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Insurance FAQs Health

  • If you are not participating in premium conversion, you may elect to reduce your FEHB coverage at any time. As a participant in premium conversion you will be able to reduce FEHB coverage only during an FEHB Open Season or in conjunction with a qualifying life event (QLE). IRS rules govern these non-Open Season opportunities for those who participate in premium conversion.
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    • 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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  • It is your opportunity to enroll in an FEHB health plan. You cannot enroll in the FEHB Program at any other time unless it is during the annual open season (approximately mid-November through mid-December each year) or if you experience a Qualifying Life Event.
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  • Transfer-in FEHB Enrollment Under CSRS/FERS, your employing office must transfer-in your FEHB enrollment as of your effective date of participation in premium conversion. Procedures and guidelines pertaining to the transfer of the FEHB enrollment of reemployed annuitants who participate in premium conversion are outlined in Payroll Office Letter P-00-13 [129 KB], FEHB Premium Conversion. Employing Agency Must Contribute Employer Share of Premium Prior to premium conversion, the employer share of the FEHB premium for reemployed annuitants under CSRS/FERS was paid from an OPM appropriation. Effective with premium conversion, your employing office must contribute the employer share of the FEHB premium for all reemployed annuitants that are enrolled in the FEHB as employees. The employer contribution for reemployed annuitants will be remitted to OPM in the same manner as that for other employees. Separation from Active Service Your participation in premium conversion ends on the last day of the last pay period as an employee. When you separate from active service, your FEHB enrollment must be transferred back from your employing agency to OPM or the appropriate retirement system.
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  • Premium conversion does not affect your EITC. The EITC is based on Total Earned Income (TEI), which includes both taxable and nontaxable earned income. Taxable earned income includes money earned as wages, salaries and tips while nontaxable earned income includes salary deferrals and reductions. Premium conversion falls under the category of nontaxable earned income because salary is reduced by an amount equal to a health insurance premium payment and a health insurance premium is then paid with these pre-tax dollars. The EITC amount is unaffected by premium conversion because premium conversion shifts health insurance premium payments from taxable to nontaxable earned income, both of which are included in the TEI when calculating the EITC.
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  • Look at the FEHB brochure for the plan that interests you. Brochures are on the OPM website at www.opm.gov/insure. You can also ask the health benefits officer in your Human Resources Office for help. When you know the plan you want to enroll in, you can make the change in Employee Express. You'll need the 3-character enrollment code for the plan.
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  • FEHB premiums deducted from the pay of a participating employee are deducted BEFORE FICA and Federal income taxes. When an employee waives participation in premium conversion, FEHB premiums will continue to be deducted from the pay after FICA and Federal income taxes. In all cases, deductions for CSRS or FERS will continue to be made first.
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  • 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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  • 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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  • We ensure that the plans provide the benefits described in the FEHB Program brochures. The health plans often make Preferred Provider Agreements and other arrangements with providers which are contractual arrangements between the carriers and the providers. Because of the discounts that a plan realizes through its contracts with PPO providers, the plan is able to reimburse a higher percentage of the negotiated PPO allowance when PPO providers are utilized. It would not be cost effective for the plan to reimburse at the higher level when the provider is not giving a discount. Furthermore, much of the benefit you receive from using PPO providers comes from the PPO provider's agreement not to bill you for more than the negotiated PPO allowance. Non-PPO providers are under no such obligation. In some areas of the country, it is much more difficult for a plan to arrange PPO contracts for all types of services. In areas where there are no PPO providers, you can still receive your plan's regular benefits, as opposed to the incentivized PPO benefit.
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  • Mary J. is a single parent with one child who will turn age 26 at the end of March. She wants to maintain her Self and Family coverage until that time. The loss of an eligible child is a QLE, and changing her coverage from Self and Family to Self Only is on account of and consistent with that QLE. At the end of March, Mary changes her coverage to Self Only. Michael M., a federal employee, has Self Only coverage and so does his wife, who is employed in the private sector. In June, she gives birth to their first child. Michael wants to cancel his FEHB coverage, saying that his wife has picked up family coverage that includes him and their new child. Michael's request is on account of and consistent with his QLE. Monique K. begins an approved period of leave without pay (LWOP) to attend school. She elects to keep her FEHB coverage, and incur an obligation to her employing agency. She may not change her FEHB coverage, but may change her premium conversion election. Agencies must determine acceptable documentation for a qualifying life event (QLE). Acceptable documentation includes birth and death certificates, marriage licenses, divorce papers, etc. When your QLE is one where documentation is not readily available the IRS has indicated that your certification of coverage under another health plan is sufficient.
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  • Please contact your tribal employer to see if they permit the use of pre-tax dollars (i.e., premium conversion) to pay for insurance premium payments.
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  • Generally, if you cancel your Spouse Equity enrollment, you may not reenroll. However, if you cancel because you:
    • become covered as an employee or a family member under another person's FEHB enrollment, or
    • become covered under a Medicare Advantage Plan or Medicaid,
    you may reenroll if you lose the other coverage. You must provide documentation of the other coverage when you cancel your Spouse Equity enrollment.
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  • Your child can be covered under your Self and Family enrollment until he/she turns age 26. There is no requirement that your child attend college to be covered under your Self and Family enrollment.
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  • Premiums vary by plan.  You may pay at a maximum approximately 30% of the premiums.  However, if you are a part-time tribal employee, your premiums will be pro-rated so your share of premiums  may be higher. Please contact your tribal employer for details.
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Total Count: 488, Number of Pages: 33, Page: 20
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