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Insurance FAQs

  • 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.
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  • When you retire, you are entitled to the full government contribution.
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  • They can apply to suspend their coverage at any time. Annuitants can call OPM's Retirement Information Office at 1-888-767-6738 to obtain a suspension form. Callers within the local Washington, DC calling area must call 202-606-0500. Former spouses can get the form from the employing office or retirement system maintaining their enrollment. Eligible individuals must submit a completed suspension form and provide all necessary documentation to show eligibility for TRICARE or CHAMPVA during the period beginning 31 days before and ending 31 days after the date they designate as using TRICARE or CHAMPVA instead of FEHB coverage.
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  • Contact your ex-spouse's agency Human Resources Office (or retirement system, if applicable) for information on how to enroll. You will need to document your eligibility. You will be required to submit a certified copy of the court order to the US Office of Personnel Management, Court Ordered Benefits Branch, P.O. Box 17, Washington DC 20044-0017. This office will review the court order to determine if you qualify to enroll. The Court Ordered Benefits Branch will issue a letter notifying you of their findings. Since it may take a few months for this notification to be sent, you should contact your former spouse's Human Resources Office and request to enroll in TCC. The notification from the Court Ordered Benefits Branch will provide instructions on enrolling under the Spouse Equity provisions of the law.
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  • To continue your health benefits enrollment into retirement, you must: (1) have retired on an immediate annuity (that is, an annuity which begins to accrue no later than one month after the date of your final separation); and (2) have been continuously enrolled (or covered as a family member) in any FEHB Program plan (not necessarily the same plan) for the five years of service immediately preceding retirement, or if less than five years, for all service since your first opportunity to enroll.
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  • This means that the person (a designated beneficiary or person entitled under the order of precedence) advised OFEGLI, in writing, that he/she does not want the money he/she is entitled to receive. A disclaimer by default means that the person doesn't ever file a claim form to claim the benefits. If someone entitled to benefits disclaims them, he/she cannot tell OFEGLI who should get the disclaimed benefits. Rather, OFEGLI must treat those benefits as if the person disclaiming had died before the Insured. If the person disclaiming was a designated beneficiary, OFEGLI would pay the disclaimed share equally to the remaining beneficiaries. If there are no remaining beneficiaries or the person disclaiming was not a designated beneficiary, OFEGLI will pay the proceeds according to the next step in the order of precedence. Perhaps a few examples will help.
    Mary designated John and Susan for 50% each. Mary dies. John disclaims his share. It does not matter that John wanted his mother, Laura, to receive the benefits. OFEGLI will pay 100% to Susan.
    Here's another example.
    Raul is single, childless, and did not designate a beneficiary. Raul dies. His parents are entitled to the benefits based on the order of precedence. His father disclaims his share of the benefits. OFEGLI will pay 100% to his mother.
    And here's a final example.
    Cyndi is married with one child. She did not designate a beneficiary. Cyndi dies. Her husband is entitled to the benefits based on the order of precedence. He disclaims the benefits. OFEGLI moves to the next step in the order of precedence and pays 100% to Cyndi's child.
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  • During the fall of each year, you will receive a copy of the Medicare & You handbook. It is also available by calling 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048, or at www.medicare.gov/publications/pubs/pdf/10050.pdf . The Medicare & You handbook has information on Medicare Parts A & B; Medicare Advantage Plans (Part C); Medicare Prescription Drug Coverage (Part D); Help for People with Limited Income and Resources; and Joining and Switching Plans. The Medicare website (www.medicare.gov) contains the handbook and other information about Medicare. If you do not have a personal computer, your local library or senior center may be able to help you access this website. You should contact your retirement system before making any change to your coverage, especially if you are considering suspending your FEHB coverage to enroll in a Medicare Advantage Plan. If you are a CSRS or FERS annuitant, you may call OPM's Retirement Information Office at 1-88USOPMRET (1-888-767-6738) or 202-606-0500 from the metropolitan Washington area, or you may write to:
    Office of Personnel Management Retirement Operations Center P.O. Box 45 Boyers, PA 16017-0045
    Other useful publications, such as the Guide to Health Insurance for People with Medicare, are also available at the Medicare number (1-800-633-4227) or from your State Health Insurance Assistance Program (SHIP) counseling office. The SHIP counselors in your state are also available by telephone or sometimes as a walk-in resource if you would like more personalized attention. You can find SHIP counseling office telephone numbers in the Medicare & You handbook or on the Medicare website at www.medicare.gov/contacts/static/allStateContacts.asp. Your FEHB plan brochure provides specific information on how its benefits are coordinated with Medicare. Some HMOs participating in the FEHB are structured to provide more comprehensive coverage if you enroll in both their HMO and their Medicare Advantage plan.
