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Insurance FAQs

  • Open Season changes for most Federal employees are effective the first day of the first full pay period that begins in January. Generally, mid-year changes are effective on the first day of the pay period which begins after your enrollment is received by your Human Resources Office.
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  • If your agency does not pay your premiums, you must pay the employee's share of the premium during the first 12 months of coverage (just as any other employee on leave without pay). You must pay both the employee and government shares, plus an administrative charge of 2 percent of the total premium, for up to 12 additional months that you continue your coverage while on military duty.
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  • Medicare beneficiaries may enroll in Original Medicare (Parts A and B) or choose to get their benefits from an array of Medicare Advantage Plans (Part C) plan options. Depending on where you live, Part C options may include Medicare Advantage Plans that are approved by Medicare but run by private companies. Medicare Advantage plans offer Medicare Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), private fee-for-service plans (PFFS), Medicare Special Needs Plans, and Medicare Medical Savings Account (MSA) plans. The Medicare Prescription Drug, Improvement and Modernization Act (MMA) established a voluntary outpatient prescription drug benefit, Medicare Part D, effective January 1, 2006. Medicare enrollees are able to receive prescription drug coverage by enrolling in a Medicare Part D plan. Medicare Advantage Plans (Medicare Part C) may also offer prescription drug coverage that follows the same rules as the Medicare Part D coverage. Other Medicare plans include Medicare Cost Plans, demonstration/pilot programs, and PACE (Programs of All-inclusive Care for the Elderly).
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  • There are a number of factors for you to consider if you are employed part-time. Although you will not be eligible for the full government contribution, your entire employee contribution will be pre-tax if you participate in premium conversion. That larger reduction in taxable income might offset the lower government contribution. If you are a part-time reemployed annuitant, we suggest that you consult your agency or a qualified tax advisor to review your individual situation.
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  • If your pay is too low to allow a withholding for life insurance premiums and your human resources office expects this to last for more than six months, you will have a choice. You can choose either to terminate some or all of your insurance coverage or to continue the coverage and pay the premiums directly. (See your human resources office for more details).
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  • As long as your spouse has a Self and Family enrollment and you are still married to your spouse, you will be covered under the enrollment. Your eligibility for coverage under your spouse's Self and Family enrollment will cease after a divorce or annulment. You may, however, be eligible for FEHB coverage under either the Spouse Equity provisions or the Temporary Continuation of Coverage provisions of the law. You would be enrolled in your own right and would pay both the Government and employee shares of the premium yourself.
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  • Yes, two Federal employees who are married may BOTH elect Option C life insurance coverage. Any eligible children would be covered under both policies.
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  • You should consult an attorney concerning such legal issues as appointing a guardian for your minor child. If you should die while your child is still a minor and he/she is entitled to your life insurance benefits, the Office of Federal Employees' Group Life Insurance (OFEGLI) will not pay benefits to your minor child. If the benefits payable are $10,000 or less, OFEGLI may pay the benefits to a surviving parent when the parent assures OFEGLI, in writing, that he/she will use the funds for the sole benefit of the child. If benefits exceed $10,000, payment depends on whether the State where the child lives requires a guardian. If the State requires a guardian, a court-appointed guardian can file a claim for death benefits on behalf of your minor child. In those cases, guardianship must be established before payment can be made. Natural parentage is not automatic guardianship. The guardian must have the authority granted by the court to collect money on behalf of the child. OFEGLI would then make payment to the guardian who would have to answer to the court regarding how/when he/she spent the money, depending on the details of the guardianship granted by the court. In those States that do not require the court appointment of a guardian, OFEGLI will pay the benefits to the person responsible for the care of the child when he/she assures OFEGLI, in writing, that he/she will use the funds for the sole benefit of the child. If there is not a guardian and one won't be appointed and the State requires one and the proceeds are greater than $10,000, OFEGLI will open an interest-bearing account payable to the minor upon reaching the legal age.
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  • Your new plan is NOT responsible for providing coverage until the effective date of your enrollment change which for most employees is the first day of the first full pay period in January. If you need medical services before the effective date of your Open Season enrollment, you should contact your old plan. Please remember, while the new enrollments are not effective until the first full pay period in January, the new plan benefits are effective January 1. Your old plan, therefore will provide coverage according to the new contract. These expenses will count toward your prior year's deductible. If you are an annuitant, you should contact your new plan. Your Open Season enrollment is effective January 1.
