The Federal Employees Health Benefits (FEHB) Program can
help you meet your health care needs. Federal employees, retirees and
their survivors enjoy the widest selection of health plans in the country.
You can choose from among Fee-for-Service (FFS) plans, and their Preferred
Provider Organizations (PPO), or Plans offering a Point of Service (POS)
Product, or Health Maintenance Organizations (HMO) if you live (or
sometimes if you work) within the area serviced by the plan.
Some FFS plans are open to all enrollees, but some require that you join
the organization that sponsors the plan, which usually involves paying a
membership fee. Some plans limit enrollment to certain employee groups.
Membership requirements and/or limitations also apply to any Point of
Service product the Fee-for-Service plan may be offering.
Federal Employee Group Life Insurance
The Federal Government established the Federal Employees' Group Life Insurance (FEGLI) Program on August 28, 1954. It is the largest group life insurance program in the world, covering over 4 million Federal employees and retirees, as well as many of their family members.
FEGLI provides group term life insurance. As such, it does not build up any cash value or paid-up value. It consists of Basic life insurance coverage and three options. In most cases, if you are a new Federal employee, you are automatically covered by Basic life insurance and your payroll office deducts premiums from your paycheck unless you waive the coverage. In addition to the Basic, there are three forms of Optional insurance that you can elect. You must have Basic insurance in order to elect any of the options. Unlike Basic, enrollment in Optional insurance is not automatic -- you must take action to elect the options.
The cost of Basic insurance is shared between you and the Government. You pay 2/3 of the total cost and the Government pays 1/3. Your age does not affect the cost of Basic insurance. You pay the full cost of Optional insurance, and the cost depends on your age.
Managed care is an important part of health care today. You
will find managed care features in all the plans. Common features of
managed care are pre-approval of hospital stays, the use of primary care
providers as "gatekeepers" to coordinate your medical care, the use of a
prescription drug formulary, and networks of physicians and other
Plan brochures tell you what services and supplies are covered and the
level of coverage. Look over the brochures carefully. The brochures
reflect the efforts of OPM and health plan representatives to eliminate
jargon and use plain language. You can get brochures from the health plans
or your human resource office. They are also available here:
When it comes to
your health care, the best surprise is no surprise.
Some of the important program features are:
No waiting periods. Your human resource office or retirement system sets the effective date of your coverage. You can use your FEHB benefits as soon as your coverage is effective - there are no waiting periods, required medical examinations or restrictions because of age or physical condition.
A choice of coverage. You can choose self only coverage just for you, or self and family coverage for you, your spouse, and unmarried dependent children under age 22. Under certain circumstances, your FEHB enrollment may cover your disabled child 22 years old or older who is incapable of self-support.
A choice of plans and options.
>Plans offering a Point of Service product
>Health Maintenance Organizations
A Government contribution. The Government contributes toward the total cost of your premium. In 2000, the Government paid up to $2,049.60 for each self only enrollment and $4,575.24 for each self and family enrollment, but not more than 75% of the total premium for any plan. The Government contribution for part-time employees may be different. See your human resource office to get the exact amount.
Salary deduction. You pay your share of the premium through a payroll deduction.
Annual enrollment opportunities. Each year you have the opportunity to enroll or change plans. By regulation, an open season is held each year from the Monday of the second full workweek in November through the Monday of the second full workweek in December. During open season you may enroll if you are eligible and not now enrolled, change plans or options, or change from self only to self and family. (You may change from self and family to self only or disenroll at any time.)
Continued group coverage. The FEHB Program offers continued FEHB coverage:
>for you and your family when you retire from Federal service (normally you need to be covered in the FEHB Program for the five years before you retire),
>for your former spouse if you divorce and he or she has a qualifying court order (see your human resource office for more information),
>for your family if you die, or
>for you and your family when you move, transfer, go on leave without pay, or enter military service (certain rules about coverage and premium amounts apply; see your human resource office).
Coverage after FEHB ends. The FEHB Program offers either temporary continuation of FEHB coverage (TCC) or conversion to non-group (private) coverage:
>for you and your family if you leave Federal service (including when you can't carry FEHB into retirement),
>for your covered dependent child if he or she marries or turns age 22, or
>for your former spouse if you divorce and he or she does not have a qualifying court order (see your human resource office for more information).
If you lose coverage under the FEHB Program, you should automatically receive a Certificate of Group Health Plan Coverage from the last FEHB Plan to cover you. If not, the plan must give you one on request. This certificate may be important to qualify for benefits if you join a non-FEHB plan.
To check the rates for postal employees follow this link:
To find info on Open Season dates (that is, when you can subscribe to a health plan) follow this link:
The Office of Federal Employees' Group Life Insurance (OFEGLI), which is a private entity that has a contract with the Federal Government, processes and pays claims under the FEGLI Program.
To read FAQ's regarding FEGLI coverage follow this link: