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Insurance FAQs

  • 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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  • 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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  • 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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  • 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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  • No, there are no pre-existing condition limitations. There may be specific plan exclusions or limitations.
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  • No. When you lose FEHB coverage other than by cancellation (including cancellation by nonpayment of premiums) you have a 31-day temporary extension of coverage, at no cost. This coverage is provided in the same enrollment category so you may convert to an individual contract with your current health benefits plan. Please review the Temporary Continuation of Coverage (TCC) pamphlet. www.opm.gov/insure/health/eligibility/tcc
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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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  • The premiums for the FEHB plan you are currently enrolled in are in the brochure you will receive from your plan during the annual Federal Benefits Open Season. The Guide to Federal Benefits is a comparison of the plans and their benefits and premiums. There are a variety of Guides targeted to specific groups of enrollees. The average premium is recalculated every year.  Per FEHB law, the government will pay the lesser of: 75% of the carrier’s total premium, or 72% of the average premium.  The enrollee is responsible for the difference between the government contribution and the total premium. If the average premium increases, the maximum government contribution also increases. The total premium is the same for all enrollees, but the Government contribution is based on your employment. Some agencies, such as the Postal Service, contribute additional money towards the total premium. As a result, the share you must pay will depend upon your employment status. All Guides are available on this website or through your Human Resources Office.
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  • No. If you receive a payment of Living Benefits, that money is yours to use as you please. You do not have to return the money if you live longer than expected.
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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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  • Your premiums will not change. The enrollment will be changed to your name and changed to a self only enrollment if there are no other eligible family members.
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  • To inquire about how much coverage you have under the Federal Employees Health Benefits (FEHB) Program, go to Retirement Services Online at https://www.servicesonline.opm.gov.  You will need your retirement claim number and Personal Identification Number (PIN) to access information about your health benefits enrollment.    If you cannot access Retirement Services Online, you can inquire about your coverage by contacting OPM’s Retirement Office at 1-888-767-6738 or retire@opm.gov.  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.
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  • No, your FEHB plan will still be the primary payor for your vision and dental care up to the limits of its coverage.
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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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  • If you are on a deferred retirement annuity, you are not eligible for FEDVIP. If you are retiring with title to an MRA+10 annuity and you postpone receiving your annuity, you are eligible for FEDVIP only when you begin to receive that annuity. You would not be eligible for FEDVIP during the time between your separation from duty and before actual receipt of your annuity.
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  • If you are a current Federal employee, you should contact your Human Resources Office and ask them to find out on what date and carrier report number your enrollment information was forwarded to your new health insurance carrier. With this information, your new carrier will be able to locate your enrollment data and forward ID cards to you. If you are an annuitant, call your plan. If they tell you they haven't gotten the paperwork yet from your retirement system, you may contact your retirement system. If you are a Civil Service Retirement System (CSRS) annuitant or a Federal Employees Retirement System (FERS) annuitant, contact OPM at retire@opm.gov. Before contacting your retirement system, have your annuity information ready, for instance, your name, civil service annuity number (beginning with CSA or CSF), phone number and address, and information about your plan, such as the carrier enrollment code.
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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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  • Yes, TRICARE enrollees are eligible to participate in the FEDVIP program if they meet other eligibility requirements (see the section on eligibility and enrollment, above).
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  •   The requirements for continuing your FEGLI life insurance into retirement are explained in the FEGLI Handbook. If you meet the requirements, you must choose what will happen to your Basic when you turn 65 or retire, whichever is later.  Your choices are:
    • 75% Reduction: your Basic coverage reduces 2% each month until it reaches 25% of its pre-reduction amount.  Your Basic is free (no premium) once the reductions begin and remains free until your death.
    • 50% Reduction: your Basic coverage reduces 1% each month until it reaches 50% of its pre-reduction amount.  There is an extra premium for this choice that you will continue to pay until you die, switch to 75% reduction, or cancel Basic.
    • No Reduction: your Basic coverage does not reduce.  You maintain the same amount of Basic coverage you had when you stopped being enrolled as an employee.  There is a larger extra premium for this choice that you will continue to pay until you die, switch to 75% Reduction, or cancel Basic.
    If you select 75% or 50%, the reduction begins the second month after your 65th birthday, or the second month after you retire, whichever is later. To see the different premiums for the different choices, visit Premiums for Annuitants. To make your choice, submit SF 2818 to your human resources office shortly before you retire. If you do not turn in the form, you will be defaulted to 75% Reduction.
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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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Total Count: 978, Number of Pages: 49, Page: 6
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