Insurance FAQs Health

Yes. There are a few things an employee should consider. First, to be eligible to continue FEHB coverage after retirement, a retiring employee must be enrolled or covered under the FEHB Program for the five years of service immediately before retirement, or, if less than five years, for all service since the first opportunity to enroll. Employees can count their coverage under TRICARE toward meeting this requirement. However, the employee must be enrolled in an FEHB health plan on the date of retirement to continue coverage. Second, if the employee dies when the cancellation is in effect, any surviving spouse will not be eligible to continue FEHB health benefits coverage.

The employing office bills you for each pay period (generally each month) you are covered.

When a drug patent expires other companies may produce a generic version of the brand name drug. A generic medication, also approved by the FDA, is basically a copy of the brand name drug and is marketed under its chemical name. A generic drug may have a different color or shape than its brand name counterpart, but it must have the same active ingredients, strength, and dosage form (i.e., pill, liquid, or injection), and provide the same effectiveness and safety as its brand name counterpart.

The effective date of the Open Season change is the first day of the first full pay period in January. For annuitants this date will always be January 1.

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.

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.

You are no longer an eligible family member when your divorce or annulment becomes final. You get a 31-day extension of your health benefits plans coverage after that date. You may convert to an individual contract offered by your health benefits plan, if you don't qualify for or don't want FEHB coverage through Spouse Equity or TCC.

The 24-month period begins the day you are separated, furloughed, or placed on leave of absence to serve on military duty. This applies even if part of your military service is covered by paid leave immediately followed by furlough or other leave without pay.

Annuitants sometimes need a new copy of “Your Federal Retirement Benefits” to show their retirement income to their mortgage lender, bank, underwriter, state income tax office, or low-income housing provider.  To request a new copy of “Your Federal Retirement Benefits”, or to receive a verification of your annuity, contact 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.

As a result of health care reform, beginning January 1, 2011, children of Federal enrollees will be covered by their parent’s FEHB Self and Family enrollment until their 26th birthday (plus a 31-day temporary extension of coverage), even if the child previously lost coverage because he/she turned 22.

We have published a final regulation that allows current FEHB annuitants and former spouses who are eligible for these programs to suspend their FEHB coverage and premium payments. The regulation allows these individuals to reenroll in the FEHB Program during the Open Season, or immediately if they are involuntarily disenrolled from the non-FEHB coverage.

No, you do not have to be enrolled in a family plan for the five years before you retire to meet the five-year requirement. As a retiree, you can enroll in a family plan during the Open Season or when an event occurs that permits a change to the family plan.

Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children.  Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self support because of a mental or physical disability that existed before age 26 is also an eligible family member. Your employing office will look at the child’s relationship to you as the enrollee to determine whether the child is a covered family member. You cannot cover other relatives, such as your mother, even if they are otherwise considered your dependents. An employee’s agency makes enrollment eligibility decisions in accordance with the law and regulations.  Ask your Human Resources Office for help in deciding whether your circumstances meet the requirements.

Call the OPM-Macon Help Desk at 478-757-3030, choose the PIN option, and request a new PIN. The Help Desk will mail your new PIN the next day. Since the Help Desk will mail your new PIN to the address your agency has on file, make sure that your Human Resources Office has your current address. We suggest you change your PIN to something easy to remember and be sure to keep your PIN in a safe place. You won't be able to use Employee Express until you get your new PIN.