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Federal Employees Health Benefits (FEHB) Program | Eligibility, Benefits & How to Enroll ?

Federal Employees Health Benefits (FEHB) Program


What is Employees Health Benefits Program (FEHB)?


Employees Health Benefits Program is the largest employer-sponsored group health insurance program in the world. This program is administered by the United States Office of Personnel Management (OPM). The program covers approximately 9 million people, including federal employees, retirees, former employees, annuities, employees and their family members, as well as some former employees and former spouses. The FEHB program can help you meet the health care needs of you and your family. Retirees, federal employees and their survivors enjoy the widest selection of health plans in the country.

The Federal Employees Health Benefits Program includes a variety of plans such as, health maintenance organizations, fee for service with a preferred provider organization, point of service, consumer operated health plans and high deductible health plans. How you get services or coverage and how to pay for them varies by plan. However, benefits available under all plans include surgical care, obstetric care, hospital care, inpatient and outpatient care, substance abuse care, mental health and prescription drug coverage. There are no pre-existing status limits or any waiting period under the FEHB, even if you change plans.

Under the Employees Health Benefits Program, you can choose from high deductible and consumer-driven qualified plans that offer catastrophic risk with high deductible, low premium, health savings qualified accounts or fee-for-service plans and their preferred provider organizations. provide security. FEHB plan brochures show what supplies or services are covered and the level of coverage. Brochures are formatted to ensure that they are all arranged evenly. You can obtain brochures from your human resources office or health plans.

Employee health benefits are provided to civilian government employees and United States government annuities through the Federal Employees Health Benefits Program. The government contributes 72% of the weighted average premium of all the schemes, not exceeding 75% of the premium of any one scheme. The FEHB program allows certain employee unions, labor unions and insurance companies to market health insurance plans to government employees.

Federal Employees Health Benefits Program Key Facts


  • Coverage continues every year until you make any changes.
  • There is no waiting period and no pre-existing status limits.
  • All FEHB plans offer international coverage.
  • The government pays about 70% of the premium cost.
  • You are saving money on premiums because they are pre-tax (premium conversion).
  • You are automatically covered under premium conversion unless you choose to waive it.
  • The Open Season is an annual event, which allows for changes in the FEHB.

How Does The Federal Employees Health Benefits Program Work ?


FEHB New Employees


Most permanent federal workers are eligible to choose health insurance. Participating in FEHB is voluntary and you must elect to be covered. The following resources will help you in choosing a health insurance plan :
When you enroll in a health insurance plan, enrollment automatically continues each year for as long as you remain eligible for the program. If you want to make changes to your health insurance, you can do so during the benefits open season.

When you enroll in health insurance, premiums are withheld from your pay on a pre-tax basis, reducing your income tax and taxable income, this is called federal employee health benefit premium conversion (FEHB-PC). If you want health insurance premiums to be withheld on an after-tax basis, you must sign a PC-waiver form electing not to participate in the FEHB-PC when you enroll in health insurance.

Initial Election Period


You have 60 days from the date of your appointment to make an election to the convalescence program. The completed Health Benefits Election Form, SF-2809, should be submitted to your servicing human resources office. If you fail to make a choice within the time limit, you are considered to have declined coverage.

Effective Date of Coverage


Your election will take effect on the first day of the first pay period that begins after your employer's office receives your enrollment request and you are in a pay position. This means your health insurance can take effect as soon as the pay period begins after the pay period in which you were hired.

Federal Employees Health Benefits Program Eligibility


Federal Employees


You are eligible to elect FEHB coverage as a federal employee unless your situation is excluded by law or regulation. However, there are many special provisions for people in temporary appointments, part-time or intermittent employment and specially designated positions. This chapter of the FEHB Handbook explains these provisions. The Federal Employee Health Benefits Handbook provides more detailed guidance on coverage requirements.

