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Special Initiatives Self Plus One

Self Plus One Enrollment Type

The FEHB Program introduces the Self Plus One Enrollment Type.

Introduction

The Bipartisan Budget Act of 2013 establishes a Self Plus One enrollment type in the Federal Employees Health Benefits (FEHB) Program. Coverage under a Self Plus One enrollment will be available beginning in January 2016. The first opportunity to enroll in Self Plus One will be during the annual Federal Benefits Open Season beginning in November 2015.

Frequently Asked Questions

  • If you are an annuitant, please contact the Retirement Office during Open Season via one of the following methods:   Office of Personnel Management Open Season Processing Center P.O. Box 5000 Lawrence, KS 66046-0500 Additional details on enrolling in an FEHB plan for employees and annuitants can be found at https://www.opm.gov/healthcare-insurance/healthcare/enrollment/. If you are an active employee and you want to enroll in Self Plus One, please note that OPM does not process enrollments for Federal employees of other agencies. Your Human Resources Office can assist you. If your local Personnel office is unable to help you, you can contact your headquarters benefits counselor for further guidance.  OPM maintains a list of Benefits Officers which can be found at  http://apps.opm.gov/abo . Please visit this site, find your headquarters agency and the contact information will be listed.    
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  • Rates are announced in early October before Open Season begins. When posted, 2016 rates will be available at www.opm.gov/openseason.
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  • A Self Only enrollment covers only the enrollee. A Self and Family enrollment covers the enrollee and all eligible family members. The new Self Plus One enrollment type covers the enrollee and one eligible family member you designate to be covered.
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  • Self Plus One is a new enrollment type in the Federal Employees Health Benefits (FEHB) Program that allows you to cover yourself and one eligible family member you designate to be covered. Starting in 2016, all FEHB plans (your health insurance plans) will offer a Self Only, a Self Plus One, and a Self and Family enrollment type. Employees and annuitants will be able to select a Self Plus One enrollment beginning in the 2015 Open Season.
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  • You should determine your eligible family members and decide which enrollment type is best for you. A Self Plus One enrollment type will cover you and one eligible family member. During Open Season 2015, you will want to pay close attention to the benefits and rates in both the plan you currently have and other FEHB plans available to you. OPM will release materials in advance of Open Season to help you make this important decision. Visit www.opm.gov/openseason to access these materials.
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  •  It will be very important during this year’s Open Season to look at the rates for the plan you are in and for other plans as well. It may be possible to save money by enrolling in a Self Plus One enrollment, but you should review your health benefit needs and the available FEHB plans to determine which plan is best suited to meet your needs.
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  • A Self Plus One enrollment covers the enrollee and one designated eligible family member. The definition of eligible family  members has not changed. Your eligible family member can include either a spouse OR a child up to age 26. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member.
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  • No. In order to decrease your enrollment to Self Plus One you will need to make an enrollment change during Open Season or in conjunction with experiencing a Qualifying Life Event. Your employing (or retirement) office will not change your enrollment unless you request it.
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  • If you choose a Self Plus One enrollment during the 2015 Open Season, your enrollment change will be effective on the 1st of January. For annuitants, Open Season enrollments are always effective on the 1st day of the year following the end of the Open Season. If you choose a Self Plus One enrollment outside of Open Season, your enrollment change will be effective on the first day of the first pay period following the one in which you make a change. For example, if you request an allowable change in the middle of February, your change will be effective on March 1st.
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  • You will be able to select a Self Plus One enrollment beginning in the 2015 Open Season.  After Open Season, you will have an opportunity to change your enrollment upon experiencing a Qualifying Life Event (QLE).
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  • Yes. You can always make changes to your plan during Open Season. In addition, you can make changes if you experience a Qualifying Life Event. For example, if you are currently married and chose a Self Plus One enrollment, in the event you divorce,  you can make a change to Self Only. Alternatively, you can change to Self and Family if you have an eligible child. Other QLEs allow you to make changes as well. You can see a list of all your QLE opportunities on the SF 2809.
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  • Annuitants are allowed to decrease enrollment at any time. This means that if you have a Self and Family enrollment and you decide you would like to change to a Self Plus One enrollment, you may do so throughout the year.  No changes to Self Plus One can be made prior to the 2015 Open Season.  Changes are effective January 1, 2016. If you have a Self Only enrollment, however, you must experience a Qualifying Life Event in order to change to Self Plus One. These are events such as marriage, divorce, or a family member’s loss of coverage under another health insurance program. For a full list of allowed QLEs, please view the SF 2809. Reminder: No changes to Self Plus One can be made prior to the 2015 Open Season. Open Season changes for annuitants are effective January 1, 2016.
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  • The Limited Enrollment Period (February 1-February 29, 2016) allows individuals participating in premium conversion (pre-tax deduction of premiums from paycheck) to decrease enrollment from Self and Family to Self Plus One. Individuals who do not participate in premium conversion ( such as annuitants) can decrease enrollment at any time. No other enrollment changes will be allowed   Contact your Human Resources office for additional information.
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  • You will be able to increase or decrease your enrollment type during the annual Open Season, or outside of Open Season if you experience a QLE that is consistent with current FEHB guidelines. A full list of QLE codes and their definitions will be outlined in the updated SF2809, which will be available soon.   Note: individuals who do not participate in premium conversion, including annuitants, may decrease their enrollment at any time.
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  • No. Only legally married spouses are considered eligible family members under any FEHB enrollment, including Self Plus One.  This has not changed with the addition of the new Self Plus One enrollment type.
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  • To switch a covered family member you must complete a Standard Form 2809. You will not be able to directly contact your carrier to make this change. Contact your agency benefits officer for more information.
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  • The weighted average for self plus one will be based on the 2016 self plus one premiums and the 2015 self and family headcount. 
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  • No, you do not have to be enrolled in Self Plus One for the five years before you retire to meet the five-year requirement. You need to be enrolled in FEHB for five years before you retire, or for the entire time for which you were eligible to be enrolled, and retire on an immediate annuity  to be eligible to continue coverage into retirement.
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  • As an active employee, you must experience a Qualifying Life Event (QLE) in order to change your enrollment outside of Open Season. These are events such as marriage, divorce, the birth or adoption of a child, or a family member’s loss of coverage under another health insurance program.  For a full list of allowed QLEs, please view the SF 2809. Reminder: No changes to Self Plus One can be made prior to the 2015 Open Season.       
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  • You are able to switch a covered family member during the annual Open Season and outside of Open Season upon experiencing a change in family status, a change in coverage, or a change in eligibility, as long as switching the family member is consistent with the QLE experienced. For example, if an enrollee has a spouse and a child, but only covers their spouse with a Self Plus One enrollment, in the event that the enrollee and spouse are divorced, the enrollee may choose to stay in Self Plus One and switch their covered family member to terminate their spouse’s coverage and add their eligible child to the enrollment. However, if an enrollee covers a spouse under a Self Plus One enrollment and then has a child, the enrollee would be allowed to increase to Self and Family to cover all of their eligible family members, but not to switch from covering their spouse to covering their new child under a Self Plus One enrollment. A full list of QLE codes and their definitions will be outlined in the updated SF2809, which will be available soon.
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Total Count: 32, Number of Pages: 2, Page: 1
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