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Insurance FAQs Health

Tribal Insurance Benefits

  • When I leave the FEHB Program, I understand I will receive a certification of my group coverage that I can use to get new coverage with my private industry employer. Will my agency or my plan certify my insurance coverage? View more
    We require FEHB carriers to issue certifications of prior coverage to enrollees. They issue certifications automatically whenever coverage terminates, whether it is termination of regular coverage, TCC coverage, or Spouse Equity coverage. If the plan does not certify your coverage, you should write to them and ask them to send you certification of coverage.
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  • How long does a new tribal employee hired after the Initial Enrollment Opportunity have to enroll? View more
    If you are a new tribal employee of a tribal employer that already participates in the FEHB Program, you have 60 days from the date of becoming eligible to enroll in it.
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  • What is the Initial Enrollment Opportunity for tribal employees? View more
    When a tribal employer chooses to participate in the FEHB Program, the Initial Enrollment Opportunity occurs.  It is the time period for you to enroll in the FEHB Program.  Please check with your tribal employer to see if they have elected to participate in FEHB.
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  • Can a tribal employee cancel coverage at any time? View more
    If you participate in premium conversion, you can only cancel during Open Season or when experiencing a specific QLE.  If you do not participate in premium conversion, you can cancel at any time.
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  • Which tribal employers are eligible to participate in the Federal Employees Health Benefits (FEHB) Program? View more
    The Affordable Care Act (healthcare reform law) states that: (1) urban Indian organizations carrying out programs under Title V of the Indian Health Care Improvement Act and (2) Indian tribes or tribal organizations carrying out programs under the Indian Self-Determination and Education Assistance Act are entitled to purchase coverage, rights, and benefits of the FEHB program for their tribal employees.   OPM uses the term “tribal employer” to refer to Indian tribes, tribal organizations, and urban Indian organizations.         
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  • Which family members are eligible? View more
    • A spouse, including a valid common law marriage (marriage means only a legal union between one man and one woman as husband and wife, as defined in the Defense of Marriage Act).
    • Children under age 26 (including adopted children, recognized natural children or stepchildren; or foster children living with tribal employee in regular parent-child relationship)                                                                                              
    • Children age 26 or older incapable of self-support, if disabling condition began before age 26
    Which family members are not eligible?         
    • Grandchildren, unless foster child requirements (as defined in the Handbook) are met                                                                                                  
    • Parents                                                                                                                                                                                                  
    • Siblings                                                                                                                                                                                                     
    • In-laws
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  • Are tribal retirees eligible to enroll? View more
    No.
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  • What is the timeframe for making changes due to a QLE? View more
    Generally, 31 days before to 60 days after the QLE.
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  • Can family members continue coverage when they are no longer eligible family members (e.g., a child turns 26, a former spouse after a divorce)? View more
    These family members will have a free 31-day extension of coverage.  They will also have the opportunity to enroll in TCC for up to 36 months and to convert to an individual policy with the health plan in which they are enrolled.
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  • Which tribal employers are eligible to participate in the Federal Employees Health Benefits (FEHB) Program? View more
    The Affordable Care Act (healthcare reform law) states that: (1) urban Indian organizations carrying out programs under Title V of the Indian Health Care Improvement Act and (2) Indian tribes or tribal organizations carrying out programs under the Indian Self-Determination and Education Assistance Act are entitled to purchase coverage, rights, and benefits of the FEHB program for their tribal employees.   OPM uses the term “tribal employer” to refer to Indian tribes, tribal organizations, and urban Indian organizations.
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  • How long is the Initial Enrollment Opportunity for tribal employees? View more
    Please contact your tribal employer for the specific dates or the specific time period of your Initial Enrollment Opportunity.
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  • Can a tribal employee continue coverage when in an insufficient or nonpay status? View more
    • If your tribal employer offers Leave Without Pay (i.e., unpaid leave), then yes, your coverage may continue for up to 365 days.  You must elect to continue or terminate enrollment. 
    • If you continue FEHB enrollment, you may pay premiums directly to the tribal employer or incur a debt to the tribal employer.  The tribal employer must pay premiums to the National Finance Center (NFC).
    • Nonpay status can be continuous or broken by periods of less than 4 months of pay status.
    • If you return to pay status, you must elect to enroll—it’s not automatic—and you have 60 days to enroll after returning.
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  • What is Open Season? View more
    Open Season is the annual time when you can enroll, change, or cancel your FEHB coverage.
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  • When do Open Season changes become effective for tribal employees? View more
    January 1st of the following calendar year.
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  • What happens if a tribal employee does nothing during the Initial Enrollment Opportunity? View more
    You will not have FEHB health insurance coverage.  You will not be able to enroll in an FEHB health plan until the annual open season (approximately mid-November through mid-December each year) or if you experience a Qualifying Life Event.
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Total Count: 48, Number of Pages: 4, Page: 2

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