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Insurance FAQs Health

  • 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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  • 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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  • 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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  • 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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  • 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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  • The plans print their provider directories and have them available during Open Season. Many plans also provide this information on their websites. If your agency has an Open Season health fair this fall, the plans probably will be there to hand out their brochures and provider directories. You can also call the plan at the number listed in the Guide to Federal Benefits. You can also find specific plan contact information on the FEHB website.
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  • If you are under premium conversion (see www.opm.gov/insure/health/faq/premconversion/index.asp), IRS rules govern when you may cancel your FEHB. You may cancel within 60 days of the date you are restored to a civilian position or have another Qualifying Life Event that permits cancellation (see Health Benefits Election Form, SF 2809, at www.opm.gov/forms/pdf_fill/sf2809.pdf [848 KB]), or during the next FEHB Open Season. If you are not under premium conversion, you may cancel at any time. In either case, you should be aware of the consequences of cancellation as described in the following question.
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  • Valium is a brand name drug whose generic counterpart is Diazepam. On the other hand, Amoxicillin is a generic drug of the brand drug Trimox.
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  • A formulary is a list of both generic and brand name drugs that are preferred by your health plan. Often, many drugs on the market produce the same results equally well. Health plans will choose formulary drugs that are just as safe and effective as the alternatives but cost less. A team of pharmacists and physicians meet to review the formulary and make changes as necessary.
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    • It saves time.
    • It's convenient.
    • It's reliable.
    Employee Express eliminates the need for completing and submitting forms by replacing forms with user-friendly technology. You'll never again have to make a special trip to personnel to drop off forms; instead, you can process changes or review your current information anytime and nearly anyplace. And perhaps best of all, Employee Express automatically checks your transaction -- a feature that wasn't available using paper forms.
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  • Several years ago we stopped allowing plans to add new dental and vision packages or to increase packages they already had in place. We allow one exception -- when an HMO offers the benefits under their community package of benefits (at no additional cost to members). We do this because we firmly believe that Federal employees are best served by benefit packages that are strong in the traditional areas of hospital, surgical, and medical benefits and that provide protection against significant and largely unforeseeable health care expenditures. Everyone wants to keep premium increases as low as possible so, generally, to increase benefits plans make trade-offs. We would not want to sacrifice medical benefits to get dental or vision benefits.   It is important that you do not choose a health plan based on dental benefits alone. You may find yourself without other benefits when you need them, which could result in large unexpected medical expenses. Remember to look at the entire benefits package when making your health plan decision.
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  • Generally, no. OPM does not process claims, and does not have access to your personal medical information. The exception is if you have filed a disputed health benefits claim with us. If you have not filed a disputed claim we do not have any of your personal health information.
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  • The TCC provisions allow children who no longer qualify as an eligible child (e.g., child reaches age 26, foster child no longer lives with the employee, foster child is no longer financially dependent on the employee) to continue their FEHB coverage for up to 36 months. The child is enrolled in his/her own right and pays both the employee’s and the Government's share of the premium, plus an additional 2% administrative cost. You should notify your employing office within 60 days after the child no longer qualifies for coverage as a family member. A child who loses FEHB coverage for any reason other than by cancellation has a 31-day temporary extension of coverage, at no cost, for the purpose of converting to a non-group contract with his/her current health benefits plan. To convert the child's coverage to a non-group plan, you or your child must apply directly to the health benefits plan within 31 days after the child's eligibility ends. For further information on health benefits, contact your personnel office.
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  • Your FEHB enrollment will continue unless you elect to have it terminate. You should also consider:
    • Any family members covered under your enrollment
    • Payment of your premiums
    Note: If your enrollment continues and you participate in premium conversion, you may not cancel your enrollment at any time. If you think you might want to stop your FEHB at some time during your military service, you should consider waiving premium conversion at this time.
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Total Count: 582, Number of Pages: 39, Page: 11
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