Cooperative Employees


You are eligible for FEHB coverage if you :
  • Appointed by a federal agency for service in association with a non-federal agency.
  • Payment is made in whole or in part from non-federal funds (such as certain employees of the Agricultural Extension Service).
  • Your condition has not been excluded from coverage.
  • Withholdings and contributions must be made from federally-controlled funds for your coverage.
  • Payment should be made on time.
  • The affiliate non-federal agency must agree in writing with your agency.
  • Required withholdings and contributions from non-federal funds must be remitted in a timely manner.
  • The withholding and contribution arrangement should be approved by the OPM.

FEHB Eligible Family Members (FEHB for Dependents)


Family members eligible for coverage under you and family nomination are your spouse and children under the age of 26. Children include an adopted child, a child born within the marriage, a stepchild and a foster child who lives with you in a recognized natural child or in a regular parent-child relationship. A child of 26 years of age or more who is incapable of self-support by reason of a physical or mental disability existing before the age of 26 is also an eligible member of the family.

You cannot include a former spouse as a family member under your health insurance enrollment after a divorce. A former spouse may temporarily elect FEHB coverage for continuation of coverage and under the provisions of the Spouse Equity Act.

You may need an administrative or court order to provide health benefits to your children. If you do not have the appropriate coverage but you are eligible for FEHB, Headquarters Employment Operations Division Team D will notify you that it has received a court order requiring you to provide health benefits for your children.

To include a foster child as a family member, you must prove that :
  • The child is under 26 years old.
  • The child lives with you.
  • The parent-child relationship is with you, not just the child's biological parent.
  • You hope to raise the child to adulthood.
  • You are the primary source of financial support for the child.
In order to continue coverage for a child over the age of 26, you will need to provide documentation that the child is unable to perform a self-supporting job because of a mental or physical disability that existed before the age of 26 and at least Expected to continue for 1 year. Additional information about eligibility, plans, enrollment, costs and plan comparisons can be found under Health Care at https://www.opm.gov/insure.

What Types of Enrollment Are Available ?


The FEHB program offers two types of enrollment :

1) Self Only :
Self nomination only involves you as a nominee. If you have only self-enrollment and you want to cover a new family member, you need to convert to self-and-family nomination.

2) Self and Family :
A self and family nomination covers you and all eligible members of your family. Cannot exclude any eligible family member from coverage. You cannot provide coverage for someone who is not an eligible family member.

A new family member is automatically added under your self and family nomination. You do not need to report the addition of a new family member to the Human Resources office. Your plan is not entitled to a fresh enrollment form as a verification of the eligibility of the family member.

What Does The FEHB Program Offer ? 


The Federal Employees Health Benefits Program provides the following benefits :
  • Group-rated premiums and benefits.
  • A government contribution towards the cost of the plan.
  • Your choice of options and plans.
  • Annual enrollment opportunities.
  • Guaranteed coverage.
  • Salary deduction for premium.
  • No medical exams, waiting periods or restrictions due to age or physical condition.
  • Devastating protection against unusually large medical bills.
  • Continuing group coverage in retirement or while you are receiving workers' compensation.
  • Temporarily continuing FEHB coverage or changing an individual contract after your enrollment or family member's coverage ends.
  • Continuing group coverage for your family after you die.

Checkbook’s Online Guide to FEHB


The online guide is an innovative way to get reliable information about the many health plans available under the FEHB and make easy, fast, personalized plan comparisons. The guide compares plans based on total costs, which include estimated out-of-pocket costs and account premiums. You will be able to compare plan costs, consider plan features, review quality ratings, assess flexibility in the choice of doctors, and other factors. All federal DOE Headquarters employees are eligible to use this online guide.

Click for additional information or support :

Can I Enroll In FEHB ?


You can enroll in the Federal Employees Health Benefits Program if you :
  • A permanent federal employee with regularly scheduled visits.
  • A temporary employee with an appointment for more than one year.
  • A temporary employee whose employment is limited to one year or less, and you have completed one year of current continuous employment.
If you are an intermittent worker or if your situation is excluded from coverage by law or regulation, you are not eligible to enroll.

How to Enroll in Federal Employees Health Benefits Program ?


During the FEHB Open season, eligible individuals may enroll to participate in the FEHB program. Outside of the open season, new employees can enroll within 60 days of being eligible for the program. Members who go out of the purview of the scheme can enroll in a different plan covering their new location. There are other circumstances that may make you eligible to enroll or change your FEHB coverage outside of the open season.

