Navigating Insurance Changes: Understanding The Opm Process

The Federal Employees Health Benefits (FEHB) Program offers health insurance to federal employees, retirees, and their dependents. During the annual FEHB Open Season, eligible individuals can enroll, change plans or options, cancel their enrollment, or change their participation in premium conversion. Outside of Open Season, changes can be made within 60 days of certain qualifying life events (QLEs), such as changes in family or employment status, or loss of other health coverage. Newly eligible employees have 60 days from becoming eligible to enroll, and members who move outside their plan's coverage area can switch to a different plan. Enrollment and changes can be made through various means, including online systems, automated systems, telephone, mail, or by submitting the Standard Form 2809, Employee Health Benefits Election Form.

Enrolling in the FEHB Program

The Federal Employees Health Benefits (FEHB) Program is the largest employer-sponsored health insurance program in the world, covering over 8 million Federal employees, retirees, former employees, family members, and former spouses.

Eligibility

As a Federal employee or employee of certain tribes, tribal organizations, or Urban Indian organizations, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your Federal agency or tribal employer applies these rules and determines your eligibility. There are special provisions for people in part-time positions or on a temporary appointment, seasonal schedule, or intermittent schedule.

Types of Plans

The FEHB Program offers a variety of plans to choose from, including:

• Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts, and lower premiums
• Nationwide Fee-for-Service (FFS) plans and their Preferred Provider Organizations (PPO)
• Health Maintenance Organizations (HMO)

The availability of certain plans may depend on your geographic location.

Enrollment Process

To enroll in the FEHB Program, follow these steps:

• Review the plan brochures carefully. These brochures are available from the health plans or your human resources office. They outline the services and supplies covered and the level of coverage provided by each plan.
• Compare the costs, benefits, and features of different plans. You can use the FEHB Plan Comparison Tool to help with this.
• Complete the Health Benefits Election Form (SF-2809) and submit it to your servicing Human Resources Office within 60 days of your date of appointment.
• Wait for your enrollment request to be processed. Your coverage will become effective on the first day of the first pay period that begins after your employing office receives your enrollment request and you are in a pay status.

Your enrollment in the FEHB Program will automatically continue each year as long as you remain eligible. You do not need to reenroll annually.

Enrollment Changes

If you wish to change your health insurance, you may do so during the Benefits Open Season or in conjunction with a qualifying life event. During the Open Season, you can enroll, change health plans or options, cancel your FEHB enrollment, and change participation in premium conversion.

Outside of the Open Season, you can still make changes to your FEHB coverage if you are a newly eligible employee or if you move outside of the area covered by your current plan. Additionally, the Office of Personnel Management (OPM) may announce special Open Seasons affecting members of specific plans only.

Changing your health plan

To make changes during the FEHB Open Season, you can utilize OPM's Open Season Online system, call 1-800-332-9798, or send a request via regular mail to the Office of Personnel Management. It is important to clearly state your Open Season request, including the desired plan, type of coverage, and enrollment code.

Outside of the Open Season, there are still options to change your health plan under specific circumstances. Newly eligible employees have 60 days from becoming eligible to enroll. Additionally, members who move outside the area covered by their current plan can enroll in a different plan that suits their new location. OPM may also announce special Open Seasons for members of specific plans.

It is worth noting that certain qualifying life events (QLEs) can also trigger changes outside of Open Season. These QLEs include changes in family status, such as the birth or adoption of a child, and changes in employment status, such as a break in service or a transition to part-time career employment.

To make changes outside of Open Season, you can enroll online using Employee Express or submit Standard Form 2809, the Employee Health Benefits Election Form, to your Human Resources Office.

Cancelling your FEHB enrollment

• A change in family status, such as the birth or adoption of a child, the acquisition of a foster child, or the death of a spouse or dependent.
• A change in employment status, such as being reemployed after a break in service of more than 3 days, returning to pay status after your coverage was terminated during a leave of absence without pay, or changing from a temporary appointment to an appointment that entitles you to a government contribution.
• Losing FEHB or other health coverage, such as when your membership in the employee organization sponsoring the FEHB plan is terminated, or when you had previously suspended your FEHB coverage to participate in another federally-sponsored health benefits program.

To cancel your FEHB enrollment, you must complete the following steps:

• Select the Payroll Documents menu group.
• Select the Health Benefits component. The Find an Existing Value tab - Health Benefits page will be displayed, allowing you to locate an existing employee to enter or change allowances.
• Enter the search criteria and select the Search button. The Elections tab - Health Benefits page will be displayed.
• Change the applicable data on the Health Benefits - Elections tab or the Health Benefits - Dependents tab.
• Complete the fields as follows: Enter the applicable event code and change the transaction code to Cancel. Select the Remarks link, then select OK.
• Select Save, then OK. You will then have the option to return to the search, search for another employee, view or change the previous or next record, or send an email to the next individual in the workflow.

It is important to note that annuitants who drop out of FEHB coverage typically cannot re-enroll in the program, except under limited circumstances. Additionally, if you cancel your enrollment, the effective date is the last day of the pay period in which your employing office receives your cancellation request.

Changing your premium conversion

Outside of Open Season, there are still some circumstances in which you can change your premium conversion. If you are a newly eligible employee, you can enroll within 60 days of becoming eligible for the program. If you move outside of the area covered by your plan, you can enroll in a different plan covering your new location. OPM may also announce special Open Seasons that only affect members of specific plans.

There are also other qualifying life events (QLEs) that may permit changes to your premium conversion outside of Open Season. These include:

• A change in family status, such as marriage, divorce, birth or adoption of a child, or death of a spouse or dependent.
• A change in employment status, such as being reemployed after a break in service of more than 3 days, returning to pay status after your coverage was terminated, or changing from a temporary appointment to an appointment that entitles you to a government contribution.
• Losing FEHB or other coverage, such as when your enrollment is terminated, canceled, or changed to Self Only, or when you move outside of the HMO's enrollment area.

Qualifying life events (QLEs)

The major QLEs that permit enrollment or change in enrollment are:

Change in family status:

• Birth or adoption of a child
• Acquisition of a foster child
• Death of a spouse or dependent
• Marriage or remarriage
• Same-sex marriage
• Common-law marriage
• Divorce or separation
• A child getting married, divorced, or becoming a Federal employee
• A stepchild moving out
• A child going away for school

Change in employment status:

• Reemployment after a break in service of more than 3 days
• Return to pay status after coverage termination during leave without pay status or after being in leave without pay status for more than 365 days
• A pay increase that is high enough for premiums to be withheld
• Restoration to a civilian position after serving in the uniformed services
• Change from a temporary appointment to an appointment that entitles you to a Government contribution
• Change to or from part-time career employment

Loss of FEHB or other health insurance coverage:

• Termination, cancellation, or change to Self Only under another FEHB enrollment
• Moving or changing worksite outside of the enrollment area when enrolled in a prepaid health maintenance organization (HMO)
• Loss of coverage under another federally-sponsored health benefits program, Medicaid, CHAMPVA, TRICARE, or TRICARE-for-Life
• Loss of coverage when previously suspending FEHB coverage to participate in one of the above programs
• Termination of membership in the employee organization sponsoring the FEHB plan
• Loss of coverage under a non-Federal health plan

Frequently asked questions