What Happens to Health Coverage on Injury

If you are injured on the job, your FEHB enrollment will continue for up to 12 months in nonpay status (from your agency) or until separation from employment, whichever occurs first. At that time, if you have been enrolled in FEHB for a full five years or for all service since your first opportunity to enroll, as of the date compensation payments began from the Office of Workers Compensation Programs, then you will also be eligible to continue FEHB for the remainder of time you are receiving workers’ compensation.

Premiums will be deducted from the compensation if compensation is expected to last more than 28 days. Employing office control of your FEHB enrollment will normally transfer from the employing agency to OWCP within 10 months to one year after you enter into a nonpay status for compensation purposes. After that, you will conduct any enrollment changes directly with OWCP.

If your surviving spouse and/or children are entitled to workers’ compensation payments as the result of your death and you are enrolled in self and family FEHB coverage, the enrollment will continue for them. Premiums will be deducted from their compensation payments. Your survivors will be able to make Open Season changes directly with OWCP.

There are different policies regarding a health care flexible spending account, depending on the origin of the injury:

• If the injury is job-related and you are eligible for workers’ compensation benefits, contributions to your FSA account will continue while you are in receipt of 45 days continuation of pay (COP). FSA contributions will not be withheld when you enter a nonpay status and begin receiving wage loss compensation benefits from OWCP.

• If the injury is not job-related, contributions to your FSA account will continue as long as you are working, or are in receipt of salary based use of sick leave or other paid leave. If you enter a nonpay status, contributions will not be made.

When an employee enters a period of nonpay status and contribution allotments have not been pre-paid, the health care FSA account will be frozen and you will not be eligible for reimbursement of any health care expenses incurred during that period until the plan year ends, or until you return to pay status and begin making contribution allotments again. You may, however, continue to submit claims for eligible health care expenses incurred prior to your period of nonpay status.

Note: If you have a dependent care FSA, dependent care expenses you incur during your nonpay (that allow you and your spouse to work or attend school) may be reimbursed up to your account balance.

When you return to a pay status, your contribution allotments will increase so that your account is paid in full at the end of the year.