Agencies enroll electronically using one of the online tools listed below: 

If the agency uses paper forms, you will need SF 2809 :
  • Print and fill out the form then provide a copy to your Human Resources office.
  • Download SF 2809 Form
  • Premium Conversion Waiver Form
  • Certification of Foster Children Form

If you are an annuity, and wish to enroll in a SelectHealth plan. So see below :

During the annual FEHB Open Season :

Outside of Open Season :
  • Call the Office of Personnel Management (OPM) Retirement Information Center at 1-888-767-6738 (or 1-800-878-5707 for TDD for the hearing impaired) to enroll by phone. Annuitants in the Washington DC local calling area should dial 202-606-0551 for TDD for the Hearing Impaired.
  • Send an email to OPM at retire@opm.gov

If receiving an annuity from another retirement system, you can obtain FEHB information by contacting :

Retirement System

Phone Number

Email Address

U.S. Lighthouse Service Retirement System

202-267-2942

cphillips@opm.gov

District Government Retirement System

202-727-5851

N/A

(Federal Reserve) Board Benefit Structure

202-452-3158

Kathy.Cimral@opm.gov

Foreign Service Retirement and Disability System

202-647-9320

N/A

Judicial Survivor's Annuity System
Judicial Retirement System

202-502-1880

carol_sefren@opm.gov

Financial Institutions Retirement System (FIRS)

202-906-7303

Valerie.waller@opm.gov


Do I Pay for Federal Employees Health Benefits Coverage ?


You share the cost of health benefits coverage with the government. Full-time employees pay only 25% of the total premium. Government contributions and premiums change every year. You can get the maximum current premium of each plan. The most recent guide to FEHB plans is available at your Human Resources office and at www.opm.gov/insure.

If you are a part-time employee, your premium share will be higher than that of a full-time employee. If you are a former spouse, a temporary employee or a nominee under temporary continuance, the government does not contribute to the cost of your enrollment. You will have to pay both government and employee shares of the cost.

Federal Employees Health Benefits Plans


You can find the names, website links and contact number of FEHB plans that serve the affected area :

State

Plan Name

Phone (FEHB Contact Number)

CT

Aetna HealthFund (external link)

877-459-6604

NJ

Aetna HealthFund (external link)

877-459-6604

NJ

Aetna Open Access (external link)

877-459-6604

NJ

GHI Health Plan (external link)

212-501-4444

NY

Aetna HealthFund (external link)

877-459-6604

NY

Aetna Open Access (external link)

877-459-6604

NY

Blue Choice (external link)

800-462-0108

NY

CDPHP Universal Benefits, Inc. (external link)

877-269-2134

NY

GHI Health Plan (external link)

212-501-4444

NY

GHI HMO Select (external link)

877-244-4466

NY

HIP of Greater New York (external link)

800-HIP-TALK

NY

Independent Health Assoc (external link)

800-501-3439

NY

MVP Health Care (external link)

888-687-6277

RI

Aetna HealthFund (external link)

877-459-6604

Nationwide

APWU Health Plan (external link)

800-222-2798

Nationwide

Blue Cross and Blue Shield Service Benefit Plan (external link)

 

Nationwide

Compass Rose Health Plan (external link)

800-769-6953

Nationwide

Foreign Service Benefit Plan (external link)

202-833-4910

Nationwide

GEHA Benefit Plan (external link)

800-821-6136

Nationwide

GEHA High Deductible Health Plan (external link)

800-821-6136

Nationwide

MHBP - Consumer Option (external link)

800-694-9901

Nationwide

MHBP - Std (external link)

800-410-7778

Nationwide

MHBP - Value Plan (external link)

800-410-7778

Nationwide

NALC (external link)

888-636-6252

Nationwide

Panama Canal Area Benefit Plan (external link)

800-424-8196

Nationwide

Rural Carrier Benefit Plan (external link)

800-638-8432

Nationwide

SAMBA (external link)

800-638-6589

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