Former Spouses Eligibility For Fehb Program Under Spouse Equity
Reviewing a Former Spouses Eligibility for Federal Employees Health Benefits Program Under Spouse Equity
Edward A. Zurndorfer
The Civil Service Retirement Spouse Equity Act of 1984 was enacted on Nov. 8, 1984. Under this act as amended, certain former spouses of federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the Federal Employee Health Benefits Program .
This column discusses the rules for a former spouse of a federal employee, a former federal employee, or an annuitant for enrolling in the FEHBP under the Spouse Equity Act. The discussion includes the eligibility requirements, types of enrollments, the application process including deadlines to apply, and what an enrolled former spouse can do during an FEHBP open season. The current FEHBP open season is being held through Dec. 13, 2021, that allows employees, annuitants, and former spouses to make changes to their FEHBP enrollment for plan year 2022.
In this column, enrollee means a current federal employee, a former federal employee, or a federal retiree currently receiving a CSRS or FERS annuity . Divorce includes certain annulments.
Should I Enroll In Part B If I Have Fehb Coverage
Deciding whether to enroll in Part B is complicated. And unlike Medicare Part A, all enrollees pay a premium for Medicare Part B . While FEHB plans cover most of the same types of expenses that Medicare covers, FEHB plans coverage may be more limited than Medicare Part B when it comes to orthopedic and prosthetic devices, durable medical equipment, home healthcare, medical supplies, and chiropractic care. Conversely, FEHB plans cover emergency care received outside the United States, and this isnt covered by Original Medicare at all and is rarely covered by Medicare Advantage. FEHB plans may also pay for vision and dental care thats not covered by Original Medicare and is limited in Medicare Advantage.
If you are covered by an FEHB HMO plan, youre normally limited to seeing providers who are part of your plan. Having Part B means you can go outside the HMOs network and see other providers, as long as theyre part of Medicare.
What Happens If I Decline Fehb Coverage
If you decline FEHB coverage, you would give up the subsidy the government pays toward it, which ranges from a low of about $350 for self-only coverage to $1,000 or more if youre also covering family members. If your family members are covered under FEHB, their coverage would end if you terminate yours.
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Determination Of Entitlement To Future Annuity
When a former spouse applies to the employing office for FEHBP benefits, the office will advise him or her that he or she must send a written requires to the retirement system for a determination of entitlement to either: a portion of the enrollees future retirement CSRS or FERS annuity or a former spouse survivor annuity.
The request must include: a certified copy of the divorce decree, property settlement, and/or court order and the enrollees name, date of birth, Social Security number and last employing agency.
Unless the enrollee is subject to the CIA or Foreign Service retirement systems, OPM not the employing agency will make the former spouse annuity benefit determination based on the court order supplied. The former spouse cannot enroll in the FEHBP until OPM makes its determination.
OPM will send the former spouse a written decision. If eligibility is determined, he or she will submit a copy of the decision to the enrollees employing office.
Are Medicare Rules Different If I Have Fehb Coverage
Most people who have retiree coverage must enroll in Medicare Part A and Part B when first eligible. If they dont enroll, their retiree plan may pay only a small amount or nothing at all for their care. Medicares rules for you are different, however, if youre a federal retiree. As a federal retiree, if you dont enroll in Medicare, your FEHB plan will act as your primary insurer and wont pay less because you qualify for Medicare.
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Why A Former Spouse Should Consider Enrolling In The Fehbp Under The Spouse Equity Provisions
In spite of the fact that a former spouse pays the full FEHBP health plan premium cost with no federal government contribution, an eligible former spouse should seriously consider enrollment in the FEHBP under Spouse Equity Act provisions. Among the reasons to enroll are guaranteed issue federal government-sponsored group health insurance , no waiting periods, no exclusions, and no catastrophic payout limit.
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Employees With An Fsa Can Access Their Full Unused Balance From 2021
You can once again access your full, unused balance from your 2021 FSAs, including: health care FSAs, dependent day care FSAs and Child Care Subsidy Grants. Ordinary “use it or lose it” rules are expected to be reinstated at the end of 2022, meaning you won’t be able to carry over your full unused balance into 2023.
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What’s Changing What’s Staying The Same For 2022
The lowest-cost plan for 2022 is the Kaiser HMO, which continues to be free to full-time employees for employee-only coverage. Your contributions under the Healthcare + Savings HDHP decreased for 2022. Employee contributions did not increase for Kaiser HMO, Trio or ACA Basic HDHP. While we work to keep plan premiums low, the rising cost of health care is impacting the cost for the Stanford Health Care Alliance , and employee contributions for this plan increased in 2022.
