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Insurance FAQs Health

Disputed Claims

  • To continue your health benefits enrollment into retirement, you must: (1) have retired on an immediate annuity (that is, an annuity which begins to accrue no later than one month after the date of your final separation); and (2) have been continuously enrolled (or covered as a family member) in any FEHB Program plan (not necessarily the same plan) for the five years of service immediately preceding retirement, or if less than five years, for all service since your first opportunity to enroll.
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  • Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for emergency care outside of the United States which Medicare doesn't provide. Some FEHB plans also provide coverage for dental and vision care. Medicare covers some orthopedic and prosthetic devices, durable medical equipment, home health care, limited chiropractic services, and some medical supplies, which some FEHB plans may not cover or only partially cover (check your plan brochure for details).
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  • Your life insurance coverage continues for up to 12 months in a LWOP or nonpay status. You do not have to pay any premiums while you are on LWOP unless you are receiving benefits from the Department of Labor, Office of Workers' Compensation Programs. The life insurance ends at the end of the 12 months with a 31-day extension of coverage and a right to convert to an individual policy.
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  • During the first 12 months of LWOP, your FEGLI coverage continues. If you die during the first 12 months, OFEGLI uses the salary at the time of death to compute the benefit. For example:
    Stan had Basic insurance only. He went on LWOP February 1, 2003. His salary at that time was $18,449. In September 2003, he got a within-grade increasing his salary to $20,849.00. He died November 15, 2003. Since he died during the first 12 months of LWOP, life insurance is payable. The basic salary used to compute the benefit is $20,849.00.
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  • Increasing life insurance:  FEGLI life insurance open seasons are extremely rare and none are currently scheduled.  Your agency and OPM's website will announce when there is a life insurance open season coming up.  The most recent FEGLI open seasons were held in 2004 and 1999. Outside of an open season, eligible employees can enroll or increase their coverage by taking a physical exam or with a Qualifying Life Event. For more information about the physical exam, please see SF 2822. FEGLI life events are marriage, divorce, death of spouse, or acquisition of an eligible child.  With a life event, you can enroll or increase coverage in Basic, Option A, up to five multiples of Option B, and/or up to five multiples of Option C.  You must submit an SF 2817 to your human resources office within 60 days after the life event. Reducing or cancelling life insurance: You can reduce or cancel your FEGLI life insurance at any time, without waiting for an open season.   If you are an employee, submit an SF 2817 to your human resources office, signing only for the coverage you want to keep.   If you are retired, there is no form; you must write a signed letter to OPM's Retirement Office stating clearly the reduction or cancellation you want to make.  Be sure to include your signature, annuity number (CSA/CSF) or social security number, and your phone number.  Send the letter to:
    • Office of Personnel Management 
    • Retirement Operations Center 
    • P.O. Box 45 
    • Boyers, PA 16017-0045
    Please note that you cannot enroll, increase coverage, or restore cancelled coverage after you have retired. Changing beneficiaries: You can change beneficiaries at any time, without waiting for an open season.  Submit an SF 2823 to your human resources office, or to OPM's Retirement Office if you have retired.  The address for OPM's Retirement Office is on page 3 of the form.
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  • Yes, it is true. As part of the Basic life insurance, employees who are under age 45 get an Extra Benefit at no additional cost. The Extra Benefit doubles the amount of the life insurance payable if you are age 35 or younger. Beginning on your 36th birthday, the Extra Benefit decreases 10% each year until, at age 45, there is no Extra Benefit.
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  • You must apply for Temporary Continuation of Coverage (TCC) with your agency Human Resources Office within 60 days from the date you separate from Federal service. TCC coverage becomes effective the day after the qualifying event. After your 31-day extension of your group coverage ends, you pay the full premium (the enrollee and Government contribution) plus a 2 percent administrative fee. For more information, contact your agency's Human Resources Office and review the TCC pamplet at www.opm.gov/insure/health/eligibility/tcc.
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  • Spouse equity is a provision of the law that allows the former spouse of a Federal employee or annuitant to enroll in FEHB if he or she meets certain requirements.
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  • 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.
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  • You can read the FEGLI Program Booklet for Federal Employees or for Postal employees) and review the FEGLI Handbook. Information on current premiums is available here. The FEGLI Calculator can help you figure out your coverage and premiums. Contact your human resources office if you have additional questions.
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  • Please report it here: https://apps.opm.gov/retire/death/death.cfm.  If you are unable to use the website, you can report it by contacting 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.
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  • Your spouse is eligible for coverage while you are in the process of getting divorced and even while you are legally separated. Your spouse loses eligibility for coverage as a family member when your divorce is final. Your spouse can apply for coverage in the FEHB Program under the Spouse Equity or Temporary Continuation of Coverage provisions of the FEHB law. Your spouse should contact your HR office to apply.
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  • Once Medicare becomes the primary payer, you may find that a lower cost FEHB plan is adequate for your needs, especially if you are currently enrolled in a plan's high option. Also, some plans waive deductibles, coinsurance, and copayments when Medicare is primary.
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  • If the union agrees to adopt our plan, premium conversion may apply to Federal employees on LWOP to work for a union.
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  • If you provide documentation to your retirement system that you are suspending your FEHB coverage to enroll in a Medicare Advantage plan, you may reenroll in FEHB if you later lose or cancel your Medicare Advantage plan coverage. However, you must wait until the next Open Season to reenroll in FEHB, unless you involuntarily lose your coverage under the Medicare Advantage plan (including because the plan is discontinued or because you move outside its service area). In this case, you may reenroll from 31 days before to 60 days after you lose the Medicare Advantage plan coverage, and your reenrollment in FEHB will be effective the day after the Medicare Advantage plan coverage ends (or ended).
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Total Count: 711, Number of Pages: 48, Page: 2
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