Q. Another plan has some extra services that I can't get in my own plan.
When is the next time I can change plans?
A. You can change plans during the annual FEHB Open Season and whenever you have a
qualifying life events (QLE) -- such as marriage. Becoming aware of another plan that has better benefits, even if you didn't expect to want the extra benefits when you had a chance to change plans before, does not qualify as a "QLE" that allows you to change plans.
Q. If I join a plan because my doctor is a participating doctor or specialist and then my doctor drops out of my plan's network in the middle of the year, can I switch plans?
A. No. You would need to wait for open season. It is not uncommon for providers to leave plans mid-year. Other plan providers will be available to provide care.
Q. I have a pre-existing heart condition. When I change plans, do I need to worry about a waiting period before I can get coverage?
A. There are no exclusions or waiting periods for pre-existing conditions in any plan in the FEHB Program. This is also true after you retire.
Q. Generally, what events allow me to change my enrollment?
A. During the annual FEHB open season, you may enroll, cancel an enrollment, change plans or options, and waive or begin participation in premium conversion. Outside of open season, you can make changes due to certain events, called
qualifying life events (QLEs). The most common QLEs for changing enrollment type or plan are: marriage, acquiring a child, moving away from the area served by your Health Maintenance Organization (HMO), losing health insurance coverage, or changing employment status.
If you waived participation in premium conversion, you can change from self-
and-family enrollment to a self-only enrollment or cancel your enrollment at any
time. You can make other changes during open season or due to certain events.
Your Human Resources Office can give you more information about these
events.
Q. When I change plans, what date will it be effective?
A. Open season changes for most Federal employees are effective the first day
of the first full pay period that begins in January. Generally, mid-year changes
are effective on the first day of the pay period which begins after your
enrollment is received by your Human Resources Office.
Q. When my youngest child turns age 22 next month, I won't have any family members who are eligible for coverage. Do I have to wait until open season to change from self-and-family to a self-only enrollment?
A. If you are an annuitant or an employee who waived premium conversion, you
can change from a self-and-family enrollment to a self-only enrollment at any
time. If you are an employee under premium conversion, your youngest child
turning age 22 is a qualifying life event (QLE) that would allow you to change
either your premium conversion election and/or your FEHB enrollment. It would
be entirely consistent with this life event to consider a change to self-only
coverage. You do not need to wait until the next Open Season to make this
change; however, you need to request a change to self-only coverage within 60
days after this event.
Q. I'm interested in changing to either a health maintenance organization (HMO) or a plan with a Point-of-Service (POS) product. How can I find out where their providers are located?
A. The plans print their provider directories and have them available during
open season. Many plans also provide this information on their web sites. If your
agency will have an open season health fair this fall, the plans probably will be
there to hand out their brochures and provider directories. You can also call
the plan at the number listed in any of the FEHB Guides. Plan brochures, plan web site addresses and FEHB guides are available at
www.opm.gov/insure/health.
Q. I want to change my FEHB enrollment to an HMO but I don't live or work in the Plan's area as required by that particular plan's brochure. Why can't I enroll in it?
A. Most health maintenance organizations (HMO) restrict enrollment to an area where its doctors and hospitals are accessible. Although some HMOs do not have restrictions on where you live or work, please recognize that if you later find it is inconvenient to get to a plan provider, you may have to wait until the next open season to change plans.