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Frequently Asked Questions Insurance

  • You should examine your Medicare coverage in order to determine if the Federal Employees Dental and Vision Insurance Program (FEDVIP) will benefit you or your family. Your FEDVIP premiums will not change if you enroll in Medicare.
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  • FEDVIP plans provide comprehensive coverage your FEHB plan may not provide. But only you can decide whether it is to your advantage to enroll in a FEDVIP plan.
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  • If the documentation showing your eligibility for TRICARE is received within the period beginning 31 days before and ending 31 days after the date you designate as the day you want to use TRICARE or CHAMPVA instead of FEHB coverage, the suspension becomes effective at the end of the day before the day you designated. Otherwise, the suspension becomes effective at the end of the month in which we receive your documentation.
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  • When you return to work after a break in service of less than 180 days, your human resources office will automatically enroll you in the same coverage that you had before you left your prior position. You will have to qualify to elect other coverage (Open Season, physical exam or life event).

    When you return to work after a break in service of 180 days or more, your human resources office will automatically enroll you in Basic and the same Optional insurance that you had in your prior position. You will have this coverage the first day you are in pay and duty status. Any previous waiver of insurance is automatically cancelled. Unless you file a new waiver, Basic insurance becomes effective your first day in pay and duty status in a position in which you are eligible for coverage.

    You may elect more insurance (if you don't already have the maximum) within 31 days of returning to service in an eligible position, regardless of the coverage you had during previous employment. If you do not make a new election, you will automatically get back whatever Optional insurance you had immediately before your separation. Any coverage that you had previously waived will be waived again.

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  • During the fall of each year, you will receive a copy of the Medicare & You handbook. It is also available by calling 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048, or at www.medicare.gov/publications/pubs/pdf/10050.pdf . The Medicare & You handbook has information on Medicare Parts A & B; Medicare Advantage Plans (Part C); Medicare Prescription Drug Coverage (Part D); Help for People with Limited Income and Resources; and Joining and Switching Plans. The Medicare website (www.medicare.gov) contains the handbook and other information about Medicare. If you do not have a personal computer, your local library or senior center may be able to help you access this website. You should contact your retirement system before making any change to your coverage, especially if you are considering suspending your FEHB coverage to enroll in a Medicare Advantage Plan. If you are a CSRS or FERS annuitant, you may call OPM's Retirement Information Office at 1-88USOPMRET (1-888-767-6738) or 202-606-0500 from the metropolitan Washington area, or you may write to:

    Office of Personnel Management
    Retirement Operations Center
    P.O. Box 45
    Boyers, PA 16017-0045

    Other useful publications, such as the Guide to Health Insurance for People with Medicare, are also available at the Medicare number (1-800-633-4227) or from your State Health Insurance Assistance Program (SHIP) counseling office. The SHIP counselors in your state are also available by telephone or sometimes as a walk-in resource if you would like more personalized attention. You can find SHIP counseling office telephone numbers in the Medicare & You handbook or on the Medicare website at www.medicare.gov/contacts/static/allStateContacts.asp.

    Your FEHB plan brochure provides specific information on how its benefits are coordinated with Medicare. Some HMOs participating in the FEHB are structured to provide more comprehensive coverage if you enroll in both their HMO and their Medicare Advantage plan.

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  • Temporary Continuation of Coverage (TCC) is available to: (1) employees who lose their FEHB Program coverage because they leave their Federal jobs, (2) children who lose their FEHB Program family member status because they reach age 26, and (3) former spouses who lose their FEHB Program family member status because of divorce or annulment. TCC allows former employees to continue their FEHB Program coverage for up to 18 months, and former family members (children and former spouses) to continue FEHB Program coverage for up to 36 months. For more information about TCC, please review the TCC pamphlet at www.opm.gov/insure/health/eligibility/tcc/index.asp.

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  • To inquire about how much coverage you have under the Federal Employees Group Life Insurance (FEGLI) Program, contact OPM's Retirement Office by emailing retire@opm.gov or calling 1-888-767-6738. The phone lines are open from 7:30 am to 7:45 pm (Eastern Standard Time). It is a busy phone number so we encourage you to call early in the morning or after 5:00 pm when the phone lines are less busy. You will need to provide your retirement claim number (CSA) or Social Security Number.

     

    Please note: For privacy reasons, the response to an email request for information on FEGLI coverage will be mailed to the address on file with the OPM Retirement Office. It will not be sent back via email.

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  • Each year OPM releases the new health insurance rates about a month prior to the FEHB Open Season. The FEHB Open Season runs from the second Monday in November through the Second Monday in December. The new rates are generally released by mid-October at http://www.opm.gov/insure/health/rates/index.asp.

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  • You are no longer an eligible family member when your divorce or annulment becomes final. You get a 31-day extension of your health benefits plans coverage after that date. You may convert to an individual contract offered by your health benefits plan, if you don't qualify for or don't want FEHB coverage through Spouse Equity or TCC.
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  • The former spouses that the regulation applies to are those of civilian Federal employees and annuitants as defined under the Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615). The regulation does not apply to "unremarried former spouses" under TRICARE law (title 10 USC). See also the chapter on former spouses in the FEHB Handbook.
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