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Insurance FAQs Health

  • You can find information about Medicare and resources on how to address issues with your Medicare enrollment at medicare.gov.
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  • You can use Employee Express anytime, 24-hours a day, seven days a week.
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  • Examples Susan L. has $100 per pay period deducted from her salary for her contribution towards FEHB coverage. Ms. L's employing agency mistakenly deducts $150 during the last pay period prior to the effective date of her participation in premium conversion. To correct the error, the agency deducts $50 for FEHB from Ms. Lee's pay in the following pay period, during which she has begun participating in premium conversion. Except for agency error, $100 would have been deducted from her pay. However, only $50 is treated on a pre-tax basis. Ms. L's employing agency mistakenly makes no FEHB deduction during the last pay period prior to the effective date of her participation in premium conversion. To correct the error, the agency deducts $200 from Ms. L's pay in the following pay period, during which she has begun participating in premium conversion. Since the deduction for FEHB coverage is taken after she begins participation in premum conversion, $200 is afforded pre-tax treatment. Ms. L's employing agency mistakenly does not process her participation in premium conversion. As a consequence, Ms. L's $100 FEHB deduction is not afforded pre-tax treatment. To correct the error, the agency changes Ms. L's premium conversion status to "participant" in the following pay period. If not for the error, Ms. L. would have had $200 deducted from her pay on a pre-tax basis. However, only $100 is eligible for pre-tax treatment. As you can see, under these rules an error correction may result in a greater or lower tax benefit than would otherwise have occurred.
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  • If you believe that OPM is not complying with a requirement of the Privacy Rule you may file with either OPM or the Department of Health and Human Services (HHS) Office of Civil Rights a written complaint, either on paper or electronically. This complaint must be filed within 180 days of when the complainant knew or should have known that the act had occurred. For more information on how to file a complaint with OPM, please review our NPP. For instructions and information on how to file a complaint directly with HHS, please refer to their website www.hhs.gov/ocr/hipaa/.
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  • The authority for agencies to pay premiums applies to employees who were called to active duty on or after December 8, 1995, and who meet certain conditions. Agencies may make retroactive payments to qualified employees for premiums paid on or after that date. Ask your Human Resources Office about the policy for your agency.
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  • We suggest that you look at The Department of Health and Human Services website (specifically HHS's Office of Civil Rights), since they are tasked with writing and enforcing these regulations. Here are two links:
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  • The Privacy Rule permits OPM to impose reasonable, cost-based fees. The fee may include only the cost of copying (including supplies and labor) and postage, if you request that the copy be mailed. We expect to charge an amount similar to that used for Freedom of Information Act (FOIA) requests.
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  • You must inform your Human Resources Office that you want to revoke your waiver during your final pay period. Your Human Resources Office will then reinstate your FEHB so that you will have an enrollment to continue under TCC or convert. If your leave and earnings statement for your final pay period does not show a withholding for an FEHB premium, contact your Human Resources Office immediately.
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  • Some health plans offer dental and vision benefits separate from the officially offered benefits stated in their FEHB brochures. Such separate benefits are described on the "Non-FEHB Benefits" page in FEHB brochures. The plans solely determine what is covered and what is excluded and you must pay any premium associated with these benefits directly to the health or dental plan. There is no government contribution toward the premium on non-FEHB benefits. Also, some health plans offer a separate dental plan that does not require you to be a member of their health plan. And, occasionally, an agency's employee organization offers dental and vision benefits to the agency's employees. Check with your Human Resources Office.
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  • A brand name drug is approved by the Food and Drug Administration (FDA), and is supplied by one company (the pharmaceutical manufacturer). The drug is protected by a patent and is marketed under the manufacturer's brand name.
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  • Premium conversion may slightly reduce the Social Security benefit you will receive upon retirement. The extent of the impact depends upon several factors:
    • the retirement system that you participate in;
    • whether your salary exceeds the Social Security wage base; and
    • the number of years left until your retirement.
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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). Your disputed claim will be reviewed in one of three Health Insurance Groups. 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 before we can decide, or if you need to do more -- such as send us more information -- before we can decide, 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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  • Medicare has two new provisions: Part C (Medicare Advantage) and Part D (Medicare Prescription Drug Coverage). Part C: You can enroll in a Medicare Advantage plan to get your Medicare benefits. Medicare Advantage is the term used to describe the various private health plan choices available to Medicare beneficiaries. Part D: There is a monthly premium for Part D coverage. Most Federal employees do not need to enroll in the Medicare drug program, since all Federal Employees Health Benefits Program plans will have prescription drug benefits that are at least equal to the standard Medicare prescription drug coverage. Still, you may want to be aware of the benefits Medicare is offering, so you can help others make informed decisions. If you have limited savings and a low income, you may be eligible for Medicare's Low-Income Benefits. For people with limited income and resources, extra help in paying for a Medicare prescription drug plan is available. Information regarding this program is available through the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.ssa.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
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  • You can find the Guide to Federal Benefits (RI 70-5) that lists the premiums for TCC at http://www.opm.gov/insure/health/planinfo/guides/index.asp.
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  • You are correct. Problems arising from oral discussions are very difficult to settle later because they are impossible to prove or disprove. In contractual situations such as under the Federal Employees Health Benefits Program, oral statements can never be regarded as official and, so, the brochures state that oral statements made by any representative of a carrier cannot modify the benefits described in the brochure. If a serious decision -- such as whether to enroll or not enroll in a plan -- hinges on such a coverage issue, do not rely on a verbal response. This is particularly true if the response disagrees with the plan's brochure benefits description.
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Total Count: 581, Number of Pages: 39, Page: 7
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