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Articles | FEHB Open Season: Important Frequently Asked Questions for Federal Retirees (and Those Soon-to-Reti . . .
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FEHB Open Season:
Important Frequently Asked Questions for Federal Retirees (and Those Soon-to-Retire)
In early November (prior to the Open Season), your
current Federal Employee Health Benefits (FEHB) plan provider will send you
a brochure, and your retirement office will send you instructions for ordering
brochures and making FEHB Open Season changes.
It is very important that you keep your address up to date to ensure that you
receive your Open Season materials each year. If you move, be sure to let
your retirement office know your new address. Any address request sent to the
Office of Personnel Management (OPM) must have your CSA or CSF claim number so
that OPM can identify you.
If you decide not to change your enrollment, do not respond
to the Open Season material. Your coverage under your current health plan
continues automatically.
Cancellation
You may voluntarily cancel your enrollment at any time. If you cancel, you
will not be entitled to a 31-day extension of coverage for conversion to a
non-group (private) policy and neither you nor your family members will be
entitled to a temporary continuation of coverage (TCC). Once your cancellation
takes effect, you will not be able to enroll again as a retiree unless you have
been continuously covered as a family member under another enrollment in the
FEHB since the date of your cancellation, and you lose the coverage because the
enrollment ends or the enrollee changes from self and family to self only.
Suspension
You may suspend your FEHB enrollment for any of the following reasons:
- to enroll in a Medicare Advantage plan (these are Health Maintenance
Organizations or Fee-for-Service plans approved by the Centers for Medicare and
Medicaid Services);
- because you are eligible under Medicaid or a similar state-sponsored program
of medical assistance for the needy; or
- because you have coverage under Peace Corps, TRICARE, TRICARE For Life, or
CHAMPVA military program.
For more information on how to suspend your FEHB enrollment, contact your
retirement office or go to http://www.opm.gov/retire. Time limitations
and other restrictions apply. For instance, you must submit eligibility
documentation that you are suspending FEHB to enroll in one of the other
programs listed in case you wish to re-enroll in the FEHB Program at a later
time.
If you have suspended FEHB coverage for one of the eligible programs (and
submitted the required documentation) but now want to enroll in the FEHB Program
again, you may enroll during Open Season. You may re-enroll outside Open Season
only if you move out of the Medicare Advantage plan's service area, or you
involuntarily lose coverage under one of the eligible programs. If you cancel
your coverage from one of those eligible programs for any reason, you cannot
re-enroll in FEHB until Open Season.
Coordination of FEHB benefits with Medicare or other
coverage
If the original Medicare Plan is your primary payer, which is generally the
case if you have Medicare and are not working, check the plan brochure to see if
the plan waives some of its FEHB cost-sharing (e.g., deductibles, coinsurance,
or copayments.
If you are interested in an HMO plan, some FEHB HMOs also offer Medicare
Advantage plans. Information on coordinating benefits with other coverage,
original Medicare or Medicare Advantage is available in Section 9 of the plan
brochures.
FREQUENTLY ASKED
QUESTIONS
What do I need in order to suspend my FEHB enrollment because I am
enrolled in a Medicare Advantage Health plan?
You must request and complete a Health Benefits Cancellation/Suspension form,
RI 799. You must provide documentation of your enrollment in a Medicare
Advantage health plan. An example of a Medicare Advantage health plan is "Secure
Horizons" or "Kaiser Permanente Senior Advantage." A copy of your Medicare card
alone will not allow you to suspend your FEHB enrollment.
As a retiree, am I entitled to the FEHB pretax premiums (premium
conversion)?
No, the IRS regulation allowing pretax premiums only applies to employees.
However, if you are reemployed in a position that conveys FEHB coverage, you can
participate in premium conversion by having your agency deduct your FEHB
premiums on a pretax basis. This is normally automatic unless you waive
participation in the premium conversion program. If you are employed by a
Federal agency and in receipt of a survivor annuity, you should contact your
employing personnel office, if you would like to transfer your FEHB enrollment
from your annuity to your employing agency and participate in premium
conversion.
I am eligible for Medicare. Can I change from one plan or option to
another at any time?
Yes, you may change plans at any time beginning on the 30th day before
becoming eligible for Medicare to anytime thereafter. However, this is a onetime
event. Medicare A & B eligibility is not an event that permits you to
suspend your enrollment in the FEHB.
I am receiving a survivor annuity based on my deceased spouse's
Federal service. I remarried after age 55. Can I add my new spouse to my current
FEHB plan?
No. While your annuity can continue if you remarry after age 55, or if you
were married to the deceased Federal retiree/employee for at least 30 years, you
cannot cover your new spouse on the enrollment. Only eligible family members of
the deceased are entitled to benefits under the FEHB program.
What do I need to do in order to suspend my FEHB enrollment because I
have Tricare, Tricare for Life, Peace Corps or CHAMPVA?
You must request and complete a Health Benefits Cancellation/Suspension
Confirmation form, RI 799. If you are a Tricare/Tricare for Life enrollee, you
must provide a copy of your Uniformed Services Identification (ID) card and, if
over age 65, a copy of your Medicare card showing Parts A and B along with the
completed Health Benefits Cancellation/Suspension Confirmation form. If you are
a CHAMPVA enrollee, you must provide a copy of your CHAMPVA Authorization card
(Acard) along with the completed Health Benefits Cancellation/Suspension form.
If you are a Peace Corps volunteer, you must provide evidence of your enrollment
along with the completed Health Benefits Cancellation/Suspension form.
For more information, go to: http://www.opm.gov/retire
Source: RI 70-09
11/09
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