Click here to skip navigation
This website uses features which update page content based on user actions. If you are using assistive technology to view web content, please ensure your settings allow for the page content to update after initial load (this is sometimes called "forms mode"). Alert box notification is currently enabled, please follow this link to disable alert boxes for your session profile.
Change Search Collection
Select a Search Collection:
An official website of the United States Government.

Insurance FAQs

Benefits

  • I am going to retire soon. What are the requirements to continue health benefits into retirement? View more
    A. In order for you to continue your health benefits enrollment into retirement, you must: (1) be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement; and (2) have been continuously enrolled (or covered as a family member) in any Federal Employees Health Benefits (FEHB) Program plan(s) (not necessarily the same plan) for the five 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). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • How can I get a new Retirement Benefits Statement? View more
    Annuitants sometimes need a new copy of “Your Federal Retirement Benefits” to show their retirement income to their mortgage lender, bank, underwriter, state income tax office, or low-income housing provider.  To request a new copy of “Your Federal Retirement Benefits”, or to receive a verification of your annuity, contact OPM’s Retirement Office at 1-888-767-6738 or retire@opm.gov.  The phone lines are open from 7:30 am to 7:45 pm (Eastern Standard Time). It is a busy phone number so we encourage you to call early in the morning or after 5:00 pm when the phone lines are less busy.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • Can a retiree apply for a flexible savings account under the Federal Flexible Spending Account Program (FSAFEDS)? View more
    No.  By law, annuitants are not eligible for FSAFEDS.  For more information, please refer to the FSAFEDS Summary of Benefits.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • My friend received bad information from a Plan's customer service representative and received care based on that bad information. My friend thinks the Office of Personnel Management should order the plan to pay or allow a mid-year plan change. I don't think it should do either. Who is right? View more
    You are correct. Problems arising from oral discussions are very difficult to settle later because they are impossible to prove or disprove. In contractual situations such as under the Federal Employees Health Benefits Program, oral statements can never be regarded as official and, so, the brochures state that oral statements made by any representative of a carrier cannot modify the benefits described in the brochure. If a serious decision -- such as whether to enroll or not enroll in a plan -- hinges on such a coverage issue, do not rely on a verbal response. This is particularly true if the response disagrees with the plan's brochure benefits description.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • I want to take advantage of the better benefits available by using a PPO doctor but my plan doesn't have any in my area. Why can't a non-PPO provider be paid as a PPO when there isn't a PPO provider in my area? View more
    We ensure that the plans provide the benefits described in the Federal Employees Health Benefits Program brochures. The health plans often make Preferred Provider Agreements and other arrangements with providers which are contractual arrangements between the carriers and the providers. Because of the discounts that a plan realizes through its contracts with PPO providers, the plan is able to reimburse a higher percentage of the negotiated PPO allowance when PPO providers are utilized. It would not be cost effective for the plan to reimburse at the higher level when the provider is not giving a discount. Furthermore, much of the benefit you receive from using PPO providers comes from the PPO provider's agreement not to bill you for more than the negotiated PPO allowance. Non-PPO providers are under no such obligation. In some areas of the country, it is much more difficult for a plan to arrange PPO contracts for all types of services. In areas where there are no PPO providers, you can still receive your plan's regular benefits, as opposed to the incentivized PPO benefit. If you are overseas, check with your plan to see how they pay the claims of non-PPO providers – some plans have special reimbursement allowances for overseas claims.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • How would I get a waiver of the 5-year coverage requirement to continue health benefits into retirement with buyout legislation? View more
    You may not need to write to the Office of Personnel Management. If you think you might qualify for a waiver of the 5-year coverage requirement, contact your Human Resources Office for information. If you meet the requirements, your agency will attach a memorandum to your retirement application stating that you meet the requirements for waiver by the Office of Personnel Management.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • My plan requires that I get preauthorization for surgery. My physician told me that I need this surgery but my plan will not authorize it. What can I do? View more
    First, have your doctor contact the plan to discuss the situation. You and your doctor can provide your plan with information to support your contention that the surgery should be authorized, such as medical records that indicate the need for the surgery, and ask your plan to reconsider its decision. If the plan reconsiders its decision but continues to uphold its denial, and after considering the plan's rationale you still disagree, consult the disputed claims section of your plan's brochure for specific information on how to write to the Office of Personnel Management to ask us to review the claim.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • My plan denied my claim and I think they should have covered the services; what can I do? View more
    First, check your plan's brochure to see if the service is covered, limited or excluded. The next step is to review the disputed claims section of your brochure. Briefly, the disputed claims section will direct you to write to the plan to explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered, and to ask the plan to reconsider your claim. If the plan again denies the claim, read the plan's decision letter carefully and then check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of your brochure will show you how to write to the Office of Personnel Management to ask us to review the claim. We can't review a denied claim unless your plan has reconsidered it first (or at least been given an opportunity to reconsider it). Your disputed claim will be reviewed in one of three Health Insurance Groups. Generally, we will acknowledge your request within 5 days. After we complete the review, we will send you a final response within 60 days. If we need more time before we can decide, or if you need to do more -- such as send us more information -- before we can decide, we will contact you within 14 work days of the time we get your request and tell you what you still need to do, if anything. We are sorry but we cannot give you a decision over the phone until the review has been completed and a written copy of the final decision has been issued.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • Why can't the doctors stay with the plan a year instead of dropping out at any time? I can't keep up with who is participating and who is not. View more
    The Federal Employees Health Benefits Program runs on a calendar year basis -- from January through December. But the carriers' provider contracts are spread throughout the year, as are the carriers' policies with other employers.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • My health plan said it would cover certain medical services, and then changed its mind. What are my options? View more
    If you disagree with the plan’s decision on your claim, the Federal Employees Health Benefits (FEHB) Program provides for an appeal process.  Check your plan’s FEHB brochure to see if the service is covered, limited, or excluded. Review and follow the directions in the disputed claims section (Section 8) of the brochure. This section will tell you how to ask the plan to reconsider your claim. You must explain why (in terms of the applicable brochure coverage provisions) you feel the services should be covered.   If the plan again denies the claim, read the plan's decision letter carefully. Then, check your plan's brochure again. If you still disagree with the plan's decision, the disputed claims section of the brochure will tell you how to write to the U.S. Office of Personnel Management to ask us to review the claim.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close
  • My child is going to college this year. Will my health maintenance organization (HMO) cover him? View more
    Yes, if you have family coverage, as long as your child is under age 26. Since you are in an HMO, your child will be covered for services received from Plan providers and for emergency care away from home. Some HMOs offer benefits that are tailored specifically to your situation and others have reciprocal agreements with plans in other areas. Check with your plan.
    How well did this answer your question? Submit
    Submitting rating...
    Thank you for your feedback!
    [x] Close
    An error occurred while trying to submit your feedback.
    Please try again later.
    [x] Close


Total Count: 11, Number of Pages: 0, Page: 1

Related Categories