Insurance FAQs

The vision carriers are:

• FEP BlueVision;
• UnitedHealthcare Vision; and
• Vision Service Plan (VSP).

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.

To qualify for Spouse Equity coverage, submit an application to your former spouse's Human Resources Office (or, if applicable, the former spouse's retirement system) within 60 days after your divorce. To be eligible, you must have been covered as a family member under your spouse's FEHB Program enrollment at least one day during the 18 months prior to divorce and you must have future entitlement to receive a portion of your spouse's retirement annuity or a survivor annuity. Also, if you remarry prior to age 55 you will lose this coverage. If you do not qualify under the Spouse Equity provisions, you may be eligible for coverage under the Temporary Continuation of Coverage provisions. You may also convert to a private policy.

No, you will pay the same premium as you paid while you were an employee. However, annuitants are paid on a monthly basis so you will pay them at the monthly rate. You may see an increase if you are employed by an agency, such as the Post Office, that contributes additional money towards the total premium. Retirees receive the same government contribution as most Federal employees.

No. Employees can only enroll in Basic, Option A and Option B this way. Obtaining a physical does not allow you to enroll in Option C. You must either enroll during an unrestricted Open Season or else in connection with a life event — marriage, divorce, death of spouse or acquisition of eligible children.

Unfortunately, parents are not eligible family members.

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.

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

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.

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%.

First, have your doctor contact the plan to discuss the situation. You and your doctor can provide your plan with information to support your contention that the surgery should be authorized, such as medical records that indicate the need for the surgery, and ask your plan to reconsider its decision. If the plan reconsiders its decision but continues to uphold its denial, and after considering the plan's rationale you still disagree, consult the disputed claims section of your plan's brochure for specific information on how to write to the Office of Personnel Management to ask us to review the claim.

If you disagree with the plan’s decision on your claim, the Federal Employees Health Benefits (FEHB) Program provides for an appeal process.  Check your plans FEHB brochure to see if the service is covered, limited, or excluded. Review and follow the directions in the disputed claims section (Section 8) of the brochure. This section will tell you how to ask the plan to reconsider your claim. You must explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered. If the plan again denies the claim, read the plan's decision letter carefully. Then, check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of the brochure will tell you how to write to the U.S. Office of Personnel Management to ask us to review the claim.   If you have a complaint that is not related to a disputed claim, email your complaint to FEHB@opm.gov.

Yes. You should still send a copy of the court order to your Human Resources Office to review and make a determination if any action is required. They will file the copy in your OPF and flag it so that they know a court order relating to health benefits has been filed. If your children aren't listed as family members on the SF 2809, they will send a copy of the court order to your FEHB plan.

Send the completed form with a certified copy of the death certificate to the insured's agency if he/she died as an employee. If you are the deceased's widow(er) and the agency told you to send your claim form and other documents directly to OFEGLI, you should do that. If the deceased was retired, send the form with a certified copy of the death certificate to: Office of Federal Employees' Group Life Insurance  P.O. Box 6512 Utica, NY 13504-6512

The authority for agencies to pay premiums applies to employees who were called to active duty on or after December 8, 1995, and who meet certain conditions. Agencies may make retroactive payments to qualified employees for premiums paid on or after that date. Ask your Human Resources Office about the policy for your agency.

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.

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).

Yes, you as the insured, can cancel coverage even if there is a court order on file.