Healthcare & Insurance Insurance FAQs

Most FEHB fee-for-service plans offer Preferred Provider Organization (PPO) arrangements. When selecting your health care practitioner, your use of PPO providers whenever possible will help reduce your out-of-pocket expenses. In addition, PPO providers will generally file your claims for you. Read your plan's FEHB brochure carefully to find out about other incentives. Contact your plan to obtain the names of PPO providers in your area. You should also visit your plan's website (identified on the front of the plan's brochure and available by link from this website). Many plans provide up-to-date lists of PPO providers on their website.

We require FEHB carriers to issue certifications of prior coverage to enrollees. They issue certifications automatically whenever coverage terminates, whether it is termination of regular coverage, TCC coverage, or Spouse Equity coverage. If the plan does not certify your coverage, you should write to them and ask them to send you certification of coverage.

• A spouse, including a valid common law marriage.
• Children under age 26 (including adopted children, recognized natural children or stepchildren (including children of same-sex domestic partners in certain states); or foster children living with tribal employee in regular parent-child relationship>
• Children age 26 or older incapable of self-support, if disabling condition began before age 26

Which family members are not eligible?   

• Grandchildren, unless foster child requirements (as defined in the Handbook) are met.
• Parents
• Siblings
• In-laws

No. If you became a part-time career employee (working 16 to 32 hours a week or 32 to 64 hours biweekly) on or after April 8, 1979, you are entitled to a partial Government contribution in proportion to the number of hours you are scheduled to work in a pay period. Employees who served on a part-time basis before April 8, 1979, and who have continued to serve on a part-time basis without a break in service (in that or any other position) are eligible for the full Government contribution, as are part-time employees who work less than 16 hours or more than 32 hours per week. The amount of the Government contribution is determined by dividing the number of hours you are scheduled to work during the pay period by the number of hours worked by a full-time employee serving in the same or comparable position (normally 80 hours per biweekly pay period). That percentage is then applied to the Government contribution made for full-time employees enrolled in that plan. The amount of the Government contribution is then deducted from the total premium (Government plus employee shares), and the remaining amount is withheld from your pay.

• Grandchildren, unless foster child requirements (as defined in the Handbook) are met.
• Parents
• Siblings
• In-laws

  Which family members are eligible for Federal Employees Health Benefits?   

• A spouse, including a valid common law marriage.
• Children under age 26 (including adopted children, recognized natural children or stepchildren(including children of same-sex domestic partners in certain states); or foster children living with tribal employee in regular parent-child relationship>
• Children age 26 or older incapable of self-support, if disabling condition began before age 26

Yes, they still pay their deductible and copay.

Yes, you can use FSAFEDS. Your husband will still pay a copay.Deductibles and copays that you and your eligible family members incur are reimbursable whether you use your FEHB health plan or another health insurance plan. 

No. For FEHB and FEDVIP, if you and your eligible family members are satisfied with the coverage that you have now, then you do not have to do anything.  Keep in mind that premiums and benefits change each year, so you should check the plan brochures.  All FEHB and FEDVIP plan brochures are on our website at www.opm.gov/healthcare-insurance/.

Yes, retirees/annuitants are eligible to participate in a FEDVIP dental plan, a FEDVIP vision plan, or both. Retirees must have retired with an immediate annuity (a FERS Minimum Retirement Age plus 10 annuity, postponed, counts as an immediate annuity). Those in receipt of a deferred annuity are not eligible to enroll in FEDVIP. Retirees can cover their eligible family members with a Self Plus One or Self and Family enrollment. More information is available on types of enrollments and eligible family members

The Self Plus One enrollment type will cover the enrollee and one eligible family member.