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Insurance FAQs

  • 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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  • Yes. If you meet the five-year requirement when your reemployment terminates, you will be able to continue your Option B. An example of this may help you to understand. Gabriela had Basic since she was first employed with the Federal Government and Option B, two multiples, since March 1991. She retired in June 1993. She was not able to continue her Option B. She was reemployed as a reemployed annuitant in June 1996. She elected Option B, two multiples as an employee. She worked until December 1999. She is now eligible to continue her Option B, 2 multiples, into retirement because she has had it for the five years of service immediately preceding her separation in 1999.
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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, this is a voluntary dental and vision program available to eligible Federal and USPS employees, retirees, and their eligible family members who want comprehensive dental and vision benefits.
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  • Only Basic insurance is available for a Living Benefit. The Office of Federal Employees' Group Life Insurance cannot pay Optional insurance as a Living Benefit. A Living Benefit election has no effect on your Optional insurance. Your Optional insurance will not change and you will continue to pay your Optional insurance premiums.
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  • Under CSRS offset, your Social Security benefits would be slightly reduced, but your CSRS Offset benefits would be increased by almost the same amount. Participating in premium conversion is most likely a benefit to you.
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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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  • Pay-As-You-Go Under the Pay-As-You-Go option, you pay your share of the FEHB premium directly to your employing agency while on LWOP. These payments will generally be made with after-tax monies, since there is no pay from which to make deductions.   Catch-Up Most employees who have a period of LWOP choose to pay their FEHB premiums via the Catch-up option. Under this option, the agency remits your share of the FEHB premium to OPM while you are on LWOP. You incur an obligation to your employing agency and are required to repay it upon your return to pay status. The repayment of the amount owed will be treated on a pre-tax basis, if it's deducted from pay and you participate in premium conversion at the time the deduction is made. If you choose to repay the amount owed to your agency directly out-of-pocket your taxable income is not reduced. Prepay Your agency may (but is not required to) offer you the option to prepay your FEHB premium from salary before you go on a period of LWOP. The amount of FEHB premiums you prepay in advance may either be deducted from your pay or paid directly "out-of-pocket" to your agency. Payments made "out-of-pocket" do not reduce taxable income. The amount of FEHB premiums that you prepay will be treated on a pre-tax basis, if it is deducted from your pay and you participate in premium conversion. IRS rules limit the amount you may prepay on a pre-tax basis. If your period of LWOP will span two tax years, the amount that you may prepay on a pre-tax basis may not exceed the amount of FEHB premiums due for the remainder of the current tax year. If you wish to prepay the amounts due for the subsequent tax year as well, the deductions must be made after-tax. You may use the "Pay-As-You-Go" or Catch-up options for amounts due in the subsequent tax year. Example Sam A. participates in premium conversion and had $100 per month in FEHB premiums deducted from his pay. He will go on LWOP for three months beginning on October 31, 2002 and opts to continue his FEHB coverage. Mr. A. uses the pre-pay option to pay from his salary the $300 in FEHB premium payments that will be due while he is on LWOP. Mr. A. will receive pre-tax treatment for only $200 of his FEHB premium prepayment- the amount he will owe for the months of November and December 2002. The remaining $100 prepaid – the amount due for January 2003 – must be given after-tax treatment.
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  • The time limit for notification is 60 days from your divorce or annulment. Either you or your former spouse must notify the employing office in writing that you want TCC. If your former spouse is retired, notify the retirement system.
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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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  • 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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  • 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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  • 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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  • 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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  • Most health maintenance organizations (HMO) restrict enrollment to an area where its doctors and hospitals are accessible. Although some HMOs do not have restrictions on where you live or work, please recognize that if you later find it is inconvenient to get to a plan provider, you may have to wait until the next Open Season to change plans.
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  • Yes.
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  • If you elect to terminate your enrollment before you go on active duty, the termination will be effective on the day you are separated, furloughed, or placed on leave of absence to enter military service. Your employing office must use SF 2810 to terminate your enrollment. This means that you are entitled to a 31-day extension of coverage and if needed, have the right to convert to an individual policy offered by the carrier of your plan.
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  • Each situation varies; however, the two plans will coordinate benefits to lower your out-of-pocket costs.
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  • No, you are not required to contact BENEFEDS. However, you can speed up the process by contacting BENEFEDS.
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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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Total Count: 978, Number of Pages: 49, Page: 8
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