The Federal Employees Health Benefit (FEHB) Program provides comprehensive health care coverage for federal employees, annuitants, and their families. According to OPM there is a wide selction of plans to choose from including, "Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan." There is an open season each year for participants to review and choose other plans if desired and in 2016 for the first time there is a Self-Plus-One options to consider.
Generally the cost of coverage is expected to increase again this year. New rates including the self plus plus rates wil lbe announced shortly. If you do not make a change during open season, you may not be able to change health plans until 2017, during the next open season in 2016. Don’t let an increase cost in health insurance be an unfortunate surprise that adversely affects your finances. Luckily, it is easy to verify the cost of the FEHB insurance for 2015. OPM's Premium Rates for the Federal Employees will be published in November.
In addition, in an effort to be more “green,” paper copies of health plan brochures will not be automatically mailed to Federal Employees Health Benefits (FEHB) Program members this open season. This is the second year of this change.
The Federal Employees Health Benefits (FEHB) Program has important features, including a wide choice of health plans and competitive benefit packages as well as no health insurance pre existing conditions limitations or waiting periods.
2015 Open Season (November 9, 2015 through December 14, 2015)
You are now able to manage your FEHB account online. To register you will need your Annuity Claim Number and they will ask you to enter a unique user name and password to activate your account. You must register again for each new open season even though you registered for the previous year. I annotated the web site address, user name, and password in the "Federal Retirement Benefits" booklet that I received when I first retired for future reference. Go to https://retireefehb.opm.gov to register and view your options. This service allows you to change enrollment, view transaction history, change or add dependent information, and request health care plan brochures.
The Federal Employees Health Benefits (FEHB) Program helps you and your family meet your health care needs. Federal employees, retirees and their survivors enjoy the widest selection of health plans in the country. You can choose from among Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan.
When you retire your agency will automatically transfer your enrollment to OPM if you are eligible. To continue your health benefits enrollment into retirement, you must:
If you die while a compensationer, your family members can continue your enrollment if you were enrolled for Self and Family at the time of your death and at least one of your covered family members receives compensation as a surviving beneficiary under the Federal Employees' Compensation law.
Tricare requires participants to have Medicare A & B. If you have Trcare you can "suspend” your FEHB healthcare coverage and use Tricare for Life in conjunction with Medicare A & B.
How can annuitants or former spouses suspend FEHB coverage to use TRICARE
They can apply to suspend their coverage at any time. Annuitants can call OPM's Retirement Information Office at 1-888-767-6738 to obtain a suspension form. Callers within the local Washington, DC calling area must call 202-606-0500. Former spouses can get the form from the employing office or retirement system maintaining their enrollment. Eligible individuals must submit a completed suspension form and provide all necessary documentation to show eligibility for TRICARE or CHAMPVA during the period beginning 31 days before and ending 31 days after the date they designate as using TRICARE or CHAMPVA instead of FEHB coverage.
The new 2016 SElf Plus One rates were recently published for this new option. The rate reduction is little to nothing for some plans and a few charge more for hte Self Plus One Option!
The Bipartisan Budget Act of 2013 establishes a Self Plus One enrollment type in the Federal Employees Health Benefits (FEHB) Program. Coverage under a Self Plus One enrollment will be available beginning in January 2016. The first opportunity to enroll in Self Plus One will be during the annual Federal Benefits Open Season beginning in November 2015.
Self Plus One is a new enrollment type in the Federal Employees Health Benefits (FEHB) Program that allows you to cover yourself and one eligible family member you designate to be covered. Starting in 2016, all FEHB plans (your health insurance plans) will offer a Self Only, a Self Plus One, and a Self and Family enrollment type. Employees and annuitants will be able to select a Self Plus One enrollment beginning in the 2015 Open Season. Visit OPM's Self Plus One website page for additional information.
Same-sex spouses that are legally married are now eligible family members under a Family and Self enrollment. Coverage for legally married same-sex spouses of Federal employees or annuitants is now available, regardless of their state of residency.
Coverage does not extend to registered domestic partners or individuals in civil unions. Additionally, children of same-sex marriages will be treated in the same manner as those of opposite-sex marriages and will be eligible family members according to the same eligibility guidelines. This includes coverage for children of same-sex spouses as stepchildren.
The word “spouse” in any OPM documentation pertaining to the programs discussed in the Benefits Administration Letter refers to both same and opposite-sex spouses, the word “marriage” refers to both same and opposite-sex marriages, and the word “child” refers to children of both same and opposite-sex marriages.
