Federal Employee Health Benefit Program

RI 70-2 For United States Postal Service Employees

FEHB and You

Overview

The United States Postal Service (USPS() provides health benefits to its career employees by participating in the Federal Employees Health Benefits (FEHB) Program, which is administered by the U.S. Office of Personnel Management (OPM), Office of Retirement and Insurance Services. FEHB began operation in July 1960 and almost 815 million people are in the program, including 2.2 million federal and postal employees, 1.85 million retirees, and eligible family members. It is the largest employer-sponsored health insurance program in the world. OPM interprets health insurance laws and writes regulations for the FEHB Program. It gives advice and guidance to the USPS and other participating agencies to process your enrollment changes and to deduct your premiums. OPM also contracts with and monitors all of the plans participating in the FEHB Program.

The purpose of this 2005 Guide to Federal Employees Health Benefits (FEHB) Plans is to provide information about enrollment and premium features that USPS career employees must consider when selecting a health insurance plan under the FEHB Program. The Guide is a summary of FEHB plans . the plan brochures give specific benefit information. You can get individual plan brochures directly from the health plans, from your local personnel office, or from the OPM web site www.opm.gov/insure which also has a copy of this guide in addition to various health plan brochures and helpful information.

You may choose from among Fee-for-Service (FFS) plans regardless of where you live (see pages 29 through 38) and from Health Maintenance Organizations (HMO's) plans if you live (or sometimes if you work) within the area serviced by the plan (see pages 39 through 65). Some HMOs also offer a Point-of-Service (POS) product which allows you to use providers who are not part of the HMO network, but at an increased cost.

While FEHB eligibility, enrollment requirements and the plans available for 2005 are the same for federal and USPS employees alike, the Postal Service pays a higher percentage contribution towards career postal employee premium rates than the rest of the federal government. All employee premium rates are calculated using the "Fair Share Formula."

Coverage

New Employees - New employees have the opportunity to select a health plan with 60 days of being hired.

Current Employees - Current employees have an opportunity to select or change plans:

• During Open Season
• When certain life events occur (see table on pages 24 through 27 of this Guide) NOTE: These elections MUST be made within certain time limits as specified in the table.

Your choice of plans and options includes Self Only coverage just for you, or Self and Family coverage for you, your spouse, and unmarried dependent children under age 22 (and in some cases, a disabled child 22 years or older who is incapable of self-support).

Eligible Family Members - Eligible family members for "self and family" health benefits registration purposes include an enrollee's:

• Spouse
• Unmarried dependent children under age 22, including legally adopted children and recognized natural (born out-of-wedlock) children.
• Unmarried dependent stepchildren and foster children, (including foster children who are also your grandchildren) under age 22 if they live with the enrollee in a regular parent-child relationship.
• Unmarried dependent children age 22 or over who are incapable of self-support because of physical or mental incapacity that existed before their 22nd birthday.

Ineligible Members - Even though the following family members may live with and/or be dependent upon the enrollee, they are NOT ELIGIBLE for coverage under the enrollee's "self and family" FEHB program enrollment:

• Parents and other relatives
• Former spouses.

Loss of Coverage - When an event occurs that causes you or your family member to lose coverage, the FEHB Program offers a continuation of coverage feature, either temporarily or by permanent conversion to a private sector policy. Such events include but are not limited to:

• Child reaching age 22
• Separation
• Retirement
• Divorce
• Application for Spouse Equity
• Death
• Relocation
• LWOP Status*
• Leave Without Pay Status - FEHB Program regulations state that you may continue your FEHB coverage for up to 365 days while you are in an LWOP status, provided that you continue to pay the employee share of the premium. The Postal Service will invoice you for your share of the premium unless you complete and submit to your personnel office PS Form 3111, FEHB Coverage or Termination While In Leave Without Pay (LWOP) Status, to terminate coverage. At 365 days in LWOP status, your FEHB coverage terminates.

