Federal Employees Health Benefits (FEHB) Program
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.
While FEHB eligibility, enrollment requirements and
the plans available for 2008 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."
What does this Program offer?
The FEHB Program offers a wide variety of types of plans and coverage to help you meet your
health care needs. It is group coverage available to employees, retirees and their dependents. If you
continuously maintain your FEHB enrollment, or are covered by the FEHB enrollment as a family
member, or a combination of both, for the five years of service immediately preceding your
retirement, and you retire on an immediate annuity, you can continue to participate in the FEHB
after retirement. The Program benefits you receive as a retiree are the same coverage Federal
employees receive and at the same cost. If you leave government employment before retiring, the
Program offers temporary continuation of coverage (TCC) and an opportunity to convert your
enrollment to non-group (private) coverage.
If you are currently enrolled in the FEHBP and do not want to change plans or enrollment type, you
do not need to do anything. Your enrollment will continue automatically.
Appendix F includes a comparison chart of all the plans in the FEHB with information comparing
basic benefits and costs.
Key FEHB facts
- The FEHB is part of the annual Open Season.
- FEHB coverage continues each year. You do not need to re-enroll each year. If you are happy with your current coverage,
do nothing. Please note that your premiums and benefits may change.
- You can choose from Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher
deductibles, health savings/reimbursable accounts and lower premiums, or Health Maintenance Organizations or
Fee-for-Service plans with comprehensive coverage and higher premiums.
- There are no waiting periods and no pre-existing condition limitations, even if you change plans.
- If you are an active Postal employee, you can use
your Health Care Flexible Spending Account or
Limited Expense Health Care Flexible Spending
Account with your FEHB plan.
- If you participate in Pre-tax Payment of Premiums,
enrollment changes can only be made during Open
Season or if you experience a qualifying life event
(QLE).
- All nationwide FEHB plans offer international coverage.
- There are separate and/or different provider networks for each plan.
- Utilizing an in-network provider will reduce your out-of-pocket costs.
How much does it cost?
The premiums for your enrollment are shared by you
and the Postal Service. For Postal Category 1, the
Postal Service pays the lesser of 84% of the average
premium of all plans weighted by the number of
enrollees in each plan or but not more than 87.5% of
the total premium for any individual plan. For Postal
Category 2, the Postal Service pays 85% of the average
premium of all plans weighted by the number of
enrollees in each plan but not more than 88.75% of the
total premium for any individual plan.
Am I eligible to enroll?
All career employees are eligible to enroll in FEHB.
Non-career employees are eligible if they meet the
eligibility requirements. If you have an appointment
other than career and you have not received information
about enrollment, you should contact the
Human Resources Shared Service Center (HRSSC)
on 1-877-477-3273, option 5 for more information.
When you retire, you are eligible to continue health
benefits coverage if you retire on an immediate annuity
under a retirement system for civilian employees
(including FERS MRA + 10 retirements) and you have
been continuously enrolled (or covered as a family
member) in any FEHB plan(s) for the 5 years of service
immediately before the date your annuity starts, or for
the full period(s) of service since your first opportunity
to enroll (if less than 5 years).
If you suspend your FEHB coverage as a retiree
because you are covered by TRICARE, a Medicare
Advantage Plan, Medicaid, or Peace Corps volunteer
coverage you may reenroll under certain conditions.
(You should contact your retirement system for
information on your eligibility.) If you are not enrolled
in or covered as a family member under FEHB
when you retire, you will not be able to enroll after
retirement.
Coverage
New Employees - New employees have the opportunity
to select a health plan within 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 34 through 37 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 enrollment 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
- 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 a Leave Without Pay
(LWOP) status, provided that you pay the employee
share of the premium, either while on LWOP or when
you return to a pay status. The Postal Service will
invoice you for our share of the premium unless you
complete and submit to the Human Resources Shared
Service Center (HRSSC) 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.
If you do not pay your FEHB premiums while in a
LWOP status, when you return to a pay status the
amount owed for unpaid premiums may be significant.
If there are FEHB past-due premiums (from one to four
unpaid FEHB premiums), up to the entire amount due
will be deducted from your salary. In addition, if there
are sufficient monies available, the premium for the current
pay period will be deducted from your pay. When
an accounts receivable account has been created for
unpaid FEHB premiums and that receivable is over 45
days old, Payroll automatically takes 15 percent of your
disposable net pay per pay period until that accounts
receivable account is paid off. This means that an
employee who returns to pay status could possibly pay
all of these amounts at the same time - the past due
FEHB premiums (maximum of four unpaid FEHB premiums),
the current FEHB premium, and up to 15 percent
of disposable net pay towards payment of any
accounts receivables for unpaid FEHB premiums.
It is your responsibility to report life events that may
cause you or your family member to lose eligibility. It is also our 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 Permissible
Changes on pages 34 through 37 of this Guide. If you
have questions, contact the HRSSC on 1-877-477-3273,
option 5.
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.
When can I enroll?
If you are a new employee who is eligible for FEHB or an employee who has become newly
eligible to enroll, you may enroll within 60 days of becoming eligible. You may also enroll during
the annual Open Season. Furthermore, you may enroll, change your
enrollment type, or change plans outside of Open Season if you experience a qualifying life event
(QLE) such as a change in family or other insurance coverage status. The Table of Permissible Changes on page 34 contains
more specific information about qualifying life events
that permit employees to enroll or change enrollment
in the FEHB Program.
For new or newly eligible employees who elect to
enroll, coverage will be effective on the first day of the
first pay period that begins after the Postal Service
receives your enrollment. An Open Season enrollment
or change is effective on the first day of the first full
pay period that begins in January.
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 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 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 12 through 13 of
this Guide)
- Cancel enrollment
If you decide to do any of the above actions, you MUST
follow the instructions on the PostalEASE FEHB Worksheet
contained in 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 on your January 25, 2008 earnings statement.
If you change plans, any covered expenses incurred
between January 1-4, 2008 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
2008. If your plan is not participating in 2008 you MUST
choose another plan during Open Season or you will
not have FEHB coverage. Ask the Human Resources
Shared Service Center (HRSSC) 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
(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 (QLE) and your election is in keeping with
the change. See pages 12 through 13 of this Guide on
Pre-tax Payment of Premium Contributions and the
Table of Permissible Changes on pages 34 through 37
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 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 12 through 13 of this
Guide). Also be sure to refer to the Table of Permissible
Changes on pages 34 through 37 of this Guide.
You can go to www.opm.gov/insure/health and
download:
- All of the Benefits Guides including the Guide for
USPS Employees, the Guide for United States Postal
Service Inspectors and Office of 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, 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 the HRSSC on 1-877-477-3273,
option 5.
How do I enroll?
- Complete the PostalEASE FEHB Worksheet on
page 30.
- 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/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