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  • Any insurance policy purchased under the conversion privilege is a private business transaction between you and the insurance company. The cost of the individual policy is determined by the insurance company and is based on your age and class of risk. If you return to Federal service and have converted your FEGLI coverage (including as a reemployed annuitant), you do not have to cancel your conversion policy. You can continue the conversion policy and have FEGLI coverage as an employee.
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  • The formulary for your health plan provides a list of medications that a team of health care specialists have approved. Your doctor will write a prescription based on your medical needs, but the formulary provides him with recommendations from the pharmacist and physician team. An effective formulary system provides a medication safety feature. When drugs and administration methods are systematically included (or deleted) in a controlled drug formulary, there are a number of benefits. For instance, each new drug added undergoes a peer review process that uncovers any safety concerns with the drug. Also, when drugs are systematically added to the formulary, there is adequate time to educate the staff before the drug is used. An organized formulary also ensures that the number and variety of drugs is kept to an effective minimum. There are approximately 13,000 prescription drugs on the market today and several drugs can often be used to treat the same condition. A formulary, based on safety and cost considerations, helps to limit the drugs recommended by your plan's health care professionals.
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  • You should contact your Human Resources Office for the appropriate information for employees covered under FEHB who are called to military duty.
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  • No. If you receive an SF 2819, that means that you are eligible to convert your insurance, but you don't need to — the choice is yours. IF you qualify to carry your coverage into retirement, you may want to do that and not convert. Just because you receive an SF 2819 does not mean that you do not qualify to carry your coverage into retirement. All employees whose current coverage as an employee is terminating (other than by voluntary cancellation) receive a copy of that form — whether or not they qualify to carry coverage into retirement.
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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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  • Your employing office or the Office of Personnel Management, if applicable, must receive your Designation of Beneficiary before you die for your Designation to be valid. A Designation delivered on a weekend or Federal holiday is not "received," and is not valid, until the next workday. If you die before your employing office receives the new Designation of Beneficiary, the Office of Federal Employees' Group Life Insurance will pay benefits in accordance with the next prior Designation on file or under the order of precedence starting with the widow or widower, if there is no designation.
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  • If you cancel your FEHB, you need to be aware of the following consequences that apply to all employees who cancel their FEHB, including:
    • You and your dependents are no longer covered under the FEHB Program.
    • You may not reenroll in FEHB until you lose your TAMP coverage or have another qualifying life event (QLE) that permits enrollment, or until the next FEHB Open Season. If you reenroll because you lose TAMP coverage, you must do so from 31 days before to 60 days after your TAMP ends, and use Code 1M on Health Benefits Election Form, SF 2809, at www.opm.gov/forms/pdf_fill/sf2809 [848 KB]. Additional QLEs that permit enrollment, for example, a change in family status, are listed on SF 2809. If you have one of these QLEs, you must enroll within the timeframes shown.
    • If you transfer to another Federal agency, your cancellation follows you and you may not reenroll until you lose your TAMP coverage or have another QLE that permits enrollment, or until the next FEHB Open Season. See above bullet for details.
    • If you separate from your employment, you will not be eligible for temporary continuation of coverage (TCC) because you will not have any FEHB enrollment to continue. Also, you will not have an FEHB enrollment to convert to an individual policy with your former insurance carrier.
    • If you retire, you will not have an FEHB enrollment to continue into retirement.
    • If you die, you will not have an FEHB family enrollment for your survivors to continue, even if they are eligible for a survivor annuity.
    Note: Your agency may ask you to sign a statement stating that you understand these consequences.
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  • Your former Human Resources Office should send the new agency your Waiver of Immediate Reinstatement of FEHB along with your FEHB records, so that your postponement may continue. Your new agency should reinstate your FEHB and transfer it in to their payroll office on the date you requested by using the Notice of Change in Health Benefits Enrollment (Standard Form 2810). It is important that you check your leave and earnings statement to be sure that your FEHB is reinstated on the date you requested.
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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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  • The legal age or age of adulthood for the FEGLI Program is 18, unless the state in which the minor lives has established a lower age of adulthood. In that case, the legal age is the lower age.
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  • Streamlining the enrollment process and premium administration into one system offer advantages to employees, agencies, payroll providers, annuity systems and the FEDVIP plans. Enrollees will only need to provide their personal information once and that information will be stored securely for future FEDVIP enrollment actions. BENEFEDS will be the one interface with payroll and annuity systems with standard file layouts. This eliminates the duplicative costs for FEDVIP plans to set up individual interfaces with all payroll and annuity systems.
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Total Count: 957, Number of Pages: 48, Page: 7
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