Human Resources and Security Specialists should use this tool to determine the correct investigation level for any covered position within the U.S. Federal Government.
If you waived participation in premium conversion, you can change from self- and-family enrollment to a Self Only enrollment or cancel your enrollment at any time. You can make other changes during Open Season or due to certain events. Your Human Resources Office can give you more information about these events.
“Changes to Federal Benefits Eligibility Due to Health Reform” are now available on OPM’s website at http://www.opm.gov/insure/health/aca/index.asp. These FAQs provide your employees with important information about child eligibility and Federal Benefits under the Affordable Care Act.
FastFacts offering a basic understanding of the Affordable Care Act and child eligibility under the Federal Benefits Health Benefits (FEHB) Program are now available on our website at http://www.opm.gov/insure/fastfacts/reform.pdf. The FastFacts is a two-page document designed to be easily posted to a bulletin board as well as distributed electronically.
These and additional resources about health care reform are available on our website at www.opm.gov/insure/health/reform.
If you have specific questions, please contact your agency’s benefits officer. If you do not know who this person is, please go to http://apps.opm.gov/abo/ where you will find a list of agencies and their Headquarters Benefits Officers.
If you disagree with the plan’s decision on your claim, the Federal Employees Health Benefits (FEHB) Program provides for an appeal process. Check your plans FEHB brochure to see if the service is covered, limited, or excluded.
Review and follow the directions in the disputed claims section (Section 8) of the brochure. This section will tell you how to ask the plan to reconsider your claim. You must explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered.
If the plan again denies the claim, read the plan's decision letter carefully. Then, check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of the brochure will tell you how to write to the U.S. Office of Personnel Management to ask us to review the claim.
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