Insurance FAQs

The Privacy Rule permits OPM to impose reasonable, cost-based fees. The fee may include only the cost of copying (including supplies and labor) and postage, if you request that the copy be mailed. We expect to charge an amount similar to that used for Freedom of Information Act (FOIA) requests.

You must request a waiver of the five-year requirement from OPM. The steps you must take are given in the FEHB Handbook at Waiver of 5-Year Enrollment Requirement - Waiver of 5-Year Enrollment Requirement. If your agency has buyout authority, you may not need to write to the OPM. 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 OPM.

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.

You can enroll in any of the nationwide dental and/or vision plans. These plans provide benefits for services received outside of the United States.

You can't cancel a change. You can, however, make another change, using Employee Express. You can change most discretionary personnel and payroll transactions such as direct deposit, Federal and state tax withholdings, savings bonds, etc. at any time. Changes to FEHB and TSP are generally limited to Open Season. During FEHB Open Season, you may change your enrollment and/or waive or begin participation in premium conversion at any time up until the last day of Open Season. Employee Express will process only the last transaction.

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.

Under CSRS offset, your Social Security benefits would be slightly reduced, but your CSRS Offset benefits would be increased by almost the same amount. Participating in premium conversion is most likely a benefit to you.

Each year OPM releases the new health insurance rates about a month prior to the FEHB Open Season. The FEHB Open Season runs from the second Monday in November through the Second Monday in December. The new rates are generally released by mid-October at http://www.opm.gov/insure/health/rates/index.asp.

No. The only way to continue coverage into retirement is to meet the five year/all opportunity rule. You cannot "buy" the years you are missing.

The reductions start at the beginning of the 2nd month after your 65th birthday or the beginning of the 2nd month after your retirement date, whichever is later. For example: Pierre retired December 31, 1999. He will turn 65 on March 15, 2005. The reductions for his Basic and Optional insurance (if applicable) will start May 1, 2005. Here's another example: Selena was 67 years old when she retired on December 31, 1999. Since she was already past 65 when she retired, the reductions for her Basic and Optional insurance (if applicable) will start February 1, 2000.

Being sent to a combat zone does NOT cancel FEGLI coverage. Civilian employees who are sent to a war zone or combat zone in a support capacity keep their FEGLI coverage, including Accidental Death & Dismemberment (AD&D) coverage. Being sent to a combat zone does not affect the amount of your FEGLI coverage. If a Federal employee working in a war zone is killed, "regular" death benefits are payable to the employee's beneficiaries. Accidental death benefits are also payable under Basic insurance (and Option A, if the employee had that coverage) unless the employee was in actual combat (or unless nuclear weapons were being used) at the time of the injury that caused the employee's death. The Office of Federal Employees' Group Life Insurance (OFEGLI) decides whether to pay accidental death benefits only after thoroughly studying the facts and documentation surrounding an employee's death. The determination is made on a case by case basis. While we cannot say that in 100% of civilian deaths AD&D benefits will be payable, we can say that it is highly unlikely for a civilian to be in actual combat. Accidental death benefits are in addition to regular death benefits. Even if accidental death benefits are not payable, regular death benefits ARE payable.

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.

You should contact your Human Resources Office for the appropriate information for employees covered under FEHB who are called to military duty.

Premiums are paid on a pre-tax basis (premium conversion) if you are an active employee and your salary is sufficient to make the premium withholding. Pre-tax premiums are not available to annuitants, survivor annuitants or compensationers.

Contact your health plan directly for this information.

President George W. Bush signed The Federal Employee Dental and Vision Benefits Enhancement Act of 2004 into law on December 23, 2004. The Act authorizes OPM to establish arrangements under which supplemental dental and vision benefits are made available to Federal and U.S. Postal Service employees, retirees, and their eligible family members, and the law gives OPM broad contracting authority to leverage the purchasing power of Federal enrollees to provide comprehensive benefits with competitive premiums.

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.

• OPM's Office of Retirement Programs website. The site provides various categories of information including the questions most frequently asked by annuitants and survivor annuitants.
• During the year, you may request information such as verification of annuity or the value of life insurance as well as make changes to your own retirement account, such as federal and state income tax withholding changes, by calling OPM on the toll-free number 1-888-767-6738, TDD for the hearing impaired 1-800-878-5707, or send email to retire@opm.gov. The automated telephone system is available 24 hours a day, 7 days a week.

We suggest that you look at The Department of Health and Human Services website (specifically HHS's Office of Civil Rights), since they are tasked with writing and enforcing these regulations. Here are two links:

• www.hhs.gov/ocr/hipaa/
• www.hhs.gov/ocr/faqs1001.doc