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    FEHB Handbook

    Welcome to opm.gov

    Healthcare & Insurance

    OPM.gov Main Insurance Healthcare Reference Materials FEHB Handbook HEALTHCARE

    Source : www.opm.gov

    Federal Employee Health Benefits (FEHB)

    Federal Employee Health Benefits (FEHB)

    Office of the Chief Human Capital Officer

    The Federal Employees Health Benefits (FEHB) program is the largest employer-sponsored health insurance program in the world, covering more than 8 million Federal employees, retirees, former employees, family members, and former spouses.

    FEHB includes different types of plans: fee-for-service with a preferred provider organization; health maintenance organizations; point-of-service; high deductible health plans; and consumer-driven health plans. How you obtain coverage or services and pay for them differs depending on the plan. However, benefits available under all plans include hospital care, surgical care, inpatient and outpatient care, obstetrical care, mental health and substance abuse care, and prescription drug coverage. There are no waiting periods or pre-existing condition limitations under FEHB, even if you change plans.

    FEHB New Employees:

    Most permanent Federal employees are eligible to elect health insurance. Participation in FEHB is voluntary and you must make an election to be covered.

    If you are a part-time career employee, the Government contribution toward your health benefits is prorated in proportion to the percentage of full-time service you are regularly scheduled to perform.

    If you are on a temporary not-to-exceed appointment, you are eligible to enroll in FEHB after you have completed 1 year of continuous employment. If you elect to enroll, you must pay both the employee and the Government shares of the premium.

    The following resources will help you elect a health insurance plan:

    Health Plan Information Guide

    Description of plans available in FEHB

    Individual plan brochures and premiums

    Plan comparison tool

    Once you enroll in a health insurance plan, your enrollment automatically continues each year, as long as you remain eligible for the program. You do not have to reenroll each year. However, if you would like to make a change in your health insurance, you may do so during the Benefits Open Season or in conjunction with a qualifying life event.

    If you enroll in health insurance, premiums are automatically withheld from your salary on a pre-tax basis, which reduces your taxable income and income taxes. This is called Federal Employees Health Benefits Premium Conversion (FEHB-PC). If you participate in FEHB-PC:

    You do not have the flexibility to cancel your health insurance coverage or change to a self-only enrollment from a family enrollment any time. You will be able to make these changes only during the Benefits Open Season or in conjunction with a qualifying life event.

    Your earnings reported to the Social Security Administration will be less since you will pay health insurance premiums with pre-tax money. This may result in a somewhat lower Social Security benefit when you retire.

    You are not able to deduct health insurance premiums as an itemized medical deduction on your income tax return.

    If you want health insurance premiums withheld on an after-tax basis, at the time you enroll in health insurance you must sign a PC-waiver form electing not to participate in FEHB-PC. After the initial opportunity to waive FEHB-PC as a new employee, you will be able to change whether you participate in FEHB-PC only during the Benefits Open Season or in conjunction with a qualifying life event.

    Initial Election Period

    As a new employee, you have 60 days from your date of appointment to make an election for the health benefits program. Your completed Health Benefits Election Form, SF-2809, must be submitted to your servicing Human Resources Office in a timely manner. If you fail to make an election within the required timeframe, you are considered to have declined coverage. You will not have another opportunity to enroll until the annual open season (conducted in late Fall) or unless you experience a qualifying life event that would allow you to enroll. Please note that the SF-2809 should be completed and submitted even if you are declining coverage.

    Effective Date of Coverage

    Your election will become effective on the first day of the first pay period that begins after your employing office receives your enrollment request and you are in a pay status. This means that the earliest your health insurance can become effective is the beginning of the pay period that begins after the pay period in which you were hired.

    FEHB Eligible Family Members:

    Family members eligible for coverage under yourself and family enrollment are your spouse (including a valid common law marriage) and children younger than age 26. Children include a child born within marriage, an adopted child, a stepchild, a foster child who lives with you in a regular parent-child relationship, or a recognized natural child. A child age 26 or older who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member.

    You cannot include a former spouse as a family member under your health insurance enrollment once you are divorced, even if the divorce decree specifies that you provide health insurance coverage for your former spouse. A former spouse can elect FEHB coverage under the provisions of Temporary Continuation of Coverage and/or the Spouse Equity Act.

    You may be required by a court or administrative order to provide health benefits to your children. If you are subject to such an order, you must be enrolled in a self and family plan that provides full benefits to your children in the area where they live, or provide documentation that you have other health coverage for the children. If you are eligible for FEHB but do not have the appropriate coverage, the HQ Employment Operations Division Team D will notify you that it has received a court order requiring you to provide health benefits for your children.

    Source : www.energy.gov


    Study with Quizlet and memorize flashcards terms like The largest employer-sponsored health program in the United States is, In employer-sponsored health plans, employees may choose their plan during the, Which laws govern the portability of health insurance? and more.

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    Terms in this set (10)

    The largest employer-sponsored health program in the United States is

    Federal Employees Health Benefits program

    In employer-sponsored health plans, employees may choose their plan during the

    open enrollment period

    Which laws govern the portability of health insurance?

    PPO and HMO

    Self-funded health plans are regulated by


    BlueCross BlueShield Association member plans offer

    all major types of health plans

    Emergency surgery usually requires

    precertification (preauthorization) within a specified time after the procedure

    Providers who participate in a PPO are paid

    a discounted fee-for-service

    Under a capitated HMO plan, the physician practice receives

    a monthly enrollment list

    What document is researched to uncover rules for private payers' definitions of insurance-related terms?

    participation contract

    Consumer-driven health plans have what effect on a practice's cash flow?

    A high-deductible payment from the patient takes longer to collect than does a copayment.

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