How Do I Enroll
- Generally, you will make your election to enroll or not to enroll with the Processing and Servicing Center during your onboarding process.
- After your first 60 days of employment, complete and submit SF- 2809 to the Retirement and Benefits Portal or mail original to U.S. Customs and Border Protection, Retirement and Benefits Advisory Services , 90K Street NE, 5th Floor, Washington, DC 20229, Mail Stop 1400.
Note: Annuitants not currently enrolled in FEHB cannot enroll after retirement.
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If I’m In The Fehb Should I Enroll In Part A
Most people dont have to pay a premium for Part A. When combined with FEHB coverage, having Part A would limit your out-of-pocket costs for the expenses it covers . Having Part A means you cant contribute to a Health Savings Account , so youd want to delay enrolling in Part A if your FEHB coverage is HSA-qualified and you want to continue making contributions to your HSA.
You can only delay Part A until you begin collecting Social Security at which point your Part A coverage will start automatically. The Office of Personnel Management , which administers the FEHB, recommends taking Part A if you dont have to pay a premium.
Will Fehb Be My Primary Coverage Or Medicare
If you have FEHB and do enroll in Medicare, then Medicare will be your primary coverage and your FEHB plan will pay after Medicare does. Having Medicare could reduce your out-of-pocket costs, because many FEHB plans waive cost sharing for enrollees who have Medicare. Even if this isnt the case, as long as your provider takes both your FEHB plan and Medicare, the most youd have to pay for care is the difference between what Medicare and your FEHB plan pay and Medicares limiting charge.
. Some states dont allow excess Medicare charges. If you live in one of these states or you see a doctor in any state that accepts Medicares rate as full payment youd only have to pay the difference between what Medicare and your FEHB plan pay and Medicares rate. Part Bs limits on what you can be charged dont apply to some services, and Part A doesnt have these limits.)
If you enroll in Part A but decline Part B, your FEHB coverage will pay after Medicare does for Part A services, but will be your primary insurer for other medical care. Medicare would no longer be your primary insurer if you return to work for the federal government, however, and in that case your FEHB plan would pay first, with Medicare paying at least some of your remaining costs.
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Stanford Increased Its Health Savings Account Contribution
For Healthcare + Savings HDHP participants, Stanfords contribution to the HSA in 2022 has increased to $850 for employee-only coverage and $1,700 for family coverage. The IRS annual contribution limits have increased to $3,650 for employee-only coverage and $7,300 for family coverage. The IRS limits combine employee and employer contributions.
Loss Of Coverage As A Family Member
Because of a divorce or an annulment, a former spouse will lose coverage as a family member . Assuming the former spouse can enroll in the FEHBP through the Spouse Equity Act provisions, the actual enrollment may not begin for several months after the divorce. Enrollment in the FEHBP will depend on how long it takes to establish eligibility for FEHBP enrollment. The following example illustrates:
Karl, a federal employee, has been married to Lisa for 15 years, all of which Karl has been a federal employee. Karl and Lisa are divorcing effective Dec. 31, 2021. Karl has been enrolled in the FEHBP and has continuously included Lisa on his FEHBP health plan. Since Karl and Lisa will be divorced as of Dec. 31, 2021, Karl during the current benefits open season switched his FEHBP enrollment from self plus one to self only. The enrollment change becomes effective Jan. 2, 2022, the first day of the 2022 leave year. Lisa will then have a 31-day extension of FEHBP enrollment from Jan. 2, 2022 to Feb. 1, 2022.
To avoid a gap in health insurance coverage between the end of the 31-day extension of coverage and when the Spouse Equity Act provisions take effect, the former spouse may:
- convert to a non-group contract during the 31-day extension of coverage, or
- continue FEHBP coverage under the Temporary Continuation of Coverage provisions of the FEHBP law.
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Will I Pay Less For Fehb Premiums If I Enroll In Medicare
FEHB premiums are not reduced if you enroll in Medicare, but having Medicare Part A and B can allow you to switch to a less expensive version of your current FEHB plan, because some FEHB insurers waive cost sharing when you have Medicare Parts A and B. Contact your FEHB insurer if youre wondering whether your plan waives cost sharing for people enrolled in Medicare.
