Implemented on July 1, 1960, the Federal Employees Health Benefits (FEHB) Program is the largest employer-sponsored group health insurance program in the world. Managed by the Office of Personnel Management (OPM), the program is governed under 5 Code of Federal Regulations (5 CFR), Part 890, offering eligible employees a choice of plans and options.
The program is voluntary and coverage becomes effective with no medical examination or restrictions because of age or physical condition. The program also offers guaranteed protection that cannot be canceled by the insurance carrier. Each health plan carrier under the FEHB program contracts with the OPM to provide certain health benefits. Contract negotiations are a bilateral process, between OPM and the carrier and the contract period is usually for one year. Each plan carrier charges a different premium. For most employees, the Government contributes up to 75% toward the cost of the premiums while employees pay the remaining balance through payroll deductions.
The program also offers a temporary 31-day extension of coverage after separation from employment, during which you may convert to a non-group policy.
The two basic types of health benefit plans available are Managed Fee-for-Service Plans and Health Maintenance Organizations (HMOs).
Fee-for-Service Plans - Under a fee-for-service plan, employees or health care providers are reimbursed for covered services, and employees are able to choose their own physician, hospital, and other health care providers. Fee-for-Service plans include the Government-wide Service Benefit Plan, administered by the Blue Cross and Blue Shield Association on behalf of Blue Cross and Blue Shield Plans, and are open to any employee eligible to enroll under the program.
Plans sponsored by unions and employee organizations are open to all Federal employees who hold full or associate memberships in the organizations that sponsor the plans; others are restricted to employees in certain occupational groups and/or agencies. Generally the organization requires a membership fee or dues paid directly to the employee organization, in addition to the premium. This fee is set by the employee organization and is not negotiated with OPM.
Health Maintenance Organizations (HMO) - Prepaid health plans that provide a comprehensive array of medical services provided through contracted physicians, hospitals, and other providers. Each HMO sets a geographic area for which health care services will be available. You must live or work within the HMO's defined service area to be eligible to enroll.
Some managed fee for service plans and HMOs offer a Point-of-Service Product where members have the option of using a selected network of providers; thereby minimizing out-of pocket expenses, or using non-network providers at an additional cost.
The program also offers High Deductible Health Plans (HDHP) and Health Savings Accounts (HSA) Options. Learn more about the FEHB program, HDHPs, and HSAs by visiting the OPM web site at http://www.opm.gov/insure/new_employ/index.asp.
Eligibility: As a Federal employee, you are entitled to enroll yourself and any eligible family members in a health plan offered under the FEHB Program, unless your position is excluded from coverage by law or regulation. Some of the more common exclusions include but are not limited to:
As a new or rehired employee, you have 60 days from the effective date of your appointment, rehire, or reinstatement in which to complete an election either to enroll in a plan or not to enroll. If you don't make an election, you are considered to have declined coverage.
If you are transferring, you are not normally eligible to change your benefits elections. However, if you moved from a post of duty overseas to one in the United States, or reverse, or if your transfer moved you out of the servicing area of your HMO, you may elect a new health plan within 60 days of your transfer effective date.
Temporary employees are eligible to enroll only after completing one year of employment and beginning a second consecutive appointment; however, you do not receive any government contribution toward your premiums.
Enrollment: To enroll or change your enrollment, you must complete Standard Form (SF) 2809, Employee Health Benefits Election Form. To make an FEHB change or enrollment, access the Employee Benefits Information System (EBIS). If you need further assistance with making your election through EBIS, please contact your local Human Resources Representative, visit The Army Benefits Center-Civilian (ABC-C) Centralized Benefits Center website or call the ABC-C directly at 1-877-276-9287, Option #4.
Elections that are made through EBIS are transmitted electronically to payroll alleviating the need for you to complete an enrollment form. Elections made through EBIS provide you an immediate receipt by allowing you to print a copy of the completed election form for your records. This form can be used as proof of enrollment until you receive identification cards from the health carrier. EBIS is easy, fast, accurate, and cost-effective.
