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Insurance FAQs

  • "Assignment" means that you give ownership and control of your Basic, Option A, and/or Option B life insurance coverage to someone else. This means that the money goes to the assignee, or the assignee's beneficiary(ies) when you die. The insurance is still on your life and you must continue to pay for the coverage, but someone else "owns" and controls your coverage. You may assign your life insurance coverage to an individual, a corporation, or an irrevocable trust. Your decision to assign your life insurance coverage is irrevocable; you cannot cancel your assignment if you change your mind. You cannot assign Option C.
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  • Any insurance policy purchased under the conversion privilege is a private business transaction between you and the insurance company. The cost of the individual policy is determined by the insurance company and is based on your age and class of risk. If you return to Federal service and have converted your FEGLI coverage (including as a reemployed annuitant), you do not have to cancel your conversion policy. You can continue the conversion policy and have FEGLI coverage as an employee.
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  • No. If you receive an SF 2819, that means that you are eligible to convert your insurance, but you don't need to — the choice is yours. IF you qualify to carry your coverage into retirement, you may want to do that and not convert. Just because you receive an SF 2819 does not mean that you do not qualify to carry your coverage into retirement. All employees whose current coverage as an employee is terminating (other than by voluntary cancellation) receive a copy of that form — whether or not they qualify to carry coverage into retirement.
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  • Only Basic insurance is available for a Living Benefit. The Office of Federal Employees' Group Life Insurance cannot pay Optional insurance as a Living Benefit. A Living Benefit election has no effect on your Optional insurance. Your Optional insurance will not change and you will continue to pay your Optional insurance premiums.
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  • The legal age or age of adulthood for the FEGLI Program is 18, unless the state in which the minor lives has established a lower age of adulthood. In that case, the legal age is the lower age.
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  • If you elect to terminate your enrollment before you go on active duty, the termination will be effective on the day you are separated, furloughed, or placed on leave of absence to enter military service. Your employing office must use SF 2810 to terminate your enrollment. This means that you are entitled to a 31-day extension of coverage and if needed, have the right to convert to an individual policy offered by the carrier of your plan.
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  • First, check your plan's brochure to see if the service is covered, limited or excluded. The next step is to review the disputed claims section of your brochure. Briefly, the disputed claims section will direct you to write to the plan to explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered, and to ask the plan to reconsider your claim. If the plan again denies the claim, read the plan's decision letter carefully and then check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of your brochure will show you how to write to the Office of Personnel Management to ask us to review the claim. We can't review a denied claim unless your plan has reconsidered it first (or at least been given an opportunity to reconsider it). Your disputed claim will be reviewed in one of three Health Insurance Groups. Generally, we will acknowledge your request within 5 days. After we complete the review, we will send you a final response within 60 days. If we need more time before we can decide, or if you need to do more -- such as send us more information -- before we can decide, we will contact you within 14 work days of the time we get your request and tell you what you still need to do, if anything. We are sorry but we cannot give you a decision over the phone until the review has been completed and a written copy of the final decision has been issued.
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  • Yes, you as the insured, can cancel coverage even if there is a court order on file.
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  • Unfortunately, there are areas of the country that HMOs have simply chosen not to participate in the FEHB Program. Reasons for this vary, but most cases involve population size or demographics. There is no minimum requirement for the number of HMO options available to enrollees throughout the country. We have encouraged HMO participation in the Program because many of our participants have asked for that choice of health plan. In fact, under the FEHBP, the only types of health plans that can be added to the Program are HMOs. And, HMOs have an annual opportunity to submit their applications to participate in the Program. If you have HMOs in your local area that do not currently participate in the FEHBP, we encourage you to ask these HMOs to consider the FEHBP market for their geographic areas. New plan application packages for the FEHB Program are available at www.opm.gov/insure/health/carriers/index.asp. Applications are due to OPM by January 31 of each year for the next contract term.
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  • Open Season changes for most Federal employees are effective the first day of the first full pay period that begins in January. Generally, mid-year changes are effective on the first day of the pay period which begins after your enrollment is received by your Human Resources Office.
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  • Yes.
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  • The premiums for the FEHB plan you are currently enrolled in are in the brochure you will receive from your plan during the annual Federal Benefits Open Season. The Guide to Federal Benefits is a comparison of the plans and their benefits and premiums. There are a variety of Guides targeted to specific groups of enrollees. The average premium is recalculated every year.  Per FEHB law, the government will pay the lesser of: 75% of the carrier’s total premium, or 72% of the average premium.  The enrollee is responsible for the difference between the government contribution and the total premium. If the average premium increases, the maximum government contribution also increases. The total premium is the same for all enrollees, but the Government contribution is based on your employment. Some agencies, such as the Postal Service, contribute additional money towards the total premium. As a result, the share you must pay will depend upon your employment status. All Guides are available on this website or through your Human Resources Office.
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  • If you believe that OPM is not complying with a requirement of the Privacy Rule you may file with either OPM or the Department of Health and Human Services (HHS) Office of Civil Rights a written complaint, either on paper or electronically. This complaint must be filed within 180 days of when the complainant knew or should have known that the act had occurred. For more information on how to file a complaint with OPM, please review our NPP. For instructions and information on how to file a complaint directly with HHS, please refer to their website www.hhs.gov/ocr/hipaa/.
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  • Yes. FEHB regulations provide that an employee’s FEHB is automatically reinstated upon return to employment following active duty. An annuitant’s FEHB is automatically reinstated on the day of separation from the uniformed services.
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  • It takes the Office of Federal Employees' Group Life Insurance (OFEGLI) an average of one week to process an election to enroll or increase coverage by getting a physical. If more than one week has passed since your doctor sent your request to OFEGLI and your human resources office has not yet received a decision, you can check on the status by calling OFEGLI at 1-800-633-4542.
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  • Your new plan is NOT responsible for providing coverage until the effective date of your enrollment change which for most employees is the first day of the first full pay period in January. If you need medical services before the effective date of your Open Season enrollment, you should contact your old plan. Please remember, while the new enrollments are not effective until the first full pay period in January, the new plan benefits are effective January 1. Your old plan, therefore will provide coverage according to the new contract. These expenses will count toward your prior year's deductible. If you are an annuitant, you should contact your new plan. Your Open Season enrollment is effective January 1.
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  • You can use Employee Express anytime, 24-hours a day, seven days a week.
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  • If you file claims after the deadline because you requested the 6 additional months of FEHB coverage, your plan will waive any timely filing restrictions. Fee-for-service plans must accept and process any claims for services received during the additional 6-month period, and reconsider any claims incurred during the additional 6 months that were previously denied for non-coverage. HMOs must provide benefits for services rendered during the additional 6 months if the provider was part of the HMO network at the time. They do not need to provide benefits if the services received during the additional 6 months were provided by non-network providers.
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  • Yes, you can submit your FEDVIP co-payments/deductibles as eligible expenses against your FSA account. However, FEDVIP insurance premiums are not reimbursable under an FSA.
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  • Yes. If you meet the five-year requirement when your reemployment terminates, you will be able to continue your Option B. An example of this may help you to understand. Gabriela had Basic since she was first employed with the Federal Government and Option B, two multiples, since March 1991. She retired in June 1993. She was not able to continue her Option B. She was reemployed as a reemployed annuitant in June 1996. She elected Option B, two multiples as an employee. She worked until December 1999. She is now eligible to continue her Option B, 2 multiples, into retirement because she has had it for the five years of service immediately preceding her separation in 1999.
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Total Count: 824, Number of Pages: 42, Page: 9
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