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.
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 website
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:
- Complete one full year (365 calendar days) of continuous
employment with no breaks in service of
more than five days;
- Have a regular scheduled tour of duty, arranged in
advance and expected to last for at least six
months, and
- 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 www.opm.gov/insure/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/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