There are two types of enrollment: (1) Self Only, provides benefits only to you and (2) Self and Family, provides benefits for you and your eligible family members. Under the FEHB law, "eligible family members" include:
A "regular parent-child relationship" means that you are exercising parental authority, responsibility, and control over the child by caring for, supporting, disciplining, and guiding the child, including making decisions about the child's education and health care.
If you enroll in health benefits, you are automatically covered by Premium Conversion unless you waive participation. Premium Conversion is a tax benefit that reduces your taxable income by allowing you to pay for health insurance on a pre-tax basis. Instead of deducting your insurance premiums from your salary, that portion of your salary will be used to purchase the benefit thereby reducing your taxable income by the amount of health insurance premiums. This enables you to save on Federal income tax, Social Security and Medicare taxes and, if applicable, State and Local income taxes.
The opportunity to waive participation in premium conversion is limited. You may only waive premium conversion during the annual open season, or during the 60 day window to enroll in health benefits if you are a new hire or rehired employee, or you may waive premium conversion in conjunction with a change in FEHB enrollment on account of and consistent with a qualifying life event. To waive Premium Conversion you must complete a waiver form. You may obtain a copy of the form from your local Human Resources Representative or you may download the form at http://www.opm.gov/asd/pdf/2000/00-215_attach3.pdf.
If you do not enroll during your first opportunity, you will not be eligible to enroll until open season, which are normally held in the November/December timeframe or until you have a qualifying life event. Examples of life events are marriage, birth of a child, divorce, death, loss of coverage under another policy, etc. If you experience a qualifying life event, you have 60 days from the date of the event to conduct a non-open season enrollment. There are many qualifying life events and you may obtain further information regarding them from your local Human Resources Representative, Site Manager or the DoDEA Headquarters Benefits Unit.
Effective Date: As a new or rehired employee, the earliest your health insurance can become effective is the beginning of the first day of the pay period that begins after your election is received and that follows a pay period during any part of which you were in a pay status.
If you are given a decision of non-eligibility to enroll or change your enrollment, you have the right to request reconsideration. When enrollment or changes to enrollment is denied, you will receive in writing the reason for denial along with instructions on how to request reconsideration.
If you wait until open season, coverage will begin the first full pay period the following January.
The deductions for the FEHB plan appear on your Statement of Earnings and Leave starting with the pay period in which the enrollment becomes effective. If a deduction or the correct deduction does not appear on your statement within 14 days after the effective date of the enrollment, please notify your local Human Resources Representative, Site Manager or DoDEA Headquarters Benefits Unit immediately. You are obligated to make the correct payment, regardless of any error in withholding made by the employing agency.
Cancellation or Changes: You may cancel your FEHB enrollment outside of the annual open season ONLY if you elected to waive participation in Premium Conversion. If you waived participation in Premium Conversion, you may cancel your health insurance coverage at any time. However, if you cancel your enrollment, you or your family members are NOT entitled to the 31-day extension of coverage for conversion to a non-group policy.
Employees who elect to participate in Premium Conversion may only make changes during the FEHB open season or upon a qualifying life event, IF the reason for the change is -on account of and consistent with- the qualifying life event.
Summary: The Federal Employee Health Benefits Program helps protect you and your family members from the expenses of illness and accident. There are many other features to the program; for example your options when entering leave without pay; Temporary Continuation of Coverage (TCC) for dependents, continued enrollment for eligible family members if you die as an employee, continuing enrollment into retirement, etc.
You are encouraged to study informational material so that you may make an informed decision regarding health care for you and your family members. You may obtain detailed information about the program from your local Human Resources Representative or you may download a variety of pamphlets, brochures and the FEHB Handbook for Enrollees and Employing Offices directly from OPM's web-site at http://www.opm.gov/insure/health.
Each health carrier has an individual plan brochure. You should review the brochure for each plan you are considering; especially checking to see if the plan offers the services you think you might need.
When choosing a plan, remember there are other things you should consider besides the cost of premiums. Out of pocket expenses, limitations on coverage, how the plan works, procedures to see a specialist and whether you must choose a doctor only from with the plan's provider network, are among the questions you need to consider when selecting a plan that best fits the needs of you and your family members.