Federal Employees Health Benefits (FEHB) Program

RI 70-02 For Career United States Postal Service Employees

Overview

The United States Postal Service (USPS) provides health benefits to its career employees by participating in the Federal Employees Health Benefits (FEHB) Program, which is administered by the U.S. Office of Personnel Management (OPM), Office of Retirement and Insurance Services. It is the largest employer-sponsored health insurance program in the world. OPM interprets health insurance laws and writes regulations for the FEHB Program. It gives advice and guidance to the USPS and other participating agencies to process your enrollment changes and to deduct your premiums. OPM also contracts with and monitors all of the plans participating in the FEHB Program.

While FEHB eligibility, enrollment requirements and the plans available for 2008 are the same for federal and USPS employees alike, the Postal Service pays a higher percentage contribution towards career Postal employee premium rates than the rest of the federal government. All employee premium rates are calculated using the "Fair Share Formula."

What does this Program offer?

The FEHB Program offers a wide variety of types of plans and coverage to help you meet your health care needs. It is group coverage available to employees, retirees and their dependents. If you continuously maintain your FEHB enrollment, or are covered by the FEHB enrollment as a family member, or a combination of both, for the five years of service immediately preceding your retirement, and you retire on an immediate annuity, you can continue to participate in the FEHB after retirement. The Program benefits you receive as a retiree are the same coverage Federal employees receive and at the same cost. If you leave government employment before retiring, the Program offers temporary continuation of coverage (TCC) and an opportunity to convert your enrollment to non-group (private) coverage.

If you are currently enrolled in the FEHBP and do not want to change plans or enrollment type, you do not need to do anything. Your enrollment will continue automatically.

Appendix F includes a comparison chart of all the plans in the FEHB with information comparing basic benefits and costs.

Key FEHB facts

• The FEHB is part of the annual Open Season.
• FEHB coverage continues each year. You do not need to re-enroll each year. If you are happy with your current coverage, do nothing. Please note that your premiums and benefits may change.
• You can choose from Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Health Maintenance Organizations or Fee-for-Service plans with comprehensive coverage and higher premiums.
• There are no waiting periods and no pre-existing condition limitations, even if you change plans.
• If you are an active Postal employee, you can use your Health Care Flexible Spending Account or Limited Expense Health Care Flexible Spending Account with your FEHB plan.
• If you participate in Pre-tax Payment of Premiums, enrollment changes can only be made during Open Season or if you experience a qualifying life event (QLE).
• All nationwide FEHB plans offer international coverage.
• There are separate and/or different provider networks for each plan.
• Utilizing an in-network provider will reduce your out-of-pocket costs.

How much does it cost?

The premiums for your enrollment are shared by you and the Postal Service. For Postal Category 1, the Postal Service pays the lesser of 84% of the average premium of all plans weighted by the number of enrollees in each plan or but not more than 87.5% of the total premium for any individual plan. For Postal Category 2, the Postal Service pays 85% of the average premium of all plans weighted by the number of enrollees in each plan but not more than 88.75% of the total premium for any individual plan.

Am I eligible to enroll?

All career employees are eligible to enroll in FEHB. Non-career employees are eligible if they meet the eligibility requirements. If you have an appointment other than career and you have not received information about enrollment, you should contact the Human Resources Shared Service Center (HRSSC) on 1-877-477-3273, option 5 for more information.

When you retire, you are eligible to continue health benefits coverage if you retire on an immediate annuity under a retirement system for civilian employees (including FERS MRA + 10 retirements) and you have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years).

If you suspend your FEHB coverage as a retiree because you are covered by TRICARE, a Medicare Advantage Plan, Medicaid, or Peace Corps volunteer coverage you may reenroll under certain conditions. (You should contact your retirement system for information on your eligibility.) If you are not enrolled in or covered as a family member under FEHB when you retire, you will not be able to enroll after retirement.

Coverage

New Employees - New employees have the opportunity to select a health plan within 60 days of being hired.