For your surviving family members to continue your health benefits enrollment after your death, all of the following requirements must be met:
All of your survivors who meet the definition of "family member" can continue their health benefits coverage under your enrollment as long as any one of them is entitled to a survivor annuity. If the survivor annuitant is the only eligible family member, the retirement system will automatically change the enrollment to Self Only. Your surviving spouse should follow up with OPM to insure this action was taken. If it wasn't, your spouse will be paying considerably higher Family Option premiums.
Under FERS, your surviving spouse who is entitled to a basic employee death benefit, or your surviving children whose benefits are offset by Social Security, may continue your health benefits enrollment by paying premiums directly to OPM.
If the survivor annuity is not large enough to cover the enrollee share of the premiums for your plan, your survivors may either change to a lower-cost plan or option (one in which the enrollee share of the premium is low enough to be withheld from the annuity) or choose to pay the premiums directly to the retirement system. Even if your employing office thinks that the survivor annuity will not cover the enrollee share of the premiums, your retirement system will transfer in the enrollment. The retirement system will notify your survivors of their options and take whatever actions they request.
When your surviving spouse will not receive any survivor benefits because your former spouse has a court-ordered entitlement to a survivor annuity, your surviving spouse can continue FEHB coverage if you had a Self and Family enrollment. The retirement system will notify your surviving spouse of his/her options and take whatever actions are requested.
When the retiree's spouse is not a federal employee they will most likely need FEHB coverage in retirement. The rules are different for CSRS and FERS employees and this is a major consideration for federal employees who intend to retire and leave their spouse other than a full survivors annuity.
Under CSRS your spouse will be eligible for FEHB coverage as long as you provide them with a survivors annuity. It can be any amount. In my opinion it is best to provide a survivors annuity large enough to cover FEHB expenses however it isn't necessary. If you elect a survivors annuity of $3600, enough to cover many plan costs, your annuity will be reduced by 2.5%.
FERS retirees must elect either 50% or 25% survivors annuity for your spouse to be eligible for FEHB coverage in retirement after the annuitant's death. The 50% election will cost you 10% of your full annuity and the 25% survivor annuity election will cost you 5% of your full annuity in retirement.
CLARIFICATION: We receive a number of questions from site visitors about spousal FEHB coverage in retirement. A spouse of an annuitant can continue coverage under the annuitant's FEHB plan after retirement when an annuitant doesn't elect a survivor's benefit until the annuitant's death. After the annuitant's death, the spouse can no longer continue FEHB coverage since in this case the employee did not elect a spousal survivor benefit. Reference OPM's "Guide to Federal Benefits." A federal employee MUST elect a minimum survivor's benefit for the spouse to be eligible for FEHB covered after the annuitant's death.
If you cancel your FEHB enrollment as an annuitant, you won't be able to reenroll in the FEHB program. There are no exceptions for other employment insurance. However, there is an exception if you suspend your FEHB enrollment because you are now covered by a Medicare Advantage plan, TRICARE, CHAMPVA, Medicaid or similar State-sponsored medical assistance program, or Peace Corps Volunteer coverage, you can restart your FEHB in the future. Annuitants can call OPM's Retirement Information Office at 1-888-767-6738 to obtain a suspension form. Callers within the local Washington, DC calling area must call 202-606-0500.
A suspension form must be completed by eligible individuals and must provide all necessary documentation to show eligibility for TRICARE or CHAMPVA during the period beginning 31 days before and ending 31 days after the date they designate as using TRICARE or CHAMPVA instead of FEHB coverage.
To reinstate your suspended FEHBP, you will need to contact the Office of Personnel Management (OPM) by.
Additional information is available at OPM's Annuitants Reference Material under Opportunities for Annuitants to Enroll or Change Enrollment.
I changed from an HMO to the Basic Blue Cross plan before retiring. We knew we would be traveling and that Blue Cross was accepted in most, if not all major locations nationwide. The change also dramatically reduced our monthly premiums and our level of service actually improved. We were pleasantly surprised at the efficiency of their plan and the Basic Option 112 plan is fashioned after an HMO model from our perspective. We also considered their Standard plan but didn't feel comfortable with the deductibles and you really don't know what the charges to you would be until after a procedure was done. The benefit of the Standard plan is that you can use any service provider even if they aren't a preferred provider. The Basic plan required you to use preferred providers and if you do use a non-preferred provider you must pay the bill in most cases except for emergency care.
Dennis V. Damp, Retired FAA