10 Musts About Open Season & Federal Health Benefits

10 Musts About Open Season & Federal Health Benefits
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The United States federal employees health benefits (FEHB) open enrollment season is coming soon. With over eight million participants, the U.S. has the largest health benefits program in the world. The numbers are staggering. Besides being the largest, the FEHB provides over 200 plans for eligible individuals to select.

Knowing the enrollment dates, who is covered and what is covered under the federal plan is vital to protect your future health and personal finances.

1. Know Open Season for Federal Health Benefits

Open season for federal health benefits only takes place once a year. According to the Office of Personnel Management (OPM​),2021’s open seasonfor health benefits is November 8 to December 13​. At this time, enrollment and changes to federal health benefits will be allowed for 2022.

At this time, you can enroll yourself and the immediate members of your family. These are the options:

  • Self only
  • Self plus one
  • Self plus family

The timeframe for electing to take part in the FEHB only occurs during the open season. Forgetting to take part or not reading the information regarding the FEHB are not acceptable reasons for electing outside the open season.

If you are a new hire outside the open season dates, you have 60 days to enroll in FEHB.

2. Understand Qualifying Life Events

There is an opportunity to enroll outside the open season if you experience certain events in your life. These events are referred to as qualifying life events (QLEs). When a QLE occurs, you can change your status to self only, self plus one or cancel coverage. You can only do this when the change is associated with QLEs.

For example, a QLE takes place if there is a change in family status. This change could be:

  • Marriage
  • Birth or adoption of a child
  • Acquisition of a foster child
  • Legal separation
  • Divorce
  • Death of spouse or dependent

Two other QLEs will all trigger the exception. One is a change in employment status. The other is if you or a family member lose FEHB or other coverage.

When any of these QLEs occur, you have several options. They include:

  • Increase your enrollment
  • Enroll
  • Change your enrollment to another FEHB or option
  • Decrease your enrollment
  • Cancel your enrollment

If a QLE doesn’t occur, you cannot enroll or change coverage outside the FEHB open season.

When you have a QLE, be aware there is a limited timeframe that you must act in to elect FEHB. You only have the first 30-60 days after a QLE to elect or cancel coverage. There are no exceptions, and some agencies have different requirements. Check with your supervisor to find out what timeframe affects your circumstances and agency.

3. Be Aware of Effective Coverage Date

If you are a current employee and make changes to your plan, the new coverage doesn’t start immediately. Any changes made in the open season take place on the first day of the first full pay period in the following January. For instance, any changes you make in ​2021 will not become effective until 2022.

A new federal employee's election will affect the first day of the new employee’s first pay period. This occurs when you are in pay status and the employing office receives your enrollment request. You won’t have health insurance until this happens.

4. Meet Eligibility Requirements

Federal employees are eligible to elect FEHB coverage unless they hold a position excluded by regulation or law. Special provisions are available to some employees. These include:

  • Part-time
  • Intermittent employment
  • Temporary appointments
  • Specifically named positions

Because each agency applies these rules and determines eligibility, check with your supervisor. Some eligible participants are below.

Federal Retirees

Federal retirees are also eligible for FEHB. Those who have reached 65 have the choice of staying with FEHB or going with Medicare.

Medicare Part A covers hospital costs as well as other services. So if you qualify for no-cost Medicare Part A at age 65, you can enroll in that plan. By doing so, it will reduce your out-of-pocket expenses. But it will also reduce your costs to FEHB and therefore keep your premiums down.

You can choose either FEHB or Medicare beginning on the 30th day before becoming eligible for Medicare. But you can only make an enrollment change once.

Family Members

Immediate family members and/or dependents to a federal employee can be eligible for FEHB. These members must have legally married spouses or a valid common law marriage. Children under 26 are also included. The definition for children includes:

  • Legally adopted children
  • Recognized natural (born out of wedlock) children
  • Stepchildren

Foster children are also eligible for FEHB coverage.

Tribal Employer

A tribal employer, according to the OPM, refers to:

  • Indian tribes
  • Tribal organizations
  • Urban Indian organizations

These groups that qualify are entitled to participate in the FEHB.

5. Enroll in Health Benefits Online

Depending on the agency, there are different ways to enroll in FEHB. Online links for different agencies include:

Unless you are a postal worker, you can also fill out the standard form 2809, employees health benefits election form. You will need to submit it to your human resources office.

6. Choose Health Benefit Plans

Comprehensive health benefits are provided through the FEHB. You’re given a choice as to what type of plan you want. The four types are:

  • Fee for service non-preferred provider organization (PPO)
  • Fee for service PPO
  • Health maintenance organizations
  • Consumer-driven
  • High deductible

Each type is flexible not only in coverages but in price. The OMP developed an FEHB plan comparison tool to assist you in making your health plan selections.