Current Employees - Current employees have an opportunity to select or change plans:

• During Open Season
• When certain life events occur (see table on pages 34 through 37 of this Guide)
  NOTE: These elections MUST be made within certain time limits as specified in the table.

Your choice of plans and options includes Self Only coverage just for you, or Self and Family coverage for you, your spouse, and unmarried dependent children under age 22 (and in some cases, a disabled child 22 years or older who is incapable of self-support).

Eligible Family Members - Eligible family members for “Self and Family” health benefits enrollment purposes include an enrollee's:

• Spouse
• Unmarried dependent children under age 22, including legally adopted children and recognized natural (born out-of-wedlock) children.
• Unmarried dependent stepchildren and foster children, (including foster children who are also your grandchildren) under age 22 if they live with the enrollee in a regular parent-child relationship.
• Unmarried dependent children age 22 or over who are incapable of self-support because of physical or mental incapacity that existed before their 22nd birthday.

Ineligible Members - even though the following family members may live with and/or be dependent upon the enrollee, they are NOT ELIGIBLE for coverage under the enrollee's “Self and Family” FEHB program enrollment:

• Parents and other relatives
• Former spouses

NOTE: Falsifying or misrepresenting family member eligibility or enrollment is a violation of federal law and may subject an employee to fine, imprisonment and/or disciplinary action.

Loss of Coverage - When an event occurs that causes you or your family member to lose coverage, the FEHB Program offers a continuation of coverage feature, either temporarily or by permanent conversion to a private sector policy. Such events include but are not limited to:

• Child reaching age 22
• Separation
• Retirement
• Divorce
• Application for Spouse Equity
• Death
• Relocation
• LWOP Status*

* Leave Without Pay Status - FEHB Program regulations state that you may continue your FEHB coverage for up to 365 days while you are in a Leave Without Pay (LWOP) status, provided that you pay the employee share of the premium, either while on LWOP or when you return to a pay status. The Postal Service will invoice you for our share of the premium unless you complete and submit to the Human Resources Shared Service Center (HRSSC) PS Form 3111, FEHB Coverage or Termination While in Leave Without Pay (LWOP) Status, to terminate coverage. At 365 days in LWOP status, your FEHB coverage terminates.

If you do not pay your FEHB premiums while in a LWOP status, when you return to a pay status the amount owed for unpaid premiums may be significant. If there are FEHB past-due premiums (from one to four unpaid FEHB premiums), up to the entire amount due will be deducted from your salary. In addition, if there are sufficient monies available, the premium for the current pay period will be deducted from your pay. When an accounts receivable account has been created for unpaid FEHB premiums and that receivable is over 45 days old, Payroll automatically takes 15 percent of your disposable net pay per pay period until that accounts receivable account is paid off. This means that an employee who returns to pay status could possibly pay all of these amounts at the same time - the past due FEHB premiums (maximum of four unpaid FEHB premiums), the current FEHB premium, and up to 15 percent of disposable net pay towards payment of any accounts receivables for unpaid FEHB premiums.

It is your responsibility to report life events that may cause you or your family member to lose eligibility. It is also our responsibility to complete and submit any required paperwork to change your enrollment and/or apply for any continuation of coverage, if eligible, within the time limits specified in the Table of Permissible Changes on pages 34 through 37 of this Guide. If you have questions, contact the HRSSC on 1-877-477-3273, option 5.

If you lose coverage under the FEHB Program, you should automatically receive a Certificate of Group Health Plan Coverage from the last FEHB plan to cover you. If not, the plan must give you one on request. This certificate may be important to qualify for benefits if you join a non-FEHB plan.

When can I enroll?

If you are a new employee who is eligible for FEHB or an employee who has become newly eligible to enroll, you may enroll within 60 days of becoming eligible. You may also enroll during the annual Open Season. Furthermore, you may enroll, change your enrollment type, or change plans outside of Open Season if you experience a qualifying life event (QLE) such as a change in family or other insurance coverage status. The Table of Permissible Changes on page 34 contains more specific information about qualifying life events that permit employees to enroll or change enrollment in the FEHB Program.

