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Frequently Asked Questions Insurance

Health

  • Problems arising from oral discussions are very difficult to settle later because they are impossible to prove or disprove. In contractual situations such as under the FEHB Program, oral statements can never be regarded as official and, so, we state in the brochures that oral statements made by any representative of a carrier cannot modify the benefits described in the brochure.
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  • No. When you lose FEHB coverage other than by cancellation (including cancellation by nonpayment of premiums) you have a 31-day temporary extension of coverage, at no cost. This coverage is provided in the same enrollment category so you may convert to an individual contract with your current health benefits plan. Please review the Temporary Continuation of Coverage (TCC) pamphlet. www.opm.gov/insure/health/eligibility/tcc
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  • If you do not want to continue your FEHB enrollment, you must notify your employing office in writing that you wish to terminate your coverage. If you do not take action to terminate the coverage, your enrollment will continue for up to 24 months while you are on military duty.
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  • If your agency does not pay your premiums, you must pay the employee's share of the premium during the first 12 months of coverage (just as any other employee on leave without pay). You must pay both the employee and government shares, plus an administrative charge of 2 percent of the total premium, for up to 12 additional months that you continue your coverage while on military duty.
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  • There are a number of factors for you to consider if you are employed part-time. Although you will not be eligible for the full government contribution, your entire employee contribution will be pre-tax if you participate in premium conversion. That larger reduction in taxable income might offset the lower government contribution. If you are a part-time reemployed annuitant, we suggest that you consult your agency or a qualified tax advisor to review your individual situation.
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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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  • 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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  • The premiums for the FEHB plan you are currently enrolled in are in the brochure you will receive from your plan during the annual Federal Benefits Open Season. The Guide to Federal Benefits is a comparison of the plans and their benefits and premiums. There are a variety of Guides targeted to specific groups of enrollees.

    The average premium is recalculated every year. 

    Per FEHB law, the government will pay the lesser of: 75% of the carrier’s total premium, or 72% of the average premium.  The enrollee is responsible for the difference between the government contribution and the total premium.

    If the average premium increases, the maximum government contribution also increases.

    The total premium is the same for all enrollees, but the Government contribution is based on your employment. Some agencies, such as the Postal Service, contribute additional money towards the total premium. As a result, the share you must pay will depend upon your employment status. All Guides are available on this website or through your Human Resources Office.

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  • The formulary for your health plan provides a list of medications that a team of health care specialists have approved. Your doctor will write a prescription based on your medical needs, but the formulary provides him with recommendations from the pharmacist and physician team.

    An effective formulary system provides a medication safety feature. When drugs and administration methods are systematically included (or deleted) in a controlled drug formulary, there are a number of benefits. For instance, each new drug added undergoes a peer review process that uncovers any safety concerns with the drug. Also, when drugs are systematically added to the formulary, there is adequate time to educate the staff before the drug is used. An organized formulary also ensures that the number and variety of drugs is kept to an effective minimum. There are approximately 13,000 prescription drugs on the market today and several drugs can often be used to treat the same condition. A formulary, based on safety and cost considerations, helps to limit the drugs recommended by your plan's health care professionals.

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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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