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The Federal Employees Health Benefits (FEHB) Program became effective in 1960. It is the largest employer-sponsored group health insurance program in the world, covering over 9 million Federal employees, retirees, former employees, family members, and former spouses.
Public Law 86-382, enacted September 28, 1959, created of the FEHB Program; the current law governing the Program is chapter 89 of title 5, United States Code. The 1959 Act became effective generally on the first day of the first pay period that began on or after July 1, 1960. It authorized the Civil Service Commission (now the Office of Personnel Management) to write any regulations necessary to carry out the Act. These regulations are in part 890 of title 5 and chapter 16 of title 48, Code of Federal Regulations.
This Handbook provides the policies and procedures of the FEHB Program and provides additional guidance to those enrolled in the FEHB Program and their employing offices. These policies and procedures reflect operations under title 5, United States Code. This guidance does not cover any authority that individual agencies, such as the U.S. Postal Service, may have under different laws.
As a Federal employee, you are entitled to enroll yourself and any eligible family members in a health plan offered under the FEHB Program, unless your position is excluded from coverage by law or regulation. If you meet the requirements, you will be eligible to continue group coverage into retirement.
There are two types of enrollment: Self Only and Self and Family. A Self and Family enrollment covers you, your spouse, and your unmarried dependent children under age 22.
Each health plan carrier under the FEHB Program charges a different premium. The Government pays up to 75% of the cost of your health benefits coverage, and you pay the remainder, based on a formula set by law.
Over 350 health plans are offered under the FEHB Program. Of the 14 available fee-for-service plans, seven are open to all enrollees, while another seven are available only to specific categories of employees. In addition, health maintenance organizations (HMOs) are available in most areas of the United States; you must live or work within a defined area to be eligible to enroll in a particular HMO.
Each year, an Open Season is held for FEHB Program enrollees to change health plans and/or the type of enrollment they have. Eligible employees may also enroll during this time. Open Season runs from the Monday of the second full workweek in November through the Monday of the second full workweek in December.
There are limited opportunities to enroll, cancel your enrollment, or change your enrollment outside of an Open Season.
Each carrier contracts with the Office of Personnel Management to provide certain health benefits to all persons who enroll in its participating plan. Contract negotiation is a bilateral process, and both OPM and the carrier must approve the final contract. Contract periods are usually one year. Individual policies or contracts are not issued to FEHB Program enrollees.
Once benefits have been agreed upon, OPM and each carrier jointly prepare a brochure describing each plan approved under the FEHB Program. This brochure is intended to be a complete statement of benefits available to the enrollee, including the plan's benefits, limitations, and exclusions.
The District Courts of the United States have original jurisdiction, concurrent with the United States Court of Federal Claims, in any civil action or claim against the United States founded upon the law. Actions to recover on claims for health benefits must be brought against OPM. Actions to review the legality of OPM's regulations or a decision made by OPM must be brought against OPM. Actions to compel enrollment must be brought against the employing office that made the enrollment decision.
Your plan's carrier may garnish your pay to collect debts you owe to it. Garnishment could occur, among other reasons, if you fail to pay deductibles and copayments or if the carrier overpaid claims in error. Federal employee retirement benefits may not be garnished for this purpose.
Your employing office must follow the provisions of 5 CFR part 582 to process a garnishment. These regulations protect some pay from garnishment, such as amounts to cover health benefits premiums and Basic life insurance withholdings. However, amounts to cover Optional life insurance withholdings are not protected. See the FEGLI Handbook for additional information about the effect of garnishment on life insurance coverage.
OPM has the overall responsibility for the administration of the FEHB Program. This includes:
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