolled in a FEHB Health Maintenance Organization (HMO) and you (or a covered family member) move or become employed outside the geographic area from which your FEHB carrier accepts enrollments; (or, if already outside this area, you move further from this area); You lose coverage due to discontinuance in whole or part of your FEHB plan; You experience a change in your family status. (Family status changes include marriage, legal separation, divorce, death of spouse or dependent, loss of coverage by your last dependent child.)