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Insurance FAQs

  • Annuitant Open Season changes are effective January 1.
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  • No, your FEHB plan will still be the primary payor for your vision and dental care up to the limits of its coverage.
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  • No. If you remarry, your new spouse and his/her children cannot receive health benefits coverage under your survivor annuitant enrollment. If, however, you are a widow(er) survivor annuitant who is also receiving an annuity based on your own Federal career or who is a current Federal employee, you may be eligible to transfer your enrollment to your retirement annuity or your employing agency in order to provide coverage for your new spouse and his or her children.
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  • A brand name drug is approved by the Food and Drug Administration (FDA), and is supplied by one company (the pharmaceutical manufacturer). The drug is protected by a patent and is marketed under the manufacturer's brand name.
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  • You can use Employee Express anytime, 24-hours a day, seven days a week.
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  • You are correct. Problems arising from oral discussions are very difficult to settle later because they are impossible to prove or disprove. In contractual situations such as under the Federal Employees Health Benefits Program, oral statements can never be regarded as official and, so, the brochures state that oral statements made by any representative of a carrier cannot modify the benefits described in the brochure. If a serious decision -- such as whether to enroll or not enroll in a plan -- hinges on such a coverage issue, do not rely on a verbal response. This is particularly true if the response disagrees with the plan's brochure benefits description.
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  • If you cancel your FEHB, you need to be aware of the following consequences that apply to all employees who cancel their FEHB, including:
    • You and your dependents are no longer covered under the FEHB Program.
    • You may not reenroll in FEHB until you lose your TAMP coverage or have another qualifying life event (QLE) that permits enrollment, or until the next FEHB Open Season. If you reenroll because you lose TAMP coverage, you must do so from 31 days before to 60 days after your TAMP ends, and use Code 1M on Health Benefits Election Form, SF 2809, at www.opm.gov/forms/pdf_fill/sf2809 [848 KB]. Additional QLEs that permit enrollment, for example, a change in family status, are listed on SF 2809. If you have one of these QLEs, you must enroll within the timeframes shown.
    • If you transfer to another Federal agency, your cancellation follows you and you may not reenroll until you lose your TAMP coverage or have another QLE that permits enrollment, or until the next FEHB Open Season. See above bullet for details.
    • If you separate from your employment, you will not be eligible for temporary continuation of coverage (TCC) because you will not have any FEHB enrollment to continue. Also, you will not have an FEHB enrollment to convert to an individual policy with your former insurance carrier.
    • If you retire, you will not have an FEHB enrollment to continue into retirement.
    • If you die, you will not have an FEHB family enrollment for your survivors to continue, even if they are eligible for a survivor annuity.
    Note: Your agency may ask you to sign a statement stating that you understand these consequences.
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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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  • The time limit for notification is 60 days from your divorce or annulment. Either you or your former spouse must notify the employing office in writing that you want TCC. If your former spouse is retired, notify the retirement system.
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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 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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  • 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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  • 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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  • No. If you receive a payment of Living Benefits, that money is yours to use as you please. You do not have to return the money if you live longer than expected.
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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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  • “Changes to Federal Benefits Eligibility Due to Health Reform” are now available on OPM’s website at http://www.opm.gov/insure/health/aca/index.asp.  These FAQs provide your employees with important information about child eligibility and Federal Benefits under the Affordable Care Act. FastFacts offering a basic understanding of the Affordable Care Act and child eligibility under the Federal Benefits Health Benefits (FEHB) Program are now available on our website at http://www.opm.gov/insure/fastfacts/reform.pdf.  The FastFacts is a two-page document designed to be easily posted to a bulletin board as well as distributed electronically. These and additional resources about health care reform are available on our website at www.opm.gov/insure/health/reform.   If you have specific questions, please contact your agency’s benefits officer. If you do not know who this person is, please go to http://apps.opm.gov/abo/ where you will find a list of agencies and their Headquarters Benefits Officers.
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  • Yes.
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  • Enrollees may choose from Self Only coverage or Self and Family coverage. Other coverage types -- such as Medicare enrolled and/or Medicare eligible -- are not available. Data shows that there is not a significant difference in the cost to the FEHB Program between employees and enrollees covered by both Medicare and an FEHB plan. The cost to employees or Medicare-eligible enrollees would not reduce substantially be creating a separate Medicare category. Interestingly, your enrollees often benefit from older enrollees' Medicare enrollment. This is because substantial savings can be realized from an aggressive coordination of benefits program between the plan and Medicare; the savings are applied to all enrollees' rates.
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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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  • No, USPS employees pay the same premiums as Federal employees and annuitants.
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Total Count: 817, Number of Pages: 41, Page: 9
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