The Federal Employees Health Benefits
(FEHB) Program can help you meet your health care needs. Federal employees, retirees and their
survivors enjoy the widest selection of health plans in the country.
You can choose from among Fee-for-Service (FFS) plans,
and their Preferred Provider Organizations (PPO), or Plans offering a Point of Service
(POS) Product, or Health Maintenance Organizations (HMO) if you live
(or sometimes if you work) within the area serviced by the plan.
Some FFS plans are open to all enrollees, but some require that you join
the organization that sponsors the plan, which usually involves paying a membership fee. Some plans limit enrollment to
certain employee groups. Membership requirements and/or limitations also
apply to any Point of Service product the Fee-for-Service plan may be offering.
Managed care is an important part of health care today. You will
find managed care features in all the plans described on this site.
Common features of managed care are pre-approval of hospital stays, the
use of primary care providers as "gatekeepers"
to coordinate your medical care, the use of a prescription drug formulary, and networks of physicians and
other providers.
You are fortunate to be able to choose from among many different
health plans competing for your business. Use this site to compare
the costs, benefits, and features of different plans.
We now show comparative benefit information for all plans. The benefit
categories we list were chosen based on enrollee requests,
differences among plans, and simplicity. However, we urge you
to consider the total benefit package, in addition to service and
cost, when choosing a health plan.
The plan brochures
tell you what services and
supplies are covered and the level of coverage. Look over the brochures
carefully. The brochures reflect the efforts of OPM and health plan
representatives to eliminate jargon and use plain language.
We also formatted the brochures to ensure they are all organized
alike. You can get brochures from the health plans or your human
resource office. They are also available on our website at
www.opm.gov/insure. When it comes to
your health care, the best surprise is no surprise.
Program Features
Some of our important program features are:
No waiting periods. You can use your benefits as soon as your coverage becomes effective. There are no pre-existing condition limitations even if you change plans.
A choice of coverage. You can choose Self Only coverage just for
you, or Self and Family coverage for you, your spouse, and unmarried
dependent children under age 22. Under certain circumstances, your FEHB
enrollment may cover your disabled child 22 years old or older who is
incapable of self-support.
A choice of plans and options.
A Government contribution. The Government pays 72 percent of the average premium toward the total cost of the your premium, but not more than 75 percent of the total premium for any plan.
Salary deduction. You pay your share of the premium through a payroll deduction and have the choice of doing so using pretax dollars.
Annual enrollment opportunities. Each year you can enroll or change your health plan enrollment. This year the Open Season runs from November 13, 2006, through December 11, 2006. Other events allow for certain types of changes throughout the year; see your Human Resources Office or retirement system for details.
Continued group coverage. The FEHB Program offers
continued FEHB coverage:
- for you and your family when you retire from Federal service
(normally you need to be covered in the FEHB Program for the five
years before you retire),
- for your former spouse if you divorce and he or she has a
qualifying court order (see your human resource office for more
information),
- for your family if you die, or
- for you and your family when you move, transfer, go on leave
without pay, or enter military service (certain rules about coverage
and premium amounts apply; see your human resource office).
Coverage after FEHB ends. The FEHB Program offers either temporary
continuation of FEHB coverage (TCC) or conversion to non-group
(private) coverage:
- for you and your family if you leave Federal service (including
when you can't carry FEHB into retirement),
- for your covered dependent child if he or she marries or turns age 22, or
- for your former spouse if you divorce and he or she does not have
a qualifying court order (see your human resource office for more
information).
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.