Expert's View

Reg Jones

If you are a relatively new employee, you’ll remember that when you went to work for the government, you had a lot of paperwork to deal with. Among the items was an explanation of two benefits where your coverage was guaranteed unless you declined it: health insurance and life insurance.

If you were like most new employees, you didn’t decline them. Therefore, I thought it would be a good idea to spend a few minutes going over what you got. If you did decline them, it’s important to know what you’re missing—and what are your options for getting in on what you missed.

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This week I’ll start with health benefits. The Federal Employees Health Benefits program is open to nearly every federal and postal employee. Enrolling in it protects you against the cost of health care for you and certain other family members. While you may have signed up on the day you were hired, you had 60 days to make up your mind.

Once you enrolled in the program your coverage was guaranteed without the need to have a medical examination, provide proof of your current health, or even report the existence of any preexisting conditions you might have. Not only did your coverage begin immediately – with no waiting period – but it provided protection against really large medical bills. The cost of that coverage is shared by you and the federal government.

When you enroll in the FEHB program, you can choose from among consumer-driven and high deductible plans, health savings/reimbursable accounts, fee-for-service (FFS) plans, preferred provider organizations (PPOs) or health maintenance organizations (HMOs), if you live (or sometimes if you work) in the plan’s service area.

When you select an FEHB plan, you have three coverage options: Self Only, which provides benefits for you alone, even if you have other family members who would be eligible; Self Plus One, which provides benefits for you and one eligible family member, for example, a spouse or a child; or Self and Family, which provides coverage for you and all of your eligible family members. If your status changes, for example, from being single to married or having a child, you can change your coverage when that occurs.

The term child includes legally adopted children, recognized children born out of wedlock, step children and, in certain cases, foster children. As a rule, that coverage can continue until your child reaches age 26, at which point he or she can continue that coverage for up to 18 months at his or her own expense under the Temporary Continuation of Coverage Provision. Note: The age limitation does not apply to any unmarried child who has been determined to be incapable of self-support because of a mental or physical disability that began before age 26.

Another benefit of the FEHB program is that you can tailor your costs and benefits by selecting from a wide range of plans.

Further, an employee can newly enroll—or one already enrolled can change plans or coverage option—in an Open Season, which occurs each fall from early November to early December for the following calendar year. Those actions also are allowed when certain life events occur, as we’ll discuss later in this series. (Note: The same applies to retirees except that they cannot newly enroll.)

Coverage in Retirement
As an important additional feature of the FEHB program, you generally can carry that coverage into retirement only if you have been enrolled in the program for the 5 consecutive years before you retire (or from your first opportunity to enroll). The exception is that if a waiver is granted, which is a rare occurrence.

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Note that I wrote “enrolled in the program.” You could change the plan you are enrolled in every year of those five and still meet the requirement.

With one exception, the premiums you’ll pay after you retire will be the same as they were when you were an employee. Here’s the exception. Postal Service employees whose premiums are subsidized through union negotiation, will lose that subsidy when they retire. They’ll pay the same premiums as everyone else.

In my next article, I’ll focus on similar considerations in the Federal Employees’ Group Life Insurance program.

How Not to Lose your FEHB in Retirement

OPM Sets Policies on Verifying FEHB Eligibility for Family Members

More Flexibility Coming to Flexible Spending Accounts, OPM Says

2021 Has a Quirk in the Calendar for Picking a Fed Retirement Date

Benefits if You Leave Government before Retirement Eligibility

FERS Retirement Guide 2021