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Insurance FAQs

  • 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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  • The following people are not eligible to enroll in FEDVIP, regardless of FEHB eligibility or receipt of an annuity or portion of an annuity.
    • deferred annuitants,
    • former spouses of employees or annuitants,
    • FEHB temporary continuation of coverage (TCC) enrollees,
    • temporary employees who are:
      • serving under an appointment limited to one year or less and have not completed at least one year of current continuous employment, excluding any break in service of 5 days or less; or
      • expected to work less than 6 months in each year.
    • intermittent employees (who do not have a prearranged regular tour of duty)
    • seasonal or occasional employment for one calendar year that amounted to less than 6 months of work does not meet the one year of current continuous employment requirement.
    • anyone receiving an insurable interest who is not an eligible family member
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  • 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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  • 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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  • 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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    • Self Only                                                                                                                                                      
    • Self and Family
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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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  • Medicare has two new provisions: Part C (Medicare Advantage) and Part D (Medicare Prescription Drug Coverage). Part C: You can enroll in a Medicare Advantage plan to get your Medicare benefits. Medicare Advantage is the term used to describe the various private health plan choices available to Medicare beneficiaries. Part D: There is a monthly premium for Part D coverage. Most Federal employees do not need to enroll in the Medicare drug program, since all Federal Employees Health Benefits Program plans will have prescription drug benefits that are at least equal to the standard Medicare prescription drug coverage. Still, you may want to be aware of the benefits Medicare is offering, so you can help others make informed decisions. If you have limited savings and a low income, you may be eligible for Medicare's Low-Income Benefits. For people with limited income and resources, extra help in paying for a Medicare prescription drug plan is available. Information regarding this program is available through the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.ssa.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
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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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  • Portability is a provision in Public Law 105-311, the Federal Employees Life Insurance Improvement Act, which was enacted October 30, 1998. It applies only to FEGLI Option B insurance, which provides coverage in multiples of 1 to 5 times an employee's annual salary. Employees that met certain requirements were eligible to continue Option B insurance following separation from Government service. The portability provision was a three-year demonstration project. It expired April 24, 2002, and is no longer available. Your agency should not give any employees a Portability Notice or other portability information. For more detailed information refer to Benefits Administration Letter 02-206 of April 26, 2002[119 KB].
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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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  • 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. Approximately half of all drugs on the market have generic versions.
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  • No, you can choose any FEDVIP plan regardless of your FEHB enrollment.
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  • Contact your health plan directly for this information.
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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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  • 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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  • 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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  • 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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Total Count: 967, Number of Pages: 49, Page: 11
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