# Insurance FAQs Health

• Spouse Equity:
1. If you qualify for Spouse Equity, you can elect FEHB coverage in your own right.
2. Your coverage continues indefinitely, as long as you continue to meet the requirements (see next section) and pay your premiums.
3. You must pay both the employee and government shares of your plans FEHB premium.
4. You do not have to pay the extra 2% administrative charge.
TCC:
1. Your coverage is limited. It will end 36 months after your divorce or annulment, or earlier if you do not pay your premiums.
2. You must pay both the employee and government shares of your plans FEHB premium, plus an administrative charge equal to 2% of total plan premiums.
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• The small reduction in Social Security benefits is greatly outweighed by the much larger tax savings. In each case we tested, the increase in take-home pay far exceeded the minor loss in monthly Social Security benefits. Here is a simple formula you can use to estimate the difference in your Social Security benefit:
1. Take the number of years you will participate in premium conversion (from now until your estimated retirement) and divide by 35.
3. Multiply the result of Step 2 by the marginal SSA rate (15% for most Federal employees)
The result is the annual loss of Social Security benefits. (# of Years of Premium Conversion /35) X Annual FEHB Premium X marginal SSA rate = Annual Loss Example You participate in FERS. We assume that you've had a full career of FICA contributions, with an ending salary (today) of \$50,000 and projected retirement at age 66 in January 2016. Your estimated Social Security benefit equals \$1,414 per month. You begin participating in premium conversion and reduce your taxable income by \$2,000, the amount of your FEHB premium. By changing your salary to \$48,000, your monthly Social Security benefit is now \$1,403, an \$11.00 per month difference in today's dollars. 15/35= .4286 X 2000 = 857 X .15 = 128/12 = 10.71 or 11 Compare that to the estimated \$67 increase in take home pay per month. For more specific information on how the Social Security benefit is calculated, refer to www.ssa.gov.
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• Be careful. Such a cancellation would be permanent. Annuitants cannot re-enroll in the program except under very limited circumstances, such as to enroll in a Medicare-sponsored health plan, as described below, or TRICARE. Another exception is if your spouse is also a Federal employee and you cancel to be covered by your spouse's FEHB plan. Further, neither you nor your family members would be eligible for continued coverage nor would you be able to convert your coverage to a private non-group policy. Do not drop out of the program unless you are sure of being able to re-enroll.
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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 Federal Employees Health Benefits Program runs on a calendar year basis -- from January through December. But the carriers' provider contracts are spread throughout the year, as are the carriers' policies with other employers.
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• As long as you have a Self and Family enrollment and one of the family members is entitled to a survivor annuity, the children are eligible for FEHB coverage until they reach age 26 or until no survivor is eligible for a survivor annuity. Children age 26 or over are eligible to continue FEHB coverage if they are incapable of self-support because of a mental or physical disability that existed before age 26.
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• By regulation, an employee who does not change the enrollment during the Open Season is considered to have canceled the plan in which enrolled. The cancellation is effective the day before the first day of the first full pay period in January. The plan is responsible for providing coverage only through midnight of that date. If you're not sure of the date, you should contact your Human Resources Office and not the plan for the effective date. You should be aware that you are not entitled to a 31-day extension of coverage because the action is considered a cancellation and not a termination. You cannot reenroll in the FEHB Program until the next open season. Also, this is considered a break in coverage. The 5-year requirement to continue your enrollment into retirement will begin when you reenroll in the FEHB Program. If you are within five years of retirement, you will have to work additional time to be eligible to continue your enrollment into retirement. If you are an annuitant, you are deemed to have enrolled in the standard option of the Blue Cross and Blue Shield (BCBS) Service Benefit Plan. OPM deems annuitants into the standard option of BCBS by default (and by law) if they do not make a plan selection. If annuitants cancel their FEHB enrollment, they can never reenroll.
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• First, 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 1-888-767-6738. Before contacting your retirement system, have your annuity information ready: 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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• Your employing office will notify you of the choices available to you and provide you with a method to make direct premium payments.
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• Yes, Qualifying Life Events (QLE).
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• Change in family status
• Change in employment status
• You or a family member lose FEHB or other health insurance coverage
• For more information, see SF 2809 for the Tables of Permissible Changes in Enrollment
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• No. There is no provision of law that allows for coverage to continue beyond 24 months during your military duty. However, at the end of the 24 months, you have a 31-day extension of coverage and the right to convert to an individual policy offered by the carrier of your plan. You are not required to provide evidence of insurability for this private coverage. There is no provision in FEHB law that allows for Temporary Continuation of Coverage (TCC) after the 24 months of coverage.