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Insurance FAQs Health

Ineligible for FEHB

  • For a small number of individuals it may make sense to waive premium conversion. There are two items to consider in making a decision to waive participation and they are: Flexibility Under IRS rules, you may reduce coverage (cancel, or change from Self and Family to Self Only) only during an Open Season or at the time of a qualifying life event. Social Security Paying your premiums with pre-tax money reduces your earnings reported to the Social Security Administration. When you begin to collect Social Security (normally this occurs at age 65), you may receive a slightly lower Social Security benefit. The extent of the impact will vary depending upon the retirement system you participate in, your salary compared with the Social Security wage base ($87,000 in 2003) and the number of years until you retire.
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  • Generally, your coverage continues for 36 months from the date of your divorce or annulment, as long as you pay your premiums on time. After your TCC enrollment ends:
    • you get a 31-day extension of coverage, and
    • you may convert to an individual contract offered by your health benefits plan,
    unless you lose coverage because you canceled your enrollment or didn't pay your premiums.
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  • Information about the new TRICARE-For-Life program can be obtained by calling 1-888-DOD LIFE (1-888-363-5433) or by going to the TRICARE website at www.tricare.osd.mil.
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  • Premiums are paid on a pre-tax basis (premium conversion) if you are an active employee and your salary is sufficient to make the premium withholding. Pre-tax premiums are not available to annuitants, survivor annuitants or compensationers.
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  • If you do not want to continue your FEHB enrollment, you must notify your employing office in writing that you wish to terminate your coverage. If you do not take action to terminate the coverage, your enrollment will continue for up to 24 months while you are on military duty.
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  • FedFlex, The Federal Flexible Benefits Plan , is the name of OPM's cafeteria plan. In order to offer pre-tax benefits, OPM was required to create a plan document in accordance with IRS regulations that outlines the benefits and employee choices under that plan.
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  • You are eligible for Medicare if you are age 65 or over. Also, certain disabled persons and persons with permanent kidney failure (or End Stage Renal Disease) are eligible. You are entitled to Part A without having to pay premiums if you or your spouse worked for at least 10 years in Medicare-covered employment. (You automatically qualify if you were a Federal employee on January 1, 1983.) If you donï't automatically qualify for Part A, and you are age 65 or older, you may be able to buy it; contact the Social Security Administration. You must pay premiums for Part B coverage, which are withheld from your monthly Social Security payment or your annuity. You must be enrolled in both Medicare Parts A and B before you can enroll in Part C. You must be enrolled in either Part A or Part B before you can enroll in Part D. The cost of any additional premium will vary depending on the Part C or Part D plan that you select.
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  • 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.
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  • 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 FEHB Program, oral statements can never be regarded as official and, so, we state in the brochures that oral statements made by any representative of a carrier cannot modify the benefits described in the brochure.
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  • You will be covered only for emergency care. Unless your HMO has a "reciprocity" agreement with a plan in your new area that allows you to get routine care, you must travel back to your HMO for care, or change plans. You can change plans anytime after moving; contact your retirement system.
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  • You can submit a court order if you are an employee, an annuitant, a former spouse, the former spouse's attorney or anyone else.
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  • No. The only way to continue coverage into retirement is to meet the five year/all opportunity rule. You cannot "buy" the years you are missing.
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  • There are a number of factors for you to consider if you are employed part-time. Although you will not be eligible for the full government contribution, your entire employee contribution will be pre-tax if you participate in premium conversion. That larger reduction in taxable income might offset the lower government contribution. If you are a part-time reemployed annuitant, we suggest that you consult your agency or a qualified tax advisor to review your individual situation.
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  • 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.
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  • When children reach age 26, they are eligible to enroll in Temporary Continuation of Coverage (TCC) or convert to an individual policy.  It is the responsibility of you or your child to know when he/she is no longer eligible for coverage and to apply for TCC or a conversion policy in a timely manner. Your employing office is not obligated to inform you of your child’s eligibility for TCC and conversion rights when he/she is no longer eligible for coverage. TCC: If a child loses coverage under your enrollment because he/she reaches age 26, he/she is eligible for TCC. You must contact your Human Resources Office within 60 days of your child’s 26th birthday to inform them that your child is turning age 26.  Your Human Resources Office will give you information about enrolling your child in TCC or converting your child to an individual policy.  Your child has 60 days to request enrollment for TCC from the later of (1) his/her 26th birthday or (2) the date of the TCC notice from the Human Resources Office. For more information about TCC, please review the TCC coverage pamphlet at www.opm.gov/insure/health/eligibility/tcc. Conversion: If a child loses coverage under your enrollment because he/she reaches age 26, he/she is entitled to convert to an individual policy offered by the carrier of your plan. Your child is not required to provide evidence of insurability.  To apply for conversion, you or your child must make a written request to the carrier of your plan.  You or your child must apply for conversion within 31 days after his/her 26th birthday.  For more information about conversion, please visit http://www.opm.gov/insure/health/reference/handbook/FEHB15.asp#31.
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Total Count: 703, Number of Pages: 47, Page: 6
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