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Insurance FAQs

  • To qualify for Spouse Equity coverage, submit an application to your former spouse's Human Resources Office (or, if applicable, the former spouse's retirement system) within 60 days after your divorce. To be eligible, you must have been covered as a family member under your spouse's FEHB Program enrollment at least one day during the 18 months prior to divorce and you must have future entitlement to receive a portion of your spouse's retirement annuity or a survivor annuity. Also, if you remarry prior to age 55 you will lose this coverage. If you do not qualify under the Spouse Equity provisions, you may be eligible for coverage under the Temporary Continuation of Coverage provisions. You may also convert to a private policy.
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  • Generally, your coverage continues for 36 months from the date of your divorce or annulment, as long as you pay your premiums on time. After your TCC enrollment ends:
    • you get a 31-day extension of coverage, and
    • you may convert to an individual contract offered by your health benefits plan,
    unless you lose coverage because you canceled your enrollment or didn't pay your premiums.
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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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  • Contact the plan directly to make a request.
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  • A court order for permanent custody is acceptable as proof of dependency, but is not necessarily required. However, a court order for temporary custody or a Power of Attorney is not acceptable proof for health benefits enrollment. Other acceptable proof of foster child status are:
    • evidence that the child has been included as a dependent on your tax returns for previous years;
    • canceled checks, money orders, or receipts for periodic payments received from you for or on behalf of the child;
    • evidence of goods or services which show regular or substantial contributions of considerable value; and
    • sworn affidavits from people unrelated to you that the child lives in your home.
    The employing office will ultimately make the final decision as to what proof is acceptable in an individual case.
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  • You will be able to enroll through BENEFEDS at www.BENEFEDS.com during Open Season. Those without access to a computer will be able to enroll by phone at 1-877-888-FEDS (3337), TTY 1-877-889-5680.
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  • Information about the new TRICARE-For-Life program can be obtained by calling 1-888-DOD LIFE (1-888-363-5433) or by going to the TRICARE website at www.tricare.osd.mil.
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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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  • Yes, and this works differently than when a survivor disclaims benefits. You can name someone as a beneficiary and someone else if that first person disclaims the benefits. It's a form of contingent beneficiary. As the insured, you CAN specify who should receive the disclaimed benefits (the beneficiary cannot specify who should receive disclaimed benefits). For example, you could word your designation like this:
    Mary Jones, 100%, unless she disclaims.  Otherwise to Johnson Wallace, 100%.
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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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  • No, FEDVIP is completely separate from your private plan. You will not be able to transfer the amount of time you spent in your private plan to your FEDVIP Plan.
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  • Yes. You can always make changes to your plan during Open Season. In addition, you can make changes if you experience a Qualifying Life Event. For example, if you are currently married and chose a Self Plus One enrollment, in the event you divorce,  you can make a change to Self Only. Alternatively, you can change to Self and Family if you have an eligible child. Other QLEs allow you to make changes as well. You can see a list of all your QLE opportunities on the SF 2809.
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  • You can submit a court order if you are an employee, an annuitant, a former spouse, the former spouse's attorney or anyone else.
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  • We have published a final regulation that allows current FEHB annuitants and former spouses who are eligible for these programs to suspend their FEHB coverage and premium payments. The regulation allows these individuals to reenroll in the FEHB Program during the Open Season, or immediately if they are involuntarily disenrolled from the non-FEHB coverage.
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  • 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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  • The National Defense Authorization Act for 2001 (Act) extended TRICARE pharmacy coverage to uniformed services Medicare eligible retirees, spouses, and survivors on April 1, 2001. Now uniformed services beneficiaries can get comprehensive prescription drug coverage through TRICARE's retail, mail order, or military treatment facility pharmacies. The Act also reinstated eligibility for TRICARE medical benefits for these beneficiaries on October 1, 2001. Beneficiaries with Medicare Parts A and B are now eligible to use TRICARE coverage for physician, hospital, surgical, and pharmaceutical services.
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  • If you disagree with the plan’s decision on your claim, the Federal Employees Health Benefits (FEHB) Program provides for an appeal process.  Check your plans FEHB brochure to see if the service is covered, limited, or excluded. Review and follow the directions in the disputed claims section (Section 8) of the brochure. This section will tell you how to ask the plan to reconsider your claim. You must explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered. If the plan again denies the claim, read the plan's decision letter carefully. Then, check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of the brochure will tell you how to write to the U.S. Office of Personnel Management to ask us to review the claim.   If you have a complaint that is not related to a disputed claim, email your complaint to FEHB@opm.gov.
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  • 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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  • Yes, taxes in 49 states and most localities will be reduced; exceptions include the state of New Jersey and the Commonwealth of Puerto Rico. OPM monitors changes in state and local tax regulations, and provides guidance to your agency as needed. Regardless of where you live, FEHB premiums are not subject to Federal taxes. FICA Taxes If you are covered by the Federal Employees Retirement System (FERS) and participate in premium conversion, FEHB premium deductions will also be excluded from gross pay before Old-Age, Survivors, and Disability Insurance (OASDI) and Medicare taxes are applied. Employer FICA contributions will also be reduced in concert with the decrease in employee withholdings.
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  • No. Employees can only enroll in Basic, Option A and Option B this way. Obtaining a physical does not allow you to enroll in Option C. You must either enroll during an unrestricted Open Season or else in connection with a life event — marriage, divorce, death of spouse or acquisition of eligible children.
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Total Count: 969, Number of Pages: 49, Page: 6
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