Government Employees Health Insurance is also known as the Federal Employees Health Benefits Program or FEHB. It provides healthcare and other benefits to employees of the federal government, including postal workers, and military personnel. While not an insurance company itself, it manages health and other benefits that are delivered through contracted insurance carriers, which vary, by state and government agency.
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Government Employees Health Insurance Eligibility
FEHB plans are available to full time and certain part time federal employees, military personnel and their immediate families. Immediate families consist of:
- Adopted children
- Legally fostered children
- In certain circumstances a former spouse
Children must be age 26 or younger unless they have a disability that classifies them as a dependent beyond age 26.
Retired Federal Employees
Retired federal Employees are also eligible to carry benefits with them into retirement for themselves and their spouse providing they meet certain criteria. The cost to retired employees is the same as for active employees.
Native American tribes are also eligible to purchase FEHB plans for their employees if they meet one of the following criteria:
They are carrying out programs under the Indian Self-Determination and Education Assistance Act
They have an urban tribal organization carrying out programs under Title V of the Indian Health Care Improvement Act (IHCIA)
Government Employees Health Insurance Enrollment
If you are a federal employee, you are eligible to enroll in a health insurance plan during “open season” which lasts from the first full week in November until the first full week in December. Your effective date for your plan will be January 1 of the following year. Newly hired employees can enroll outside of open season within 60 days of their date of hire. There are also other circumstances where enrollment is allowed outside of open season. These include:
- Death of a spouse or dependent
- Divorce or legal separation
- Birth or adoption of a child
- Foster child
- Change in employment status
- Spouse or dependent losing health coverage on another plan
Government Employees Health Insurance Plans
FEHB plans are available in all 50 states plus Washington, DC, Guam, and Puerto Rico. Availability of specific plans depends on where you live and what government agency in which you work. The FEHB website offers a link where you can click on your state to view the specific plans available in your area. These state links also offer copies of plan brochures for you to read more about each option.
FEHB offers both HMO plans and FFS plans (Fee for Service) from which to choose. Most FFS plans are PPOs (Preferred Provider Organizations). With these you get to choose your medical doctors from a list of preferred providers, but in doing so, you save money in co-pays.
Government Employees Health Insurance Benefits
Under FEHB plans, you receive several other benefits in addition to health insurance. These include:
- Flexible Spending Accounts
- Dental/Vision Coverage
- Life Insurance Plans
Government Employees Health Insurance Claims Disputes
With FEHB plans, you have a process you can follow if you feel a claim was unfairly denied or your insurance provider has refused a medical service that your doctor has stated is necessary. You should first write or call you plan provider and provide them with the specifics of the medical procedure. If your physician says the procedure is medically necessary you may want that doctor to speak with the company representative directly. If your claim is still denied you can write to the FEHB Office of Personnel Management and explain your situation. Each case will be reviewed and you will be contacted within 60 days of the date it was filed.
Government Employees Health Insurance Contact Information
If you have a health insurance plan under FEHB and you need to contact the agency managing these with questions, concerns, or claims disputes you can do so via the following methods.
U.S. Office of Personnel Management
Federal Employees Health Benefits Program, Room 3424
1900 East Street, NW
Washington, DC 20415-0001
Phone Number: (202) 606-1800