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Insurance FAQs

  • When a drug patent expires other companies may produce a generic version of the brand name drug. A generic medication, also approved by the FDA, is basically a copy of the brand name drug and is marketed under its chemical name. A generic drug may have a different color or shape than its brand name counterpart, but it must have the same active ingredients, strength, and dosage form (i.e., pill, liquid, or injection), and provide the same effectiveness and safety as its brand name counterpart.
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  • While you may count the time you are covered under transitional TRICARE toward meeting the 5 year/initial opportunity requirement to continue your FEHB into retirement, you must be covered under FEHB on the day you retire. If you plan to retire during your transitional TRICARE period, you must reinstate your FEHB before your retirement date. Your Human Resources Office can assist you.
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  • The former spouses that the regulation applies to are those of civilian Federal employees and annuitants as defined under the Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615). The regulation does not apply to "unremarried former spouses" under TRICARE law (title 10 USC). See also the chapter on former spouses in the FEHB Handbook.
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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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  • No, any coverage provided under your FEHB plan remains as your primary coverage. FEDVIP coverage would pay secondary to that coverage. FEDVIP is not intended to replace any existing coverage.
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  • Yes. You should still send a copy of the court order to your Human Resources Office to review and make a determination if any action is required. They will file the copy in your OPF and flag it so that they know a court order relating to health benefits has been filed. If your children aren't listed as family members on the SF 2809, they will send a copy of the court order to your FEHB plan.
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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, there are no pre-existing condition limitations. There may be specific plan exclusions or limitations.
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  • Not all screens are accessible by all employees or available at all agencies. For example, if you participate in premium conversion, you may not change from Self and Family to Self Only or cancel your FEHB enrollment at any time. Therefore, this menu option will not appear. You may still be able to change your enrollment if you have experienced a qualifying life event, or QLE. If you don't find the change option on your menu, see your Human Resources Office.
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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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  • Being sent to a combat zone does NOT cancel FEGLI coverage. Civilian employees who are sent to a war zone or combat zone in a support capacity keep their FEGLI coverage, including Accidental Death & Dismemberment (AD&D) coverage. Being sent to a combat zone does not affect the amount of your FEGLI coverage. If a Federal employee working in a war zone is killed, "regular" death benefits are payable to the employee's beneficiaries. Accidental death benefits are also payable under Basic insurance (and Option A, if the employee had that coverage) unless the employee was in actual combat (or unless nuclear weapons were being used) at the time of the injury that caused the employee's death. The Office of Federal Employees' Group Life Insurance (OFEGLI) decides whether to pay accidental death benefits only after thoroughly studying the facts and documentation surrounding an employee's death. The determination is made on a case by case basis. While we cannot say that in 100% of civilian deaths AD&D benefits will be payable, we can say that it is highly unlikely for a civilian to be in actual combat. Accidental death benefits are in addition to regular death benefits. Even if accidental death benefits are not payable, regular death benefits ARE payable.
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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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  • To inquire about how much coverage you have under the Federal Employees Group Life Insurance (FEGLI) Program, contact OPM's Retirement Office by emailing retire@opm.gov or calling 1-888-767-6738. 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. You will need to provide your retirement claim number (CSA) or Social Security Number.   Please note: For privacy reasons, the response to an email request for information on FEGLI coverage will be mailed to the address on file with the OPM Retirement Office. It will not be sent back via email.
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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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  • The date of the court order itself is not relevant. But the date the agency or retirement system (as applicable) received the court order is relevant. If someone submitted a court order before July 22, 1998, it is not valid and the Office of Federal Employees' Group Life Insurance (OFEGLI) cannot honor it.
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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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  • 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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  • The 24-month period begins the day you are separated, furloughed, or placed on leave of absence to serve on military duty. This applies even if part of your military service is covered by paid leave immediately followed by furlough or other leave without pay.
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  • Yes, you can submit your FEDVIP co-payments/deductibles as eligible expenses against your FSA account. However, FEDVIP insurance premiums are not reimbursable under an FSA.
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  • Yes.
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Total Count: 966, Number of Pages: 49, Page: 8
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