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  • The Help Desk:
    • Tells you what transactions you can do (link to question #4) and how to do them using Employee Express;
    • Gives numbers for the Employee Express phone system;
    • Gives locations for touch screens (kiosks) and contacts for Human Resources Offices;
    • Gives the Employee Express email address;
    • Issues new PINs
    • Automatically sends a verification letter to you for health benefits changes you make in Employee Express. (For paperwork on other changes, contact your Human Resources Office.)
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  • The Judiciary Branch, U.S. Postal Service, and some smaller Executive Branch agencies with independent compensation-setting authority, have already implemented their own FEHB premium conversion plans; the employees of these entities will not participate in our premium conversion plan. At the present time, annuitants and compensationers whose FEHB premiums are deducted from annuities and benefits are not eligible to participate in premium conversion. There are special rules for reemployed annuitants; see below.
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  • No. You may be eligible to obtain insurance as a reemployed annuitant, but you will have to pay the same rates as any other employee for such insurance. Your agency will give you more information when you are reemployed.
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  • Yes. There are a few things an employee should consider. First, to be eligible to continue FEHB coverage after retirement, a retiring employee must be enrolled or covered under the FEHB Program for the five years of service immediately before retirement, or, if less than five years, for all service since the first opportunity to enroll. Employees can count their coverage under TRICARE toward meeting this requirement. However, the employee must be enrolled in an FEHB health plan on the date of retirement to continue coverage. Second, if the employee dies when the cancellation is in effect, any surviving spouse will not be eligible to continue FEHB health benefits coverage.
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  • No, USPS employees pay the same premiums as Federal employees and annuitants.
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  • Yes.
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  • The employing office has 14 days to notify you of your TCC rights and send you an election form. You must return the election form and a certified copy of your divorce decree within 60 days from your divorce date or 65 days after the date of the employing office notice, whichever is later. Your coverage will be effective the day after your 31-day extension of coverage as a family member ends.
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  • Each year OPM releases the new health insurance rates about a month prior to the FEHB Open Season. The FEHB Open Season runs from the second Monday in November through the Second Monday in December. The new rates are generally released by mid-October at http://www.opm.gov/insure/health/rates/index.asp.
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  • No, unlike FEHB, employees may not opt out of premium conversion for FEDVIP. If employees do not wish to have premium conversion for FEDVIP, they should not enroll.
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  • No. The law defines family members as a spouse and children under age 26. Public Law 104-199, Defense of Marriage Act, states, " the word 'marriage' means only a legal union between one man and one woman as husband and wife, and the word 'spouse' refers only to a person of the opposite sex who is a husband or a wife."
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  • No. The only way to continue coverage into retirement is to meet the five year/all opportunity rule. You cannot "buy" the years you are missing.
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  • Please report it here: https://apps.opm.gov/retire/death/death.cfm.  If you are unable to use the website, you can report it by contacting 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.
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  • Pay-As-You-Go Under the Pay-As-You-Go option, you pay your share of the FEHB premium directly to your employing agency while on LWOP. These payments will generally be made with after-tax monies, since there is no pay from which to make deductions.   Catch-Up Most employees who have a period of LWOP choose to pay their FEHB premiums via the Catch-up option. Under this option, the agency remits your share of the FEHB premium to OPM while you are on LWOP. You incur an obligation to your employing agency and are required to repay it upon your return to pay status. The repayment of the amount owed will be treated on a pre-tax basis, if it's deducted from pay and you participate in premium conversion at the time the deduction is made. If you choose to repay the amount owed to your agency directly out-of-pocket your taxable income is not reduced. Prepay Your agency may (but is not required to) offer you the option to prepay your FEHB premium from salary before you go on a period of LWOP. The amount of FEHB premiums you prepay in advance may either be deducted from your pay or paid directly "out-of-pocket" to your agency. Payments made "out-of-pocket" do not reduce taxable income. The amount of FEHB premiums that you prepay will be treated on a pre-tax basis, if it is deducted from your pay and you participate in premium conversion. IRS rules limit the amount you may prepay on a pre-tax basis. If your period of LWOP will span two tax years, the amount that you may prepay on a pre-tax basis may not exceed the amount of FEHB premiums due for the remainder of the current tax year. If you wish to prepay the amounts due for the subsequent tax year as well, the deductions must be made after-tax. You may use the "Pay-As-You-Go" or Catch-up options for amounts due in the subsequent tax year. Example Sam A. participates in premium conversion and had $100 per month in FEHB premiums deducted from his pay. He will go on LWOP for three months beginning on October 31, 2002 and opts to continue his FEHB coverage. Mr. A. uses the pre-pay option to pay from his salary the $300 in FEHB premium payments that will be due while he is on LWOP. Mr. A. will receive pre-tax treatment for only $200 of his FEHB premium prepayment- the amount he will owe for the months of November and December 2002. The remaining $100 prepaid – the amount due for January 2003 – must be given after-tax treatment.
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Total Count: 565, Number of Pages: 29, Page: 3