U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

• What Changes can I make during Open Season?
• What changes can I make outside of Open Season?
• When I change plans, what date will it be effective?
• Another plan has some extra services that I can't get in my own plan. When is the next time I can change plans?
• If I join a plan because my doctor is a participating doctor or specialist and then my doctor drops out of my plan's network in the middle of the year, can I switch plans?
• I have a pre-existing heart condition. When I change plans, do I need to worry about a waiting period before I can get coverage?
• When my youngest child turns age 22 next month, I won't have any family members who are eligible for coverage. Do I have to wait until Open Season to change from Self and Family to a Self Only enrollment?
• I'm interested in changing to either a health maintenance organization (HMO) or a plan with a Point-of-Service (POS) product. How can I find out where their providers are located?
• I want to change my FEHB enrollment to an HMO but I don't live or work in the Plan's area as required by that particular plan's brochure. Why can't I enroll in it?

Q. What changes can I make during Open Season?

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.

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.

Q. What changes can I make outside of Open Season?

A. 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.

Q. When I change plans, what date will it be effective?

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.

Q. Another plan has some extra services that I can't get in my own plan. When is the next time I can change 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.

Q. If I join a plan because my doctor is a participating doctor or specialist and then my doctor drops out of my plan's network in the middle of the year, can I switch 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.

Q. I have a pre-existing heart condition. When I change plans, do I need to worry about a waiting period before I can get coverage?

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.

Q. When my youngest child turns age 22 next month, I won't have any family members who are eligible for coverage. Do I have to wait until Open Season to change from Self and Family to a Self Only enrollment?

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.

Q. I'm interested in changing to either a health maintenance organization (HMO) or a plan with a Point-of-Service (POS) product. How can I find out where their providers are located?

A. The plans print their provider directories and have them available during Open Season. Many plans also provide this information on their websites. If your agency has 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 the Guide to Federal Benefits. You can also find specific plan contact information on the FEHB website.

Q. I want to change my FEHB enrollment to an HMO but I don't live or work in the Plan's area as required by that particular plan's brochure. Why can't I enroll in it?

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.

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