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Insurance FAQs Health

  • Unfortunately, there are areas of the country that HMOs have simply chosen not to participate in the FEHB Program. Reasons for this vary, but most cases involve population size or demographics. There is no minimum requirement for the number of HMO options available to enrollees throughout the country. We have encouraged HMO participation in the Program because many of our participants have asked for that choice of health plan. In fact, under the FEHBP, the only types of health plans that can be added to the Program are HMOs. And, HMOs have an annual opportunity to submit their applications to participate in the Program. If you have HMOs in your local area that do not currently participate in the FEHBP, we encourage you to ask these HMOs to consider the FEHBP market for their geographic areas. New plan application packages for the FEHB Program are available at www.opm.gov/insure/health/carriers/index.asp. Applications are due to OPM by January 31 of each year for the next contract term.
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  • No. Approximately half of all drugs on the market have generic versions.
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  • The Office of Personnel Management in Macon, Georgia (OPM-Macon), will mail a PIN to you within your first two weeks on the job.
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  • 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. Another way to cut costs is to request generic drugs instead of brand name drugs. A generic medication is a copy of a brand name drug. It has the same active ingredients and receives the same Food and Drug Administration approval but costs less. Most plans charge you a lower copay if you use generic drugs.
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  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal law that provides far-reaching health insurance reforms and medical privacy protections for all Americans. Title I of HIPAA offers important, though limited, Federal protections that improve the availability and continuity of health coverage for workers and their families. Under certain conditions, this law guarantees the availability of new health coverage with no exclusions for pre-existing conditions for individuals who lose employment-based health coverage due to changes in employment or family status. The Departments of the Treasury, Labor, and Health and Human Services are jointly responsible for Federal rules concerning health insurance portability and accessibility requirements. However, since HIPAA gives enforcement authority to the individual states and allows states to impose more generous protections than those under HIPAA, a key source of information for individuals is your State Insurance Commissioner.
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  • No. According to the FEHB law, if you or your former spouse didnt notify the employing office within the 60-day limit, your opportunity to elect TCC ends 60 days after your divorce or annulment.
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  • You can change plans during the annual FEHB Open Season and whenever you have a qualifying life events (QLE) -- such as marriage. Becoming aware of another plan that has better benefits, even if you didn't expect to want the extra benefits when you had a chance to change plans before, does not qualify as a "QLE" that allows you to change plans.
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  • 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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  • You may not need to write to the Office of Personnel Management. If you think you might qualify for a waiver of the 5-year coverage requirement, contact your Human Resources Office for information. If you meet the requirements, your agency will attach a memorandum to your retirement application stating that you meet the requirements for waiver by the Office of Personnel Management.
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  • The Health Insurance Portability and Accountability Act (HIPAA) requires that we prepare and distribute our Notice of Privacy Practices. Since all individuals enrolled in the Federal Employees Health Benefits (FEHB) Program receive a copy of their Plan brochure, we believe that this was the most cost-effective way to ensure that we complied with this requirement.
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  • Yes. Generic drugs are less expensive than brand name products, and so the amount you pay as part of your prescription drug cost-sharing is less than what you pay for brand names. In addition, most plans charge you a lower copay if you use generic drugs.
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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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  • 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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  • During the FEHB Open Season, you may: enroll in any health benefit plan for which you are eligible; change from one plan, option, or type of enrollment to another;. cancel your enrollment; Change your pre-tax waiver status.
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  • If you file claims after the deadline because you requested the 6 additional months of FEHB coverage, your plan will waive any timely filing restrictions. Fee-for-service plans must accept and process any claims for services received during the additional 6-month period, and reconsider any claims incurred during the additional 6 months that were previously denied for non-coverage. HMOs must provide benefits for services rendered during the additional 6 months if the provider was part of the HMO network at the time. They do not need to provide benefits if the services received during the additional 6 months were provided by non-network providers.
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Total Count: 581, Number of Pages: 39, Page: 9
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