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Frequently Asked Questions Insurance

Health

  • Outside of Open Season, you can make changes due to certain events, called qualifying life events (QLEs) The most common QLEs for changing enrollment type or plan are: marriage, acquiring a child, moving away from the area served by your Health Maintenance Organization (HMO), losing health insurance coverage, or changing employment status.
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  • To continue your health benefits enrollment into retirement, you must: (1) have retired on an immediate annuity (that is, an annuity which begins to accrue no later than one month after the date of your final separation); and (2) have been continuously enrolled (or covered as a family member) in any FEHB Program plan (not necessarily the same plan) for the five years of service immediately preceding retirement, or if less than five years, for all service since your first opportunity to enroll.
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  • When you enroll in a Medicare Advantage plan, you may not need FEHB coverage because the Medicare Advantage plan will provide you with many of the same benefits. You should review the Medicare Advantage Plan benefits carefully before making a decision to suspend or cancel FEHB coverage. You should contact your retirement system to discuss suspension and reenrollment.
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  • No, you will pay the same premium as you paid while you were an employee. However, annuitants are paid on a monthly basis so you will pay them at the monthly rate. You may see an increase if you are employed by an agency, such as the Post Office, that contributes additional money towards the total premium. Retirees receive the same government contribution as most Federal employees.
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  • Yes, you may change your FEHB enrollment to any available plan or option at any time beginning 30 days before you become eligible for Medicare. You may use this enrollment change opportunity only once. You may also change your enrollment during the annual Open Season, or because of another event that permits enrollment changes (such as a change in family status).
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  • No. In order to decrease your enrollment to Self Plus One you will need to make an enrollment change during Open Season or in conjunction with experiencing a Qualifying Life Event. Your employing (or retirement) office will not change your enrollment unless you request it.
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  • You need to complete the SF 2809 if you change your enrollment from Self and Family to Self Only or vice versa.

    For example, if you have Self and Family coverage and you plan to keep Self and Family coverage, you do not need to complete any forms. You must let the health plan know the date of the divorce so that your ex-spouse can be removed from your enrollment. If you have Self and Family coverage and you now plan on enrolling in Self Only coverage, you must notify your Human Resources Office. You will have to complete an SF 2809.

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  • Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for emergency care outside of the United States which Medicare doesn't provide. Some FEHB plans also provide coverage for dental and vision care. Medicare covers some orthopedic and prosthetic devices, durable medical equipment, home health care, limited chiropractic services, and some medical supplies, which some FEHB plans may not cover or only partially cover (check your plan brochure for details).
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  • If you choose a Self Plus One enrollment during the 2015 Open Season, your enrollment change will be effective on the 1st of January. For annuitants, Open Season enrollments are always effective on the 1st day of the year following the end of the Open Season.

    If you choose a Self Plus One enrollment outside of Open Season, your enrollment change will be effective on the first day of the first pay period following the one in which you make a change. For example, if you request an allowable change in the middle of February, your change will be effective on March 1st.

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  • You must apply for Temporary Continuation of Coverage (TCC) with your agency Human Resources Office within 60 days from the date you separate from Federal service. TCC coverage becomes effective the day after the qualifying event. After your 31-day extension of your group coverage ends, you pay the full premium (the enrollee and Government contribution) plus a 2 percent administrative fee. For more information, contact your agency's Human Resources Office and review the TCC pamplet at www.opm.gov/insure/health/eligibility/tcc.
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