For new or newly eligible employees who elect to enroll, coverage will be effective on the first day of the first pay period that begins after the Postal Service receives your enrollment. An Open Season enrollment or change is effective on the first day of the first full pay period that begins in January.

FEHB Open Season

Each year you have the opportunity to enroll or change enrollment during an Open Season. The 2007 Open Season is from November 12 through December 11 at 5:00 p.m. Central Time. Employees may make any one - or a combination - of the following changes:

• Enroll if not enrolled
• Change from one option to another
• Change from Self Only to Self and Family
• Change from Self and Family to Self Only
• Change from pre-tax to post tax premium deductions or vice versa (see pages 12 through 13 of this Guide)
• Cancel enrollment

If you decide to do any of the above actions, you MUST follow the instructions on the PostalEASE FEHB Worksheet contained in this Guide and enter your election in PostalEASE by 5:00 p.m. Central Time on December 11, 2007. It is critical that this be done timely.

Your new enrollment or any changes that you make to your existing coverage will take effect on January 5, 2008 and the change in premium rate deductions will be seen on your January 25, 2008 earnings statement. If you change plans, any covered expenses incurred between January 1-4, 2008 will count toward the prior year deductible of the plan you are changing from.

If you decide NOT to change your enrollment, DO NOTHING, and your present enrollment will continue automatically unless your plan is not participating in 2008. If your plan is not participating in 2008 you MUST choose another plan during Open Season or you will not have FEHB coverage. Ask the Human Resources Shared Service Center (HRSSC) for a list of the plans that will terminate at the end of the 2007 plan year.

If you decide to cancel your coverage during Open Season, you must cancel your enrollment in PostalEASE, which includes a confirmation by you that you clearly accept the consequences of canceling. The cancellation will become effective on January 4, 2008.

If you pay premium contributions on a pre-tax basis (which most career employees do) you will not be able to cancel or reduce (change from Self and Family to Self Only) coverage unless you experience a qualifying life event (QLE) and your election is in keeping with the change. See pages 12 through 13 of this Guide on Pre-tax Payment of Premium Contributions and the Table of Permissible Changes on pages 34 through 37 of this Guide.

You, as an employee, are responsible for being informed about your health benefits. You should thoroughly read this Guide, the brochures of plans that interest you, and the bulletin board notices on health benefits topics. These include family member eligibility, the option to continue or terminate an enrollment during periods of non-pay status or insufficient pay, dual enrollment prohibition, coverage for former spouses, and discontinued health insurance plans. Be sure to read the section on the pre-tax payment of health insurance premium contributions, which specifies Internal Revenue Service (IRS) restrictions for reducing or canceling coverage (see pages 12 through 13 of this Guide). Also be sure to refer to the Table of Permissible Changes on pages 34 through 37 of this Guide.

You can go to http://opm.gov/insure/health and download:

• All of the Benefits Guides including the Guide for USPS Employees, the Guide for United States Postal Service Inspectors and Office of Inspector General Employees, the Guide for Certain Temporary (Noncareer) USPS Employees, and the Guide for TCC and Former Spouse Enrollees.
• Plan brochures that include benefits, cost, and other major features of each health plan

After referring to these sources, if you still have questions regarding eligibility, enrollment criteria, continued coverage after certain life events, or on any other FEHB policies, or if you need assistance making your choice in PostalEASE, contact the HRSSC on 1-877-477-3273, option 5.

How do I enroll?

• Complete the PostalEASE FEHB Worksheet on page 30.
• Access PostalEASE on the Intranet (from the Blue page), the Internet (https://liteblue.usps.gov), an employee Self-Service Kiosk (available in some facilities), or by calling the Employee Service Line toll-free at 1-877-477-3273, option 1.

How do I get more information about this Program?

Visit the FEHBP online at www.opm.gov/insure/health for information including:

• How to compare and choose among health plans
• Health plan websites and plan brochures
• How to file a disputed claim request
• Getting quality healthcare
• Medicare and FEHB

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