Federal Benefits
FastFacts
The Federal Employees Health
Benefits (FEHB) Program
* What is the FEHB Program? FEHB
provides comprehensive health
insurance. You can choose from fee-
for-service (FFS) plans, health
maintenance organizations (HMOs),
consumer-driven health plans (CDHPs)
and high deductible health plans
(HDHPs). Find more information on
types of plans at
www.opm.gov/insure/health/planinfo/ty
pes.asp.
* Am I eligible? Most Federal
employees are eligible to enroll; those
who are not eligible usually have
limited appointments of short
duration, or work sporadically only
during certain seasons or when
needed by their Federal agency. If
you think you may be eligible and
your agency has not provided
information about enrollment, contact
your Human Resources (HR) office.
* When can I enroll? New
employees, employees who are newly
eligible, and those who experience
certain FEHB qualifying life events
(QLE) such as marriage, divorce,
birth, death, etc., may enroll within
60 days of becoming eligible or of the
QLE. (Find a summary of the major
QLEs at
www.opm.gov/insure/health/planinfo/
qle.asp.) All other employees may
enroll during the annual Federal
Benefits Open Season (held from mid-
November through mid-December).
* How do I enroll? Some agencies
use the Health Benefits Election Form
(SF 2809) while others use an online
self-service system such as Employee
Express, MyPay, Employee Personal
Page, EBIS, etc. Contact your HR office
for details.
* How much do I pay? What you pay
is based on the plan and option you
choose. Generally, premiums are
shared by you and your Federal agency.
Premiums vary by plan but generally
you pay about 30% and your agency
pays about 70%.
You can find health insurance premiums
on our website at
http://www.opm.gov/healthcare-
insurance/healthcare/plan-
information/premiums/ or in the health
plan brochures
You can also find this information when
using our Plan Comparison Tool at
http://www.opm.gov/healthcare-
insurance/healthcare/plan-
information/compare-plans/
* Can I pay my premiums pre-tax?
Paying premiums pre-tax (known as
premium conversion) allows Federal
employees to use pre-tax dollars to pay
premiums for the FEHB Program. You
will automatically be under premium
conversion unless you elect to waive it.
Federal retirees are not eligible to pay
premiums with pre-tax dollars.
* What enrollment restrictions
will I have under premium
conversion? You will not be allowed
to change your enrollment to Self
Only or cancel outside of Open Season
or experiencing an FEHB-specific QLE.
* When can I change my
enrollment?
During the annual Open Season or
when you experience a QLE.
* What are some important
things I should know?
There are no waiting periods
and no pre-existing condition
limitations, even if you
change plans;
Each plan contracts with
doctors and hospitals (known
as a provider network). Your
doctor may participate in one
or more provider networks;
You will reduce your out-of-
pocket costs by visiting
doctors and hospitals who
contract with your plan. Visit
your plan’s website to
determine which providers
participate in the plan’s
network;
FEHB coverage automatically
continues each year; you do
not have to reenroll;
You can continue FEHB
coverage into retirement if
you meet certain eligibility
and enrollment
requirements;
If you are enrolled in the
Federal Flexible Spending
Account Program, you may
submit your health benefits
copayments, coinsurance and
deductibles as eligible
expenses for your FSA
account.
* Are there resources I can use
to help me find the right health
plan? Yes, the list of resources
below can help you. You can find
these on our website at
www.opm.gov/insure/health.
Compare Health Plans, a tool
that allows comparison of
benefits of up to four plans in
one view
Information on plan quality
o Satisfaction ratings of
customers enrolled in
each plan
o Plan effectiveness of
patient care measures
* Where can I go for more
details or additional
information?
Your health plan’s brochure
Our website at
www.opm.gov/insure/health
