Last week I previewed the Federal Employees Health Benefits program open season that will run November – December 13. At the end of that article, I mentioned that updated plan information would be available on November 8. In anticipation of that, I thought it would be a good idea to go over the basics as they apply to current federal employees.
The FEHB program is open to nearly all federal and postal employees. Your first opportunity to enroll is within 60 days from either the date on which you are hired or the date on which you first become eligible. If you didn’t enroll then—or you did and later dropped coverage—you can enroll during an open season like the one coming up.
Coverage is provided without your having to get a physical examination. And there aren’t any waiting periods before you can receive benefits.
The premium cost is split between you and the government, with the government providing the majority, about 70 percent. That applies to both active employees and retirees.
Anyone enrolled in the FEHB program change plans or options during open season, while those newly enrolling will have the same choices.
Because there are around 270 organizations providing benefits, you should be able to pick a plan or level of coverage that meets your needs and your wallet. While most FEHB plans are offered by health maintenance organizations (HMOs), others are fee-for-service plans. Several of them are open to any employee, but a few are offered by employee organizations, which usually require that you be a member of that organization to enroll.
The net result is a choice ranging from about a dozen plans, in more rural areas, to as much as about three dozen, in some urban areas.
You have three coverage choices when you enroll in the FEHB program:
• Self-Only, which provides benefits for you alone:
• Self Plus One, which provides benefits for you and one eligible family member;
• Self and Family, which provides benefits for you and all eligible family members.
The term “eligible family member” means your spouse, including a common law marriage spouse recognized in the state where you live, and children under age 26. In the latter case, an exception to the age limit is made if the child is incapable of self support because of a mental or physical disability that began before age 26.
Next week I’ll focus on how and when things change when you retire.