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Insurance FAQs Health

Service Standards

  • I'm enrolled in a fee-for-service plan. How can I get the most value for my benefit dollar? View more
    Most FEHB fee-for-service plans offer Preferred Provider Organization (PPO) arrangements. When selecting your health care practitioner, your use of PPO providers whenever possible will help reduce your out-of-pocket expenses. In addition, PPO providers will generally file your claims for you. Read your plan's FEHB brochure carefully to find out about other incentives. Contact your plan to obtain the names of PPO providers in your area. You should also visit your plan's website (identified on the front of the plan's brochure and available by link from this website). Many plans provide up-to-date lists of PPO providers on their website.
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  • My child will turn age 26 this year but she is disabled and incapable of self support. Can I continue to cover her under my FEHB enrollment? View more
    Your child age 26 or over who is incapable of self-support because of a disability that existed before age 26 may be eligible for coverage under your FEHB enrollment. For more information, please see the FEHB Handbook for Enrollees and Employing Offices.
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  • What are your customer service standards? View more
    Because the U.S. Office of Personnel Management (OPM) administers the Federal Employees Health Benefits (FEHB) program, the largest employer-sponsored health insurance program in the world, we believe we have a commitment to you. Following are the standards we follow:
    • Your choice of health benefits plans will compare favorably for value and selection with the private sector.  
    • When you use the Guide to Federal Benefits and plan benefit brochures, you will find they are clear, factual and give you the information you need.  
    • When you change plans or options, your new plan will issue your identification card within 15 calendar days after it gets your enrollment form from your agency or retirement system.  
    • Your fee-for-service plan should pay your claims within 20 work days; if more information is needed, it should pay within 60 calendar days.  
    • If you ask us to review a claim dispute with your plan, our decision will be fair and easy to understand, and we'll send it to you within 60 calendar days. If you need to do more before we can review a claim dispute, we will tell you within 14 work days what you still need to do.  
    • When you write to us about other matters, we will respond within 30 calendar days after we get your letter. If we need time to give you a complete response, we will let you know.
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  • When I leave the FEHB Program, I understand I will receive a certification of my group coverage that I can use to get new coverage with my private industry employer. Will my agency or my plan certify my insurance coverage? View more
    We require FEHB carriers to issue certifications of prior coverage to enrollees. They issue certifications automatically whenever coverage terminates, whether it is termination of regular coverage, TCC coverage, or Spouse Equity coverage. If the plan does not certify your coverage, you should write to them and ask them to send you certification of coverage.
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