Federal Employees Health Benefits (FEHB) Program

RI 70-08PS - For Certain Temporary (Non-Career) United States Postal Service Employees

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. 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 2008 Guide to Benefits is to provide information about enrollment and premium features that USPS non-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. Some plans available to federal and Postal employees are sponsored by unions or associations that charge a membership fee in addition to health premiums. You should read individual plan brochures carefully before making any final coverage decisions.

You may choose from among Fee-for-Service (FFS) plans regardless of where you live (see pages 34 through 37) 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 40 through 63). 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. New to the FEHB Program is the addition of High Deductible Health Plans located at the very end of this Guide.

FEHB eligibility, enrollment requirements premium costs, and the plans available for 2008 are the same for USPS temporary (non-career) employees as for federal (non-postal) temporary employees.

Certain non-career Rural Carriers and Transitional Employees who are represented by the American Postal Workers Union (APWU) and the National Association of Letter Carriers (NALC) may elect to have premium costs withheld from pay on a pre-tax basis. If you are an employee in either category be sure to read pages 9 through 10 of this Guide which provide information regarding pre-tax payment. There are advantages and disadvantages to the pre-tax payment of premium contributions that you need to understand. Certain restrictions may affect your ability to cancel coverage outside of FEHB Open Season.

Coverage

To be eligible for FEHB enrollment, non-career employees must meet three requirements:

1. Complete one full year (365 calendar days) of continuous employment with no breaks in service of more than five days;
2. Have a regular scheduled tour of duty, arranged in advance and expected to last for at least six months, and
3. Maintain sufficient earnings each biweekly pay period to have the total cost of premiums withheld from pay after mandatory deductions for Social Security, retirement, Medicare and federal tax.

Newly Eligible - Newly eligible non-career employees may select a health plan within 60 days of becoming eligible.

Currently Enrolled - Non-career employees currently enrolled under the FEHB program have an opportunity to select or change plans:

• During Open Season, or;
• When certain qualifying life events occur (see Table of Qualifying Events on pages 30 through 33 of this guide). These elections must be made within the timeframes specified in this 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.

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

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
• Insufficient Pay *

* If at any time after your initial enrollment, you do not have sufficient earnings to allow for health insurance premium withholdings, the unpaid premium will be withheld in the following pay period provided there is a sufficient amount of earnings to cover the premium cost after mandatory deductions have been made. When two adjustments for insufficient earnings have occurred, you will receive a statement and an invoice will be sent to your employing office for the total amount due. The total amount of the invoice must be paid within 30 days of the invoice date or your FEHB coverage will be terminated retroactive to the date the initial unpaid health insurance premiums were due.

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 your local personal office to change your enrollment and/or apply the any continuation of coverage, if eligible, with the time limits specified in the Table on pages 29 through 32 of this Guide.

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 2007 Open Season is from November 12 through December 11, 2007 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 9 through 10 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 11, 2007. 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 5, 2008 and the change in premium rate deductions will be seen in your January 25, 2008 earnings statement. If you decide not to change your enrollment, do nothing, and your present enrollment will continue automatically unless your plan is not participating in 2008. If your plan is not participating in 2008 you must choose another plan during this Open Season or you will not have FEHB coverage. Ask the Human Resources Shared Service Center (HRSSA) for a list of the plans that will terminate at the end of the 2007 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 4, 2008.

If you pay premium contributions on a pre-tax basis, 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 9 through 10 of this Guide on Pre-tax Payment of Premium Contributions and the OPM table of permissible changes pages 29 through 32 of this Guide.

You as an employee are responsible for being informed about your health benefits. You should thoroughly read this Guide, the brochures of individual plans that interest you, and the bulletin board notices on health benefits topics. These topics include family member eligibility, the option to continue or to terminate enrollment during periods of non-pay status or insufficient pay, dual enrollment prohibition, coverage for former spouses, and discontinued health insurance plans. If you choose to have your premium contribution deducted on a pre-tax basis, be sure to read the section in this Guide on the pretax payment of health insurance premium contributions, which specifies Internal Revenue Service (IRS) restrictions for reducing or canceling coverage (see pages 9 through 10 of this guide).

You can go to http://opm.gov/insure/archive/health and download:

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

After referring to these sources, if you still have questions regarding eligibility, policy, enrollment criteria, and continued coverage after certain life events, or if you need assistance making your choice in PostalEASE, contact the HRSSA on 1-877-477-3273, option 5.

How do I enroll?

• Complete the PostalEASE FEHB Worksheet on page 25.
• Access PostalEASE on the Intranet (from the Blue page), the Internet (https://liteblue.usps.gov), an employee Self-Service Kiosk (available in some facilities), or by calling the Employee Service Line toll-free at 1-877-477-3273, option 1.

How do I get more information about this Program?

Visit the FEHBP online at www.opm.gov/insure/archive/health for information including:

• How to compare and choose among health plans
• Health plan websites and plan brochures
• How to file a disputed claim request
• Getting quality healthcare
• Medicare and FEHB

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