Fee for Service Non-PPO

A fee for service plan (FFS) is what is traditionally thought of when discussing health insurance. Insurance will either pay you or the medical provider directly for services. If you are being reimbursed for medical expenses, you'll need to file an insurance claim.

Although a non-PPO is a little more expensive, it does give you choices. For example, you'll be able to choose the doctors or hospitals you want.

Fee for Service PPO

A PPO is a network of healthcare providers and hospitals. This network has agreed to reduce their prices to the plan. If you participate, this results in lower health costs for you. The disadvantage is you have fewer choices. You must go to the healthcare providers on the PPO's list.

Health Maintenance Organizations

Health Maintenance Organizations (HMO) operate in a specific geographic area. They provide healthcare through a network of providers and hospitals. An HMO is like a one-stop-shop of healthcare insurance. They coordinate and take care of all the paperwork. HMOs limit your out-of-pocket costs.

The downside of an HMO is that you are limited to a specific geographic area because you are required to stay in their network. And you must have a primary physician refer you to a specialist if needed. In addition, if you receive care from a provider who's not in the network, it isn't covered unless it's an emergency.

Consumer-Driven Health Plans

Consumer-Driven Health Plans (CDHP) give several approaches to motivate you to control costs. You do this by monitoring and controlling the cost of your healthcare. There’s freedom in how you spend healthcare monies up to a certain amount.

There is full coverage for preventative care if received in-network. But there is a downside. The limit for catastrophic is higher than in other health plans.

High Deductible Plan

A high deductible plan (HDHP) is just what it sounds like. You pay a large deductible before the insurance kicks in. For a self-only enrollee, it's a minimum of $1,250, and for a family, it's a minimum of $2,500. Most HDHPs have first-dollar coverage for preventative care. This means the deductible doesn't apply.

Read more:Health Insurance Basics

7. Choose Life Insurance Benefits

The U.S. Federal Employees’ Group Life Insurance (FEGLI) is the largest life insurance program worldwide. It covers over four million participants. Those covered include:

  • Federal employees
  • Retirees
  • Family members

The FEGLI provides group term life that doesn't build up any cash value. It's basic life insurance, but there are three different options that you can elect for an additional cost.

The cost of the basic term life policy is shared between you and the federal government. The federal government pays one-third of the total cost of basic life insurance.

If you wish to choose optional insurance, you pay the full cost of the difference. If you're not sure if basic life insurance is enough, the FEGLI calculator is available to help you determine what combination of options will be the most efficient from a coverage and price standpoint.

8. Choose Vision and Dental Plans

FEHB does not pay for vision and dental, but they provide the opportunity to purchase the coverages. Eligible federal and postal employees, retirees and eligible families are enrolled on a pay-all basis. Because of the size of the program, dental and vision insurance can be purchased with competitive premiums.

For eligible federal and postal employees, the premiums are withheld on a pre-tax basis.

Enrollment for vision and dental coverages takes place during the FEHB open season. Employees and family members must be eligible for, although not necessarily enrolled in, FEHB to qualify for these dental and vision plans.

9. Set Up Your Flexible Spending Account

The federal government offers a health care flexible spending account. You can put a portion of your pre-tax salary, up to $5,000 a year, into the flexible spending account. These monies can be used for expenses that FEHB does not cover. For example, these dollars can be used to purchase over-the-counter medications.

Because your contribution comes out of your salary pre-tax, you have the potential of saving. You could see savings of up to 30 percent on your taxes.

10. Participate in Thrift Savings Plan

The Thrift Savings Plan (TSP) is similar to a traditional 401(k). You receive one percent of your salary into your TSP account regardless of if you want to participate or not. If you want to participate, every pay period, your contribution will be deducted pre-tax. Your contribution is the amount or percentage that you designate.

Any employee who joined on or after October 1, 2020, was automatically enrolled into the TSP at 5 percent. These deductions will continue automatically unless one of the following actions takes place:

  • Change the amount contributed
  • Stop your contributions
  • Reach the IRS contribution limit

Depending on eligibility, you have the potential of receiving matching contributions from the agency on the first 5 percent of contributions you make. The first 3 percent is matched dollar for dollar. The next 2 percent is matched at 50 cents on the dollar.

Conclusion

Be vigilant about the dates for FEHB's open season. Know your eligibility status and how your dependents are affected. If you have a qualifying life event, make sure you know the deadlines for FEHB. The QLE of marriage or a new baby is a happy occurrence; not signing up for benefits in a timely manner is not.