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Insurance FAQs

  • You can find the Guide to Federal Benefits (RI 70-5) that lists the premiums for TCC at http://www.opm.gov/insure/health/planinfo/guides/index.asp.
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  • Yes, you as the insured, can cancel coverage even if there is a court order on file.
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  • If you elect a full Living Benefit, you stop paying premiums and the Government no longer pays its contributions for your Basic life coverage. If you elect a partial Living Benefit, your agency will adjust the withholdings and contributions for your post-election Basic Insurance Amount. The amount of the post-election Basic does not change. Subsequent salary changes have no effect on the Basic amount. However, if you have Option B coverage, it will continue to change with salary changes. A Living Benefit election has no effect on your any Optional insurance you may have.
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  • The authority for agencies to pay premiums applies to employees who were called to active duty on or after December 8, 1995, and who meet certain conditions. Agencies may make retroactive payments to qualified employees for premiums paid on or after that date. Ask your Human Resources Office about the policy for your agency.
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  • We suggest that you look at The Department of Health and Human Services website (specifically HHS's Office of Civil Rights), since they are tasked with writing and enforcing these regulations. Here are two links:
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  • Some health plans offer dental and vision benefits separate from the officially offered benefits stated in their FEHB brochures. Such separate benefits are described on the "Non-FEHB Benefits" page in FEHB brochures. The plans solely determine what is covered and what is excluded and you must pay any premium associated with these benefits directly to the health or dental plan. There is no government contribution toward the premium on non-FEHB benefits. Also, some health plans offer a separate dental plan that does not require you to be a member of their health plan. And, occasionally, an agency's employee organization offers dental and vision benefits to the agency's employees. Check with your Human Resources Office.
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  • No, USPS employees pay the same premiums as Federal employees and annuitants.
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  • To continue life insurance benefits as an OWCP compensationer, you must have carried FEGLI for the 5 years of service immediately before the beginning date of compensation or, if you had it less than 5 years, for the full period(s) of service during which you were eligible to be insured. This coverage is subject to the same conditions as those of a civil service retiree. Please see your human resources office if you are receiving compensation benefits.
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  • There are limited circumstances where an Attorney-in-Fact, named in a power of attorney, may sign the FE-6 on behalf of a claimant. Whenever possible, however, the claimant should sign the claim form. For more information, please call the Office of Federal Employees' Group Life Insurance at 1-800-633-4542.
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  • No, your FEHB plan is separate from the dental and vision insurance program. You may enroll in any dental or vision plan (assuming you live in the service area, if it is a regional plan).
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  • Be careful. Such a cancellation would be permanent. Annuitants cannot re-enroll in the program except under very limited circumstances, such as to enroll in a Medicare-sponsored health plan, as described below, or TRICARE. Another exception is if your spouse is also a Federal employee and you cancel to be covered by your spouse's FEHB plan. Further, neither you nor your family members would be eligible for continued coverage nor would you be able to convert your coverage to a private non-group policy. Do not drop out of the program unless you are sure of being able to re-enroll.
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  • A brand name drug is approved by the Food and Drug Administration (FDA), and is supplied by one company (the pharmaceutical manufacturer). The drug is protected by a patent and is marketed under the manufacturer's brand name.
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  • Premium conversion may slightly reduce the Social Security benefit you will receive upon retirement. The extent of the impact depends upon several factors:
    • the retirement system that you participate in;
    • whether your salary exceeds the Social Security wage base; and
    • the number of years left until your retirement.
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  • The Privacy Rule permits OPM to impose reasonable, cost-based fees. The fee may include only the cost of copying (including supplies and labor) and postage, if you request that the copy be mailed. We expect to charge an amount similar to that used for Freedom of Information Act (FOIA) requests.
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  • The small reduction in Social Security benefits is greatly outweighed by the much larger tax savings. In each case we tested, the increase in take-home pay far exceeded the minor loss in monthly Social Security benefits. Here is a simple formula you can use to estimate the difference in your Social Security benefit:
    1. Take the number of years you will participate in premium conversion (from now until your estimated retirement) and divide by 35.
    2. Multiply this by your current annual FEHB premium
    3. Multiply the result of Step 2 by the marginal SSA rate (15% for most Federal employees)
    The result is the annual loss of Social Security benefits. (# of Years of Premium Conversion /35) X Annual FEHB Premium X marginal SSA rate = Annual Loss Example You participate in FERS. We assume that you've had a full career of FICA contributions, with an ending salary (today) of $50,000 and projected retirement at age 66 in January 2016. Your estimated Social Security benefit equals $1,414 per month. You begin participating in premium conversion and reduce your taxable income by $2,000, the amount of your FEHB premium. By changing your salary to $48,000, your monthly Social Security benefit is now $1,403, an $11.00 per month difference in today's dollars. 15/35= .4286 X 2000 = 857 X .15 = 128/12 = 10.71 or 11 Compare that to the estimated $67 increase in take home pay per month. For more specific information on how the Social Security benefit is calculated, refer to www.ssa.gov.
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  • You must inform your Human Resources Office that you want to revoke your waiver during your final pay period. Your Human Resources Office will then reinstate your FEHB so that you will have an enrollment to continue under TCC or convert. If your leave and earnings statement for your final pay period does not show a withholding for an FEHB premium, contact your Human Resources Office immediately.
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  • First, check your plan's brochure to see if the service is covered, limited or excluded. The next step is to review the disputed claims section of your brochure. Briefly, the disputed claims section will direct you to write to the plan to explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered, and to ask the plan to reconsider your claim. If the plan again denies the claim, read the plan's decision letter carefully and then check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of your brochure will show you how to write to the Office of Personnel Management to ask us to review the claim. We can't review a denied claim unless your plan has reconsidered it first (or at least been given an opportunity to reconsider it). Your disputed claim will be reviewed in one of three Health Insurance Groups. Generally, we will acknowledge your request within 5 days. After we complete the review, we will send you a final response within 60 days. If we need more time before we can decide, or if you need to do more -- such as send us more information -- before we can decide, we will contact you within 14 work days of the time we get your request and tell you what you still need to do, if anything. We are sorry but we cannot give you a decision over the phone until the review has been completed and a written copy of the final decision has been issued.
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  • If you separate from service to enter the military you are considered to be in a nonpay status for FEGLI Purposes. As long as you have reemployment rights under USERRA, you can keep your FEGLI coverage for up to 12 months, or until 90 days after your military service ends, whichever date comes first. This coverage is free. At the end of 12 months (or 90 days after the military service ends), the coverage terminates. You also get the 31-day extension of coverage and the right to convert. Public Law 110-181, the Department of Homeland Security Appropriations Act, enacted January 28, 2008, authorizes the continuation of FEGLI coverage for an additional 12 months for Federal employees called to active duty whose coverage terminated after the law's enactment. The law allows employees who enter on active duty or active duty for training in one of the uniformed services for more than 30 days to continue their FEGLI for up to 24 months. FEGLI coverage is free for the first 12 months. However, employees must pay both the employee and agency share of the premiums for their Basic coverage, and also pay the entire cost (there is no agency share) for any Optional insurance they may have for the additional 12 months of coverage. See more details in BAL 08-203 [30 KB]. At the end of 12 months, or 90 days after your military service ends, whichever date comes first your former agency must complete an Agency Certification of Insurance Status (SF 2821) and a Notice of Conversion Privilege (SF 2819). If a claim needs to be filed while you are still covered under FEGLI, you or your survivors should contact your former employing agency.
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  • Spouse Equity:
    1. If you qualify for Spouse Equity, you can elect FEHB coverage in your own right.
    2. Your coverage continues indefinitely, as long as you continue to meet the requirements (see next section) and pay your premiums.
    3. You must pay both the employee and government shares of your plans FEHB premium.
    4. You do not have to pay the extra 2% administrative charge.
    TCC:
    1. Your coverage is limited. It will end 36 months after your divorce or annulment, or earlier if you do not pay your premiums.
    2. You must pay both the employee and government shares of your plans FEHB premium, plus an administrative charge equal to 2% of total plan premiums.
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  • No, FEDVIP plans are separate from any Non-FEHB dental plan offered through your FEHB plan.
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Total Count: 964, Number of Pages: 49, Page: 10
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