FEHB: Federal Employees Health Benefits Program
The Federal Employees Health Benefit Program or FEHB can help you and your family meet your health care needs. The program applies to Public Sector employees and retirees, as well as their survivors.
The FEHB program covers over nine million Public Sector employees, retirees, former employees, family members and former spouses. Like most employer-sponsored health insurance programs, FEHB is voluntary and paid for through employee and employer contributions.
Each federal health insurance carrier contracts with the Office of Personnel Management (OPM) to provide health benefits to all people who enroll in the participating plan.
Most federal employees and postal workers are eligible to elect FEHB program coverage. There are primarily three types of federal health benefit plans: FFS/PPO (fee-for-service/preferred provider organization), HMO (health maintenance organization) and HDHP (high deductible health plan).
Advantages of an FEHB Plan
FEHB plans offer certain advantages and guarantees, such as;
- An annual opportunity, known as “Open Season,” to enroll in an FEHB plan or change plans (usually mid-November to mid-December). You may also make changes to your FEHB plan following certain qualifying life events, e.g., marriage, divorce, legal separation, birth or adoption of a child, or death of a spouse or dependent.
- A choice of federal health insurance plans and options with group-rated premiums and benefits.
- Guaranteed protection that cannot be canceled by the federal health insurance carrier.
- Coverage offered without medical examinations or restrictions because of age, current health or pre-existing medical conditions.
- No waiting periods after the effective date of enrollment in an approved FEHB plan.
- A government contribution toward the cost of your federal health insurance plan (unless you are on a temporary appointment).
- A payroll deduction method of making premium payments toward your FEHB plan.
- A temporary 31-day extension of coverage after separation from employment, during which you may convert to a private non-group health insurance plan.
- Continued enrollment for eligible family members after the death of the federal employee or annuitant
- Ability to pay your premiums with pre-tax dollars (This is called “premium conversion.”)
Federal employees, including postal workers and annuitants, are eligible to elect FEHB coverage, unless law or regulation specifically excludes their position. There are also special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions. Federal retirees and their surviving spouses retain their FEHB eligibility at the same cost as current employees.
During the annual FEHB “Open Season,” anyone eligible to participate in the FEHB program may enroll, change health plans or cancel FEHB enrollment altogether. Outside of Open Season, newly eligible employees may enroll within 60 days of meeting FEHB eligibility requirements.
An Open Season enrollment is effective on the first day of the first full pay period that begins in January of the following year. An enrollment based on a “qualifying life event” as discussed above is generally effective the first day of the first pay period that begins after the enrollment request is received.
Types of FEHB Enrollment
There are two types of FEHB enrollment: Self-Only and Self-and-Family. A Self-Only enrollment provides benefits only for you as the enrollee. You may enroll on a Self-Only basis even though you have a family, but your family members will not be eligible. A Self-and-Family FEHB enrollment generally covers you, your spouse and your dependent children under age 26.
Employees are not eligible to enroll if they are an intermittent employee (i.e., they do not have a prearranged regular tour of duty) or if their position is excluded from coverage by law or regulation.
You can compare health plans, link to plan web sites, and get information on plan quality as well as download plan brochures and guides on the OPM web site at http://www.opm.gov/insure.