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Insurance FAQs Health

  • 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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  • 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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  • 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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  • Your Human Resources Office will compile your health benefits records and forward them to OPM along with your retirement application and other records. OPM will review your health benefits records to determine if you are eligible to continue your FEHB enrollment into retirement. If you are eligible, OPM will process a transfer-in action and forward you a copy of this action for your records.
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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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  • If the State in which you reside recognizes common-law marriages, yes.
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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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  • A. Yes, you will be able to reenroll in the future because you are canceling your enrollment to be covered by another FEHB enrollment.
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  • You can reenroll in the FEHB Program for any reason during a future Open Season. If you are involuntarily disenrolled from TRICARE or CHAMPVA, you are eligible to immediately reenroll in the FEHB Program. Your request to reenroll must be received within the period beginning 31 days before and ending 60 days after your TRICARE or CHAMPVA coverage ends. Otherwise, you must wait until Open Season.
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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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  • 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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  • Yes, taxes in 49 states and most localities will be reduced; exceptions include the state of New Jersey and the Commonwealth of Puerto Rico. OPM monitors changes in state and local tax regulations, and provides guidance to your agency as needed. Regardless of where you live, FEHB premiums are not subject to Federal taxes. FICA Taxes If you are covered by the Federal Employees Retirement System (FERS) and participate in premium conversion, FEHB premium deductions will also be excluded from gross pay before Old-Age, Survivors, and Disability Insurance (OASDI) and Medicare taxes are applied. Employer FICA contributions will also be reduced in concert with the decrease in employee withholdings.
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  • If your agency does not pay your premiums, you must pay the employee's share of the premium during the first 12 months of coverage (just as any other employee on leave without pay). You must pay both the employee and government shares, plus an administrative charge of 2 percent of the total premium, for up to 12 additional months that you continue your coverage while on military duty.
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  • The formulary for your health plan provides a list of medications that a team of health care specialists have approved. Your doctor will write a prescription based on your medical needs, but the formulary provides him with recommendations from the pharmacist and physician team. An effective formulary system provides a medication safety feature. When drugs and administration methods are systematically included (or deleted) in a controlled drug formulary, there are a number of benefits. For instance, each new drug added undergoes a peer review process that uncovers any safety concerns with the drug. Also, when drugs are systematically added to the formulary, there is adequate time to educate the staff before the drug is used. An organized formulary also ensures that the number and variety of drugs is kept to an effective minimum. There are approximately 13,000 prescription drugs on the market today and several drugs can often be used to treat the same condition. A formulary, based on safety and cost considerations, helps to limit the drugs recommended by your plan's health care professionals.
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Total Count: 498, Number of Pages: 34, Page: 4
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