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FEHB Plan Frequently Asked Questions

NARFE has created an extensive list of frequently asked questions and their answers to help federal employees and annuitants navigate Federal Employee Health Benefits (FEHB)

Additionally, if you have a question not addressed here that you’d like NARFE to add, please contact us.

General

Am I eligible for an FEHB plan?

  • Eligibility (opm.gov)
  • To enroll in FEHB coverage, you must be eligible under one of the following categories.
    • Employees
      • As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility.
      • You are eligible to enroll in an FEHB plan, if you are an:
        • Employee on a temporary appointment who is expected to work 130 hours per month or more for at least 90 days;
        • Employee on a seasonal schedule who will be working a schedule of less than six months per year and are expected to work 130 hours per month or more for at least 90 days; or
        • Intermittent employee who is expected to work 130 hours per month or more for at least 90 days.
      • The FEHB Handbook provides additional information about employee eligibility and explains the special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions, as well as FEHB coverage for Federal employees who are serving in the military.
    • Annuitants and Survivor Annuitants
      • Federal annuitants and their surviving spouses retain their eligibility for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement) and must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person’s FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.
      • The pamphlet Information for Retirees and Survivor Annuitants, RI 79-2, summarizes the main FEHB requirements and benefits for Federal annuitants.
      • The FEHB Handbook provides additional information about the special FEHB considerations for annuitants and compensationers.
    • Family Members
      • Family members eligible for coverage under your Self +1 or Self and Family enrollment include:
        • Your spouse, including a common-law spouse only if the marriage was initiated in a state that recognizes such marriages,
        • Child under age 26 including:
          • biological child,
          • stepchild,
          • adopted child, or
          • foster child; and
        • Child age 26 or older incapable of self-support, if disabling condition began before age 26.
      • Your employing office will review your evidence to determine whether your family member is eligible for coverage.
      • The FEHB Handbook and FAQs provide additional information about family members’ eligibility for coverage.
    • Temporary Continuation of Coverage (TCC)
      • Temporary Continuation of Coverage is a feature of the FEHB Program that allows certain people to continue their FEHB coverage after regular coverage ends temporarily. As a TCC enrollee, you must pay the full premium for the plan you select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative fee.
      • The TCC pamphlet and FEHB Handbook provide additional information about TCC.
        • Former Spouses
        • Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.
        • The FEHB Handbook and FEHB FastFacts for Former Spouse provide additional information about former spouse eligibility for coverage.

How do I decide on an FEHB plan?

  • The FEHB Program allows you to choose from Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan.
  • Use this site to compare the costs, benefits, and features of different plans. We chose the different benefit categories based on enrollee requests, differences among plans, and simplicity. However, we urge you to consider the total benefit package, in addition to service and cost, and provider availability when choosing a health plan.
  • The FEHB plan brochures show you what services and supplies are covered and the level of coverage. Review the brochures carefully. The brochures are formatted to ensure they are all organized alike. You can get brochures from the health plans or your human resource office.

BlueCross Blue Shield

What is the Medicare Prescription Drug Program?

  • It is part of the Inflation Reduction Act of 2022 to lower prescription drug costs. FEHB plans decided the Medicare Prescription Drug Program (MPDP) provides additional benefits without an additional base cost (for most), so the assumption is that it will be a better deal for most people, and NARFE agrees. So, the default of whether to be in or out is set based on that assessment. But it’s not a one-size-fits-all approach. It depends primarily on if it helps with your prescription drug needs and cost. Many will find they don’t need the extra drug coverage and/or costs and will choose to opt-out. This new offering will work well for some members, especially for specialty drugs.
  • You will find more information specific to FEP at https://www.fepblue.org/medicarerx
  • There is no penalty for delaying applying for Part D as your FEHB coverage is considered “creditable”. There is no charge to have the new Medicare Prescription Drug Program under BC/BS (or any other FEHB plan offering this benefit). However, there may be a Part D IRMAA surcharge.
  • You can opt-out at any-time. FEP website says:
    • If you miss the opt-out deadline in the letter:
    • You can tell us at any point that you want the regular FEP prescription drug benefits instead of MPDP.
    • If it’s before January 1, 2024, you can call us at 1-888-338-7737 (TTY: 711).
    • Before or after January 1, you can also contact Medicare at 1-800-MEDICARE (1-800-633-4227) or mail us at: FEP Medicare Prescription Drug Program, PO Box 3539, Scranton, PA 18505.
      If you decide to opt out or dis-enroll, you can re-enroll during Open Season in a future year.
  • NARFE has a webinar on the pros and cons on Medicare Advantage plans archived for their members at https://www.narfe.org/federal-benefits-institute/narfe-webinars/webinar-archive/