Unit HomeBenefitsHealth Benefits
Human Resources and Organizational Management

 

Human Resources and Organizational Management

Headquarters Marine Corps

Federal Employees Health Benefits (FEHB) Program

Types of Enrollment

  • Self Only – covers just the employee
  • Self and Family – covers all eligible family members
    • Family members include spouse (including common law marriages), dependent children, and children incapable of self-support
      Children include a child born within marriage, an adopted child, a stepchild, a foster child who lives with you in a regular parent-child relationship, or a recognized natural child
    • Under the Health Care Reform Act, dependents are covered up to age 26. Children up to the age of 26 can be covered under FEHB even if they are eligible for health care insurance under their own employer
    • The onset of a mental or physical disability must have existed prior to the age of 26 for a child who is incapable of self-support

Types of Plans

  • Fee-for-Service (FFS)
    • FFS Plans Non-Preferred Provider Organization (PPO)
    • FS Plans with PPO
  • Health Maintenance Organization (HMO)
  • Point of Service (POS)
    • Can use either in-network or out-of-network (for additional fee)
  • Consumer Driven Health Plans (CDHP)
    • Employees manage their own health plans
  • High Deductible Health Plan (HDHP)
    • Deductible ranges from $1,000 to $5,000

Cost of Health Care Insurance

  • Full time employees pay the enrollee share
  • Part time employees pay a pro-rated share
  • Temporary employees pay 100% of the premium (employee and government share) plus a 2% administration fee

Ineligible employees include

  • Temporary employees with appointments NTE one (1) year
  • Intermittent Work Schedules

How to enroll

  • Enroll through EBIS up to 60 days after new appointment
  • Decide whether to waive premium conversion within the first 60 days of employment
    • FEHB is subject to automatic premium conversion enrollment

Opportunities to Enroll or Change Enrollment

  • New appointment
  • Open Season
  • Qualifying Life Event (QLE)
    • See list of QLEs in SF2809 Form
    • Must have a QLE to change enrollment outside of Open Season if enrolled in premium conversion
    • You have 60 days after a QLE to change enrollment
  • Belated Enrollment
    • Opportunity to enroll outside of established time frames due to a cause beyond the employee’s control
    • Effective date of coverage is retroactive

Temporary Continuation of Coverage (TCC)

TCC is a feature of the FEHB Program that allows eligible individuals to temporarily continue their FEHB coverage.

  • Eligible individuals include:
    • Employees who separated from federal service (Exception: Employees who involuntarily separated due to gross misconduct are ineligible for TCC)
      • Covered under TCC for up to 18 months
    • Children who are past the age of 26 or who recover from a prior disability
      • Covered under TCC for up to 36 months
    • Former spouses who lose coverage due to divorce or annulment
      • Covered under TCC for up to 36 months
  • Cost of TCC is 100% of the premium plus a 2% administrative fee

Continuing FEHB Coverage into Retirement

Employees must have been continuously enrolled or covered as a family member in any FEHB program plan (not necessarily the same plan) for the five years of service immediately preceding the retirement

  • If the employee has less than 5 years of service, then FEHB coverage must have been for all service under which employee was eligible

Waivers of the 5 year requirement may only be granted by OPM.

FEHB Court Orders

The Federal Employees Health Benefits (FEHB) Children's Equity Act of 2000 requires mandatory self and family enrollment coverage for FEHB-eligible employees who do not comply with a court or administrative order to provide health insurance coverage for their child(ren).

References
    
SF-2809: Health Benefits Election Form w/Qualifying Life Events  
FEHB Handbook  
FEHB Fee-for-service (FFS) Premiums  
FEHB Health Maintenance Organization (HMO) Premium Rates  
FEHB RI 79-27: Temporary Continuation of Coverage  
DON Certification for a Child Incapable of Self-Support  
DON Foster Child Certification  
DON Request to Add or Delete a Family Member from FEHB Enrollment   
How to Access EBIS   
EBIS Login  
OPM FEHB Website  
OPM FEHB FAQs   
Health Care Reform