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Insurance FAQs Health

  • Public Law 107-14 provides beneficiaries over age 65 of the Department of Veterans Affairs (VA) with coverage secondary to Medicare under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). CHAMPVA provides similarly attractive benefits to VA eligible beneficiaries as those benefits provided to uniformed services beneficiaries under the TRICARE or new TRICARE-for-Life programs.
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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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  • To verify your current health benefits plan, contact 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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  • The FEHB Program runs on a calendar year basis - from January through December. The carriers' provider contracts, however, which are between the provider and the carrier, are spread throughout the year, as are the carriers' policies with other employers.
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  • No. You would need to wait for Open Season. It is not uncommon for providers to leave plans mid-year. Other plan providers will be available to provide care.
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  • Yes, Qualifying Life Events (QLE).
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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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  • The Open Season dates are set by Federal regulation 5 C.F.R. § 890.301(f), available at http://law.justia.com/us/cfr/title05/5-2.0.1.1.32.3.143.1.html. Each year OPM provides an Open Season from the Monday of the second full workweek in November through the Monday of the second full workweek in December.
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  • First, check your plan's brochure to see if the service is covered, limited or excluded. The next step is to review the disputed claims section of your brochure. Briefly, the disputed claims section will direct you to write to the plan to explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered, and to ask the plan to reconsider your claim. If the plan again denies the claim, read the plan's decision letter carefully and then check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of your brochure will show you how to write to the Office of Personnel Management to ask us to review the claim. We can't review a denied claim unless your plan has reconsidered it first (or at least been given an opportunity to reconsider it). Generally, we will acknowledge your request within 5 days. After we complete the review, we will send you a final response within 60 days. If we need more time or if you need to do more -- such as send us more information - we will contact you within 14 work days of the time we get your request and tell you what you still need to do, if anything. We are sorry but we cannot give you a decision over the phone until the review has been completed and a written copy of the final decision has been issued.
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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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  • Because the U.S. Office of Personnel Management (OPM) administers the Federal Employees Health Benefits (FEHB) program, the largest employer-sponsored health insurance program in the world, we believe we have a commitment to you. Following are the standards we follow:
    • Your choice of health benefits plans will compare favorably for value and selection with the private sector.  
    • When you use the Guide to Federal Benefits and plan benefit brochures, you will find they are clear, factual and give you the information you need.  
    • When you change plans or options, your new plan will issue your identification card within 15 calendar days after it gets your enrollment form from your agency or retirement system.  
    • Your fee-for-service plan should pay your claims within 20 work days; if more information is needed, it should pay within 60 calendar days.  
    • If you ask us to review a claim dispute with your plan, our decision will be fair and easy to understand, and we'll send it to you within 60 calendar days. If you need to do more before we can review a claim dispute, we will tell you within 14 work days what you still need to do.  
    • When you write to us about other matters, we will respond within 30 calendar days after we get your letter. If we need time to give you a complete response, we will let you know.
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  • As long as the annuitant was enrolled in Self and Family coverage when he/she suspended FEHB coverage and made arrangements to leave a survivor annuity, the survivor annuitant can reenroll in the FEHB Program under the same conditions as an annuitant.
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  • The TAMP is the Transitional Assistance Management Program, and it offers transitional TRICARE eligibility to certain separating active duty members and their eligible family members for 180 days. Your Human Resources Office can assist you in determining if you are eligible for transitional TRICARE under the TAMP.
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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.
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  • Your agency should contact you or your dependent and give you an opportunity to select another plan. If they were unable to reach you and you learned after the enrollment time frame that your plan discontinued, they must use SF 2810 to reinstate your old enrollment code. This is for enrollment history purposes only, and cannot be sent to your old carrier since the plan is discontinued. Your agency should give you an opportunity to select another plan, and process the change retroactive to the date after your enrollment under your former plan terminated. When selecting another plan, please remember you are responsible for determining if any providers used participate in your new plan's network.
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Total Count: 581, Number of Pages: 39, Page: 10
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