The decision whether to enroll in Part B often hinges on whether you have to pay more for it because of your income. You pay more for Part B in 2020 if you earn over $87,000 , according to your tax return from two years ago. These higher premiums can range from $202.40/month to $491.60/month. Youll have to gauge how much you are willing to pay in Part B premiums in exchange for lower cost sharing when you visit the doctor.
Should I Enroll In Medicare Part D If I Have Fehb Coverage
You generally dont have to sign up for a Part D plan if you are covered through FEHB. The prescription coverage through your FEHB plan may have fewer restrictions than the Part D plans in your area. FEHB plans limit what youll have to pay each year in covered medical and prescription drug costs, but Part D plans do not. If you do sign up for Part D, it will usually be your primary insurer.
If youre eligible for Extra Help, you probably do want to use Medicare Part D, because the co-pays for people with Extra Help pay are typically lower than the costs in FEHB plans. People with the most generous level of Extra Help pay only $3.60 for generics and $8.95 for brand medications in 2020.
Because FEHB is considered creditable coverage, you wont have to pay a late enrollment penalty if you dont take Part D now and decide to enroll in the future.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals.
In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including as an associate at Sachs Policy Group, where he worked with insurer, hospital and technology clients on Medicare and Medicaid issues.
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Working For The Federal Government What Every Employee Should Know
If you have never worked for the Federal Government, it is important that you take a few minutes and read this information. If you have worked for the Federal Government and have been away for a while or are a current Federal employee, you should also review this information because a number of rules and procedures have changed. A word of advice – there are many things you will learn throughout your employment in the Federal workforce. Pay close attention, save all your paperwork, learn where to go and get answers, and never assume anything is the same from day to day. Please keep this booklet as a handy reference. Should you have any questions or concerns, please call the Office of Human Resources Management on 301-504-7925.
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Why Should You Enroll
- No restrictions due to pre-existing conditions
- Government contributions to the cost
- Employees pay premiums with pre-tax dollars
- Retirees pay premiums with after-tax dollars unless they are a retired public safety officer
- High deductible health plans available with a health savings account or health reimbursement arrangement
- Continued coverage after retirement
Federal Employees Health Benefits Program
The IRS participates in the Federal Employees Health Benefits Program , one of the best health care insurance programs in the world. You can choose from a variety of health care plans and options, and your IRS health benefits cover you and your family members at reasonable rates. This program offers:
- One of the widest selections of plans in the country
- Annual open season
- Coverage that continues into retirement, at the same rate
- Pre-tax options
The 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.
Here are even more important program features:
- No waiting periods. You can use your benefits as soon as your coverage becomes effective. There are no pre-existing condition limitations even if you change plans.
- A choice of coverage. You can choose self-only coverage 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.
- Fee-for-Service plans
- Plans offering a Point of Service product
- Health Maintenance Organizations
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Concierge Health Care Support For Hdhp Members
During 2022, those enrolled in the Healthcare + Savings HDHP or ACA Basic HDHP have access to a concierge service through Included Health , helping you navigate your health insurance, resolve claims, get a second opinion, find great doctors and more. Your Included Health personal care team will be available 24/7 to support you in making good healthcare decisions throughout the year. Learn more
Should I Suspend My Fehb Cover To Enroll In Other Coverage
You can suspend your enrollment in FEHB to enroll in Medicare Advantage or other eligible coverage by contacting your agencys retirement system, and providing them documentation that you enrolled. If you do this, youll be allowed to leave your Medicare Advantage plan and return to FEHB. You usually have to wait until Medicares fall open enrollment and FEHBs Open Season to re-enroll in FEHB. You wont have to wait until an enrollment period if your Medicare Advantage plan ends through no fault of your own. In that case, you could re-enroll between 31 days before and 60 days after your Medicare Advantage plan ends. The FEHB coverage would begin the day after the Advantage plan terminates.
FEHB also allows you to suspend your enrollment if you want to use health coverage through Medicaid, Peace Corps, CHAMPVA, TRICARE, or TRICARE-for-Life. You can re-enroll in FEHB if this other coverage ends through no fault of your own. If you cancel your FEHB coverage instead of suspending it, youll never be able to re-enroll.
Although FEHB coverage can be more generous overall than Medicare Advantage or Original Medicare, having additional coverage may not be helpful if you cant afford its premiums. If you qualify for the Medicare Savings Program or Medicaid, you may find your healthcare costs are lower overall if you dont use FEHB.
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