NYS DMNA

FEHB/Benefits

FEHB OVERVIEW

As a new/newly eligible Federal employee, you may be able to enroll in health insurance, dental insurance, vision insurance, flexible spending accounts, life insurance, and/or apply for long term care insurance. Here’s some basic information about each program. You can find more comprehensive information at www.opm.gov/insure, in the Guide to Federal Benefits at www.opm.gov/insure/08/guides or by contacting your agency’s human resources office.

**1 JAN 2016 -  New Enrollment Option will be available for Self +1** -  The annual Open Season beginning on November 9, 2015 will include the Self Plus One enrollment type in the available enrollment choices. This enrollment type will cover the enrollee and one eligible family member.

                                                                  
Federal Employees Health Benefits (FEHB) Program
www.opm.gov/insure/health
FEHB provides comprehensive health insurance. You can choose from fee-for-service plans, health maintenance organizations, consumer-driven plans and high deductible health plans. Generally, premiums for your enrollment are shared by you and your Federal agency.

2015 RATE CHARTS

                                              
Federal Employees Dental and Vision Insurance Program (FEDVIP)
www.opm.gov/insure/DentalVision
FEDVIP provides comprehensive dental insurance and vision insurance. You can choose from seven dental plans and three vision plans. FEDVIP features nationwide, regional, and international plans. You pay the entire premium.                                                                                                    
Federal Flexible Spending Account Program (known as FSAFEDS)
www.fsafeds.com
FSAFEDS allows you to set aside money from your paycheck, before taxes are deducted. You incur eligible health care and/or child care/elder care expenses and then receive reimbursement from that pre-tax money. Enrolling in FSAFEDS will lower the amount of income tax you pay because the amount you allot to your FSAFEDS account(s) is not taxed. You can end up saving anywhere from 20% to 40% on eligible products and services.      
Federal Employees’ Group Life Insurance Program (FEGLI)
www.opm.gov/insure/life
FEGLI provides group term life insurance. If you are in a FEGLI-eligible position, you are automatically covered under Basic life insurance, unless you choose to waive that coverage. Generally, premiums for Basic insurance are shared by you and your Federal agency. You can also elect Optional insurance for you, and/or your eligible family members, and pay the entire premium for that coverage.                                                                          
Federal Long Term Care Insurance Program (FLTCIP)
www.ltcfeds.com
FLTCIP offers insurance that helps cover the costs of certain long term care services. Long term care is the assistance you receive to perform activities of daily living or supervision you receive because of a severe cognitive impairment. Your premium is based on your age on the date you apply as well as the benefit options you select. The FLTCIP is medically underwritten. Certain medical conditions, or combinations of conditions, will prevent some people from qualifying for coverage. .                                                                                                          
If I’m eligible, how long do I have to enroll in or apply for the Program?
You have 60 days from date of becoming eligible to enroll in any or all of these three programs. Once you enroll, you may not change your enrollment (e.g. cancel, change plans, etc,) until the next annual open season or until you experience a qualifying life event.
You are automatically enrolled in Basic insurance and can waive it anytime. You have 31 days from date of becoming eligible to enroll in Optional insurance. You can apply at any time if you provide satisfactory medical information on an SF 2822.
You have 60 days from date of becoming eligible to apply with Abbreviated Underwriting. You can apply anytime with Full Underwriting.
How do I enroll as a new or newly eligible employee?
Complete and submit a standard form (SF) 2809; some agencies may have electronic enrollment.
Enroll at BENEFEDS.com or by calling
1-877-888-3337.
Enroll at www.FSAFEDS.com or by calling
1-877-372-3337.
Complete and submit an
SF 2817; some agencies may have electronic enrollment.
Complete and submit an application at www.LTCFEDS.com or by calling 1-800-582-3337.
When does my coverage as a new or newly eligible employee become effective?
The first day of the first pay period that begins after your enrollment request is received and that follows a pay period during any part of which you are in pay status.
The first day of the first pay period that begins after your enrollment request is received.
The next day after you enroll.
Basic: The day you enter on duty in pay status.
Optional: The first day you enter on duty in pay status on or after the day your agency receives your election.
If your application is approved, the first day of the month after approval. Certain medical conditions or combinations of conditions will prevent some people from being approved.
Which of my family members are eligible?
-Spouse, including a valid common law marriage (marriage means only a legal union between one man and one woman as husband and wife).
-Unmarried dependent child under age 22, including adopted child, recognized natural child, stepchild/foster child (if living with employee/annuitant in regular parent-child relationship); and
-Child age 22 or over incapable of self-support, if disabling condition happened before age 22.
Your spouse, adult children, parents, parents-in-law, and stepparents may apply (whether or not you apply).
When can I make changes to my coverage?
During the annual open season (mid-November through mid-December) or if you experience a program-specific qualifying life event (QLEs differ for each program).
Provide satisfactory medical information on an SF 2822 or experience a FEGLI-specific QLE.
At any time, but changes to coverage may require additional underwriting.
Can I Continue Coverage if I Leave Federal Service
-31-day free extension of coverage;