It is your responsibility to report life events that may cause you or your family member to lose eligibility. It is also your responsibility to complete and submit any required paperwork to change your enrollment and/or apply for any continuation of coverage, if eligible, within the time limits specified in the Table of Qualifying Life Events on pages 24 through 27 of this guide. If you have questions, see your local personnel office.

If you lose coverage under the FEHB Program, you should automatically receive a Certificate of Group Health Plan Coverage from the last FEHB Plan to cover you. If not, the plan must give you one on request. This certificate may be important to qualify for benefits if you join a non-FEHB plan.

FEHB Open Season

Each year you have the opportunity to enroll or change enrollment during an open season. The 2004 Open Season is from November 8 through December 14 at 5:00 p.m. Central Time. Employees may make any one

• or a combination . of the following changes:
• Enroll if not enrolled
• Change from one plan to another
• Change from one option to another
• Change from Self Only to Self and Family
• Change from Self and Family to Self Only
• Change from pre-tax to post tax premium deductions or vice versa (see pages 4 through 6 of this Guide)
• Cancel enrollment

If you decide to do any of the above actions, you MUST follow the instructions on the FEHB Worksheet contained in the center of this Guide and enter your election in PostalEASE by 5:00 p.m. Central Time on December 14, 2004. It is critical that this be done timely.

Your new enrollment or any changes that you make to your existing coverage will take effect on January 8, 2005 and the change in premium rate deductions will be seen in your January 28, 2005, earnings statement. If you change plans, any covered expenses incurred between January 1-7, 2005, will count toward the prior year deductible of the plan you are changing from.

If you decide NOT to change your enrollment, DO NOTHING, and your present enrollment will continue automatically unless your plan is not participating in 2005. If your plan is not participating in 2005 you MUST choose another plan during open season or you will not have FEHB coverage. Ask your local personnel office for a list of the plans that will terminate at the end of the 2004 plan year.

If you decide to cancel your coverage during open season, you must cancel your enrollment in PostalEASE, which includes a confirmation by you that you clearly accept the consequences of canceling. The cancellation will become effective on January 7, 2005.

If you pay premium contributions on a pre-tax basis (which most career employees do) you will not be able to cancel or reduce (change from Self and Family to Self Only) coverage unless you experience a qualifying life event and your election is in keeping with the change. See pages 4 through 6 of this Guide on Pretax Payment of Premium Contributions and the OPM table of permissible changes on pages 24 through 27 of this Guide.

Note to those considering retirement: To be eligible to carry your FEHB enrollment into retirement, you must have been continuously covered, either as an enrollee or as an eligible family member under another FEHB enrollment, for the 5 years immediately preceding retirement, or if less than 5 years, for the entire period since your first opportunity to enroll.

You, as an employee, are responsible for being informed about your health benefits. You should thoroughly read this Guide, the brochures of plans that interest you, and the bulletin board notices on health benefits topics. These include family member eligibility, the option to continue or terminate an enrollment during periods of non-pay status or insufficient pay, dual enrollment prohibition, coverage for former spouses, and discontinued health insurance plans. Be sure to read the section on the pre-tax payment of health insurance premium contributions, which specifies Internal Revenue Service (IRS) restrictions for reducing or canceling coverage (see pages 4 through 6 of this Guide). Also be sure to refer to the table of permissible changes on pages 24 through 27 of this Guide.

After referring to these sources, if you still have questions regarding eligibility, enrollment criteria, continued coverage after certain life events, or on any other FEHB policies, or if you need assistance making your choice in PostalEASE, contact your local personnel office.

NOTE: Falsifying or misrepresenting family member eligibility or enrollmen is a violation of federal law and may subject an employee to fine, imprisonment and/or disciplinary action.

You can also look at and download:

• All of the FEHB Guides including the Guide for USPS Employees, the FEHB Guide for United States Postal Service Inspectors and Office of Inspector General Employees, the FEHB Guide for Certain Temporary (Non-career) USPS Employees, and the FEHB Guide For TCC and Former Spouse Enrollees.
• Plan brochures that include benefits, cost, and other major features of each health plan.

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