Frequently Asked Questions About FEHB Coverage for Federal Civilian Employees Called to Military Duty
To Military Duty Benefits Introduction
Q. I am enrolled in an FEHB plan and just received orders to report for military duty. What should I do?
A. You should contact your human resources office for the appropriate information for employees covered under FEHB who are called to military duty.
Q.What issues should I consider in making my decision to continue or terminate my FEHB enrollment?
A. Your FEHB enrollment will continue unless you elect to have it terminate. You should also consider:
Note: If your enrollment continues and you participate in premium conversion, you may not cancel your enrollment at any time. If you think you might want to stop your FEHB at some time during your military service, you should consider waiving premium conversion at this time.
Q. How long will my FEHB coverage continue while I'm on active duty?
A. FEHB law (5 U.S.C. 8905a) permits you to continue your FEHB enrollment for up to 24 months if you were called to active duty on or after September 14, 2001, and meet certain requirements. You must:
Q. How will I know if I am serving in support of a contingency operation?
A. Your agency will be able to determine this by examining your military orders. If there is any question, you will need to contact your military unit.
Q. When does the 24-month period begin?
A. The 24-month period begins the day you are separated, furloughed, or placed on leave of absence to serve on military duty. This applies even if part of your military service is covered by paid leave immediately followed by furlough or other leave without pay.
Q. I have heard that my agency may pay my premiums while I am on active duty. Is this true?
A. Yes, FEHB law (5 U.S.C. 8906(e)(3)) gives agencies the authority to pay your premiums if you meet certain conditions. You must:
Although the law gives your agency the authority to pay your premiums if you meet these conditions, your agency must decide to implement this authority. Ask your human resources office about the policy for your agency.
Q. I have returned from active duty. May I receive a refund for the premiums I've paid?
A. The authority for agencies to pay premiums applies to employees who were called to active duty on or after December 8, 1995, and who meet certain conditions. Agencies may make retroactive payments to qualified employees for premiums paid on or after that date. Ask your human resources office about the policy for your agency.
Q. What happens if my orders do not show that I am called to active duty in support of a contingency operation, or I do not meet all the requirements of FEHB law for my agency to pay my premiums?
A. If you do not meet these requirements, the authority for you to continue your FEHB comes from the Uniformed Services Employment and Reemployment Rights Act (USERRA) (38 U.S.C. 4317). Public Law 108-454 amended this Act to allow you to continue your FEHB for 24 months if you were called to military duty and elected to continue your health insurance coverage on or after December 10, 2004. If you made your election before December 10, 2004, you are eligible to continue your FEHB for 18 months.
If your FEHB continues under this provision, your agency does not have authority to pay your premiums while you are on military duty. For additional information, see Benefits Administration Letter 06-401 at BAL 06-401 Federal Employees Health Benefits (FEHB) Program: Extended Coverage for Employees Called to Active Military Duty.
Q. If my agency does not pay my FEHB premiums, what amount am I responsible for?
A. No. If your agency does not pay your premiums, you must pay the employee's share of the premium during the first 12 months of coverage (just as any other employee on leave without pay). You must pay both the employee and government shares for up to 12 additional months that you continue your coverage while on military duty.
Q. How do I make premium payments while I am on military duty?
A. Your employing office will notify you of the choices available to you and provide you with a method to make direct premium payments.
Q. Can I continue coverage beyond the 24-month period?
A. No. There is no provision of law that allows for coverage to continue beyond 24 months during your military duty. However, at the end of the 24 months, you have a 31-day extension of coverage and the right to convert to an individual policy offered by the carrier of your plan. You are not required to provide evidence of insurability for this private coverage. There is no provision in FEHB law that allows for Temporary Continuation of Coverage (TCC) after the 24 months of coverage.
Q. What if I decide I do not want to continue my FEHB coverage while I'm on military duty?
A. If you do not want to continue your FEHB enrollment, you must notify your employing office in writing that you wish to terminate your coverage. If you do not take action to terminate the coverage, your enrollment will continue for up to 24 months while you are on military duty.
Q. If I decide to terminate my coverage, will it be considered a break in coverage for meeting the requirements for continuing my FEHB after I retire?
A. No. The termination is not considered a break in the continuous enrollment necessary for continuing FEHB coverage during retirement. If you decide not to continue your coverage, your enrollment is terminated, not canceled. To avoid a gap in your coverage after you return to work, you must reinstate your enrollment on or before the last day of your TRICARE coverage. See our questions and answers on Return from Military Service at http://www.opm.gov/insure/health/qa/fedcivil.asp.
Q. If I elect to terminate my FEHB enrollment, when will the termination be effective?
A. If you elect to terminate your enrollment before you go on active duty, the termination will be effective on the day you are separated, furloughed, or placed on leave of absence to enter military service. Your employing office must use SF 2810 to terminate your enrollment. This means that you are entitled to a 31-day extension of coverage and if needed, have the right to convert to an individual policy offered by the carrier of your plan.
Q. What happens if my plan leaves the FEHB program while I am on military duty?
A. Your agency should contact you or your dependent and give you an opportunity to select another plan. If they were unable to reach you and you learned after the enrollment time frame that your plan discontinued, they must use SF 2810 to reinstate your old enrollment code. This is for enrollment history purposes only, and cannot be sent to your old carrier since the plan is discontinued. Your agency should give you an opportunity to select another plan, and process the change retroactive to the date after your enrollment under your former plan terminated. When selecting another plan, please remember you are responsible for determining if any providers used participate in your new plan's network.
Q. My FEHB enrollment terminated after 18 months. My agency just informed me they can extend my coverage for 6 months if I request it. Will this be an opportunity for me to change plans?
A. No. If you request the additional coverage, you will be reinstated into the same plan. However, if the plan you were in no longer exists, your agency must allow you to select another plan. Your change would be retroactive to your reinstatement date. As in the above question, remember that you are responsible for determining if providers used during the additional 6-month period participate in your new plan's network.
Q. My FEHB enrollment terminated after 18 months. What factors should I consider in deciding if I should request the 6 additional months of FEHB coverage allowed by current law?
A. If your FEHB is retroactively reinstated for 6 additional months, FEHB will become the primary payer and TRICARE the secondary payer during the additional 6 month coverage period. Thus, any payments made by TRICARE during that 6-month period could be reconciled with the FEHB carrier and any benefit adjustments could cause a difference in the amounts that you owe. Factors such as covered vs. non-covered services, network vs. out-of-network providers, deductibles, copayments, coinsurance, Health Maintenance Organization (HMO) geographic considerations, and catastrophic coverage applications may alter your total out-of-pocket expenses. Some additional issues for you to consider are:
Q. Will my plan deny my claims if I request the 6 additional months of FEHB coverage and file claims after the timely filing deadline?
A. 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.
Q. I am satisfied with the coverage I had under TRICARE during my active duty, and I do not want my agency to retroactively add the 6 additional months of FEHB. Is there anything I am required to do?
A. If your agency requires a yes or no response, and you want your coverage to remain as it is, tell your agency that you do not want the 6 additional months of FEHB. If your agency has advised you they will not take any action without your consent, you do not need to do anything. If you have any questions, contact your human resources office.