FORM

http://www.opm.gov/forms/pdf_fill/sf2809.pdf


FEHB & The AFFORDABLE CARE ACT (ACA)

AFFORDABLE CARE ACT - To assist federal employees with the Affordable Care Act, please read the FEHB FAST FACTS and the FEHB LETTER to better understand your benefits. For additional information, please visit the OPM insurance web site.

OPM's Benefit Administration Letter concerning the Affordable Care Act and FEHB

OPM's Benefit Administration Letter explaining how ACA affects FEHB


FAQ’S

I am going to retire soon. What are the requirements to continue health benefits into retirement?

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.

What changes can I make outside of Open Season?

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.

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

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.

I have just returned from active military duty. My FEHB enrollment terminated during my military service. Can I get my FEHB back?

Yes. FEHB regulations provide that an employee’s FEHB is automatically reinstated upon return to employment following active duty. An annuitant’s FEHB is automatically reinstated on the day of separation from the uniformed services.

I am going into a Leave Without Pay (LWOP) status, if I terminate my FEHB will it be considered a break in coverage?

If you elect to terminate your enrollment (or the enrollment automatically terminates), the termination will take effect at the end of the last pay period in which premiums were withheld from pay. FEHB coverage will continue at no cost to you for an additional 31 days. During the 31 days, you and your covered family members may convert to an individual contract with your insurance carrier. The termination is not considered a break in the continuous coverage necessary for continuing FEHB coverage into retirement. However, the period during which the termination is in effect does not count toward satisfying the required 5 years of continuous coverage. When you return to pay status, or at the end of the first pay period your pay becomes sufficient to cover your premium, you must re-enroll within 60 days if you want FEHB coverage.

What do I need to do if I go LWOP and want to continue my FEHB enrollment?

If you elect to continue your coverage, you must elect to pay the premiums directly or to incur a debt in the amount of the unpaid premiums. If you elect to pay directly, mail a check or money order payable to DFAS-Cleveland. Include on the check your name, social security number, a note that the payment is for "FEHB premium", and the pay period for which the payment is being made. Mail to: DFAS-Cleveland, ATTN: DFAS-GAG/CL, P.O. Box 99559, Cleveland OH 44199.

 If you elect to incur a debt, or if you elect to pay directly but fail to pay the entire amount due, you will receive a notice stating the total amount due. The notice will be sent when you return to pay status, your pay becomes sufficient, or you separate from employment. By electing to continue coverage you agree to repay the resulting debt in full and to allow the debt to be collected by withholdings from any salary payments to you from the Federal Government. If the amount due cannot be withheld in full from salary, it will be recovered from a lump sum payment of accrued leave, income tax refunds, amounts payable under the Civil Service Retirement System or Federal Employees Retirement System, or any other source normally available for the recovery of a debt due the United States.

 

 

© NYS DMNA: Technician Resources - FEHB/Benefits
URL: http://dmna.ny.gov/hro/tech/?page=1276787987
Page Last Modified: 28 Jan 15
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