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Insurance FAQs

  • 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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  • 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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  • No. When you receive a partial Living Benefit, the amount of your remaining Basic insurance is frozen. It does not increase due to a salary increase, nor does it decrease due to a salary reduction. If you receive a full Living Benefit, your remaining Basic Insurance Amount equals zero, and this also is unchanged due to changes in salary.
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  • You can enroll in any of the nationwide dental and/or vision plans. These plans provide benefits for services received outside of the United States.
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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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  • If you were unable to choose another plan during military service, your Human Resources Office should reinstate your old enrollment code (for enrollment history purposes only), give you an opportunity to change to another plan, and immediately process your change. To avoid any break in coverage, they should make your new enrollment effective on the date they would have reinstated your old enrollment.
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  • No. If an annuitant, survivor, or former spouse suspends Self and Family coverage, the coverage of all family members is suspended as well.
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  • First, have your doctor contact the plan to discuss the situation. You and your doctor can provide your plan with information to support your contention that the surgery should be authorized, such as medical records that indicate the need for the surgery, and ask your plan to reconsider its decision. If the plan reconsiders its decision but continues to uphold its denial, and after considering the plan's rationale you still disagree, consult the disputed claims section of your plan's brochure for specific information on how to write to the Office of Personnel Management to ask us to review the claim.
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  • Yes, Public Law 110-417, the Duncan Hunter National Defense Authorization Act allows new opportunities for certain employees. The new election applies if you are a civilian employee in the Department of Defense eligible for FEGLI who is designated as "emergency essential" under section 1580 of Title 10. You may elect Basic, Option A and Option B (up to the maximum of 5 multiples). You must make the election on the SF 2817  [278 KB] (or its electronic equivalent) within 60 days of the date of the notification of the designation as an emergency essential employee. Contact your employing agency human resources office for more information. See more details in BAL 08-204  [45 KB].
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  • No, you can choose any FEDVIP plan regardless of your FEHB enrollment.
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  • If you are terminally ill, you can assign your FEGLI coverage to a viatical settlement firm in exchange for cash. Some viatical firms also accept assignments if you are chronically ill.
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  • If you do not meet these requirements, the authority for you to continue your FEHB comes from the Uniformed Services Employment and Reemployment Rights Act (USERRA) (38 U.S.C. 4317). Public Law 108-454 amended this Act to allow you to continue your FEHB for 24 months if you were called to military duty and elected to continue your health insurance coverage on or after December 10, 2004. If you made your election before December 10, 2004, you are eligible to continue your FEHB for 18 months. If your FEHB continues under this provision, your agency does not have authority to pay your premiums while you are on military duty. For additional information, see Benefits Administration Letter 06-401 at BAL 06-401 Federal Employees Health Benefits (FEHB) Program: Extended Coverage for Employees Called to Active Military Duty. [54 KB]
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  • Unfortunately, there are areas of the country that HMOs have simply chosen not to participate in the FEHB Program. Reasons for this vary, but most cases involve population size or demographics. There is no minimum requirement for the number of HMO options available to enrollees throughout the country. We have encouraged HMO participation in the Program because many of our participants have asked for that choice of health plan. In fact, under the FEHBP, the only types of health plans that can be added to the Program are HMOs. And, HMOs have an annual opportunity to submit their applications to participate in the Program. If you have HMOs in your local area that do not currently participate in the FEHBP, we encourage you to ask these HMOs to consider the FEHBP market for their geographic areas. New plan application packages for the FEHB Program are available at www.opm.gov/insure/health/carriers/index.asp. Applications are due to OPM by January 31 of each year for the next contract term.
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  • Contact your health plan directly for this information.
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  • The Office of Federal Employees' Group Life Insurance pays interest on claims from the date of the insured's death to the date of the payment. OFEGLI pays a maximum of two years worth of interest, even if the time from date of death to date of payment is over two years.
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  • No. Approximately half of all drugs on the market have generic versions.
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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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  • Most FEHB fee-for-service plans offer Preferred Provider Organization (PPO) arrangements. When selecting your health care practitioner, your use of PPO providers whenever possible will help reduce your out-of-pocket expenses. In addition, PPO providers will generally file your claims for you. Read your plan's FEHB brochure carefully to find out about other incentives. Contact your plan to obtain the names of PPO providers in your area. You should also visit your plan's website (identified on the front of the plan's brochure and available by link from this website). Many plans provide up-to-date lists of PPO providers on their website. Another way to cut costs is to request generic drugs instead of brand name drugs. A generic medication is a copy of a brand name drug. It has the same active ingredients and receives the same Food and Drug Administration approval but costs less. Most plans charge you a lower copay if you use generic drugs.
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  • Living Benefits payments received on or after January 1, 1997, are not subject to Federal income tax. However, some states have laws, regulations, or rulings concerning the taxability of Living Benefits (also called accelerated death benefits). You should consult a tax advisor or your State's tax department for specific information concerning State income tax laws. Qualified payments from viatical settlement firms received on or after January 1, 1997 are also not subject to Federal income tax provided the companies meet certain tax exemption qualifications. If you are considering assigning your insurance to a viatical settlement firm, you should consult a tax advisor to determine if you and the viatical settlement firm meet the tax exemption qualification standards.
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    • Change in family status
    • Change in employment status
    • You or a family member lose FEHB or other health insurance coverage                                                                
    • For more information, see SF 2809 for the Tables of Permissible Changes in Enrollment                                                                                                                                                                           
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Total Count: 964, Number of Pages: 49, Page: 11
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