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Frequently Asked Questions Insurance

Health

  • Generally, your coverage continues for 36 months from the date of your divorce or annulment, as long as you pay your premiums on time.

    After your TCC enrollment ends:

    • you get a 31-day extension of coverage, and
    • you may convert to an individual contract offered by your health benefits plan,

    unless you lose coverage because you canceled your enrollment or didn't pay your premiums.

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  • If the union agrees to adopt our plan, premium conversion may apply to Federal employees on LWOP to work for a union.
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  • Open Season changes for most Federal employees are effective the first day of the first full pay period that begins in January. Generally, mid-year changes are effective on the first day of the pay period which begins after your enrollment is received by your Human Resources Office.
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  • Your premiums will not change. The enrollment will be changed to your name and changed to a self only enrollment if there are no other eligible family members.
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  • Information about the new TRICARE-For-Life program can be obtained by calling 1-888-DOD LIFE (1-888-363-5433) or by going to the TRICARE website at www.tricare.osd.mil.
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  • Yes, taxes in 49 states and most localities will be reduced; exceptions include the state of New Jersey and the Commonwealth of Puerto Rico. OPM monitors changes in state and local tax regulations, and provides guidance to your agency as needed. Regardless of where you live, FEHB premiums are not subject to Federal taxes.

    FICA Taxes

    If you are covered by the Federal Employees Retirement System (FERS) and participate in premium conversion, FEHB premium deductions will also be excluded from gross pay before Old-Age, Survivors, and Disability Insurance (OASDI) and Medicare taxes are applied. Employer FICA contributions will also be reduced in concert with the decrease in employee withholdings.

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  • As long as your spouse has a Self and Family enrollment and you are still married to your spouse, you will be covered under the enrollment. Your eligibility for coverage under your spouse's Self and Family enrollment will cease after a divorce or annulment. You may, however, be eligible for FEHB coverage under either the Spouse Equity provisions or the Temporary Continuation of Coverage provisions of the law. You would be enrolled in your own right and would pay both the Government and employee shares of the premium yourself.
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  • Your new plan is NOT responsible for providing coverage until the effective date of your enrollment change which for most employees is the first day of the first full pay period in January. If you need medical services before the effective date of your Open Season enrollment, you should contact your old plan. Please remember, while the new enrollments are not effective until the first full pay period in January, the new plan benefits are effective January 1. Your old plan, therefore will provide coverage according to the new contract. These expenses will count toward your prior year's deductible.

    If you are an annuitant, you should contact your new plan. Your Open Season enrollment is effective January 1.

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  • Medicare beneficiaries may enroll in Original Medicare (Parts A and B) or choose to get their benefits from an array of Medicare Advantage Plans (Part C) plan options. Depending on where you live, Part C options may include Medicare Advantage Plans that are approved by Medicare but run by private companies. Medicare Advantage plans offer Medicare Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), private fee-for-service plans (PFFS), Medicare Special Needs Plans, and Medicare Medical Savings Account (MSA) plans.

    The Medicare Prescription Drug, Improvement and Modernization Act (MMA) established a voluntary outpatient prescription drug benefit, Medicare Part D, effective January 1, 2006. Medicare enrollees are able to receive prescription drug coverage by enrolling in a Medicare Part D plan. Medicare Advantage Plans (Medicare Part C) may also offer prescription drug coverage that follows the same rules as the Medicare Part D coverage.

    Other Medicare plans include Medicare Cost Plans, demonstration/pilot programs, and PACE (Programs of All-inclusive Care for the Elderly).

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  • If you cancel your FEHB, you need to be aware of the following consequences that apply to all employees who cancel their FEHB, including:
    • You and your dependents are no longer covered under the FEHB Program.
    • You may not reenroll in FEHB until you lose your TAMP coverage or have another qualifying life event (QLE) that permits enrollment, or until the next FEHB Open Season. If you reenroll because you lose TAMP coverage, you must do so from 31 days before to 60 days after your TAMP ends, and use Code 1M on Health Benefits Election Form, SF 2809, at www.opm.gov/forms/pdf_fill/sf2809 [848 KB]. Additional QLEs that permit enrollment, for example, a change in family status, are listed on SF 2809. If you have one of these QLEs, you must enroll within the timeframes shown.
    • If you transfer to another Federal agency, your cancellation follows you and you may not reenroll until you lose your TAMP coverage or have another QLE that permits enrollment, or until the next FEHB Open Season. See above bullet for details.
    • If you separate from your employment, you will not be eligible for temporary continuation of coverage (TCC) because you will not have any FEHB enrollment to continue. Also, you will not have an FEHB enrollment to convert to an individual policy with your former insurance carrier.
    • If you retire, you will not have an FEHB enrollment to continue into retirement.
    • If you die, you will not have an FEHB family enrollment for your survivors to continue, even if they are eligible for a survivor annuity.

    Note: Your agency may ask you to sign a statement stating that you understand these consequences.

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