HR: Benefits: Federal Employees
Health Benefits
 
 Health Plan Choices

The Guide to Federal Employees Health Benefits Plans lists numerous FEHB plans available in most every state. Select from fee-for-service including the option of a Preferred Provider Organization (PPO), Health Maintenance Organizations (HMOs), Point-of-Service (POS) plans, Consumer-Driven Plans, or High Deductible Health Plans with Health Savings Accounts. Some of these plans are open to all eligible employees, some are open only to members of labor organizations, while others depend on where the employee resides. The plans differ in benefits and cost per pay period. Consider your family's health care needs and carefully study the brochures on the plans available to you before selecting coverage. Choose a plan that you can afford and that best suits your needs. Plan brochures can be accessed on the OPM Webpages.

 

Dental and Vision Insurance

The Federal Employees Dental and Vision Program (FEDVIP) is available to eligible federal employees and their eligible family members on an enrollee-pays-all basis. This program allows dental and vision insurance to be purchased at group rates, with no pre-existing condition limitations. You are not required to enroll in the FEHB Program to be able to enroll in dental and/or vision coverage through FEDVIP. Further program details may be found at OPM's Dental and Vision webpage.

You can enroll in a dental plan and/or vision plan for self-only, self plus one, or self and family coverage. Eligible family members include your spouse and unmarried dependent children who are under age 22, or a dependent child who is incapable of self-support. Biweekly premiums will be withheld from your pay on a pre-tax basis.

Plan options and premium rates for FEDVIP dental plans may be viewed here. Plan options and premium rates for FEDVIP vision plans may be viewed here.

Employees must enroll within 31 days of initial appointment or eligibility date. If you waive initial enrollment or become dissatisfied with the plan you choose, you may make a new election during Open Enrollment, which will occur annually in conjunction with the FEHB Open Enrollment period. You can enroll through the BENEFEDS Portal. You will be directed to a secure website where you will be asked to enter your name, personal information such as address and Social Security Number, the agency you work for, and the dental and/or vision plan you select. If you do not have access to a computer, you will be able to enroll by phone at 1-877-888-3337, TTY 1-877-889-5680.

 

Eligibility Requirements

You are eligible to enroll in the Federal Employees Health Benefits (FEHB) Program if you are employed on a regularly scheduled (full-time or part-time) appointment which is not limited to one year or less. Under the FEHB Program there are no medical examinations, no waiting periods, and no restrictions because of age or physical conditions.

To qualify for FEHB coverage, a temporary employee must complete one year of current continuous employment, excluding any breaks in service of 5 days or less and must have a regularly scheduled tour of duty of at least 40 hours per pay period.

The Smithsonian offers group health coverage to certain temporary employees not eligible under the FEHB Program through the Trust Fund health benefits program. To qualify for this program, the temporary employee must have an appointment of one year or more and a regularly scheduled tour of duty of at least 40 hours per pay period. Temporary employees eligible for this program are responsible for the entire cost of health premiums. There is no government contribution.

On June 26, 2013, the Supreme Court ruled that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional. As a result of this decision, the United States Office of Personnel Management (OPM) will now be able to extend benefits to Federal employees and annuitants who have legally married a spouse of the same sex.

All legally married same-sex spouses will be eligible family members under a Self and Family FEHB enrollment. In addition, the children of same-sex marriages will be treated just as those of opposite-sex marriages and will be eligible family members according to the same eligibility guidelines. This includes coverage for children of same-sex spouses as stepchildren. For those employees who already have a Self and Family insurance plan, coverage for their same-sex spouse will begin immediately upon notifying their FEHB carrier of a newly eligible family member. For those employees electing Self and Family for the first time, benefits will become effective on the first day of the first pay period after the enrollment request is received in HR. Employees