Frequently Asked Questions About Changing Health Plans
A. 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.
A. 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.
A. There are no exclusions or waiting periods for pre-existing conditions in any plan in the FEHB Program. This is also true after you retire.
A. During the annual FEHB open season, you may enroll, cancel an enrollment, change plans or options, and waive or begin participation in premium conversion. Outside of open season, you can make changes due to certain events, called qualifying life events (QLEs). The most common QLEs for changing enrollment type or plan are: marriage, acquiring a child, moving away from the area served by your Health Maintenance Organization (HMO), losing health insurance coverage, or changing employment status.
If you waived participation in premium conversion, you can change from self- and-family enrollment to a self-only enrollment or cancel your enrollment at any time. You can make other changes during open season or due to certain events. Your Human Resources Office can give you more information about these events.
A. Open season changes for most Federal employees are effective the first day of the first full pay period that begins in January. Generally, mid-year changes are effective on the first day of the pay period which begins after your enrollment is received by your Human Resources Office.
A. If you are an annuitant or an employee who waived premium conversion, you can change from a self-and-family enrollment to a self-only enrollment at any time. If you are an employee under premium conversion, your youngest child turning age 22 is a qualifying life event (QLE) that would allow you to change either your premium conversion election and/or your FEHB enrollment. It would be entirely consistent with this life event to consider a change to self-only coverage. You do not need to wait until the next Open Season to make this change; however, you need to request a change to self-only coverage within 60 days after this event.
A. The plans print their provider directories and have them available during open season. Many plans also provide this information on their web sites. If your agency will have 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 any of the FEHB Guides. Plan brochures, plan web site addresses and FEHB guides are available at www.opm.gov/insure/health.
A. Most health maintenance organizations (HMO) restrict enrollment to an area where its doctors and hospitals are accessible. Although some HMOs do not have restrictions on where you live or work, please recognize that if you later find it is inconvenient to get to a plan provider, you may have to wait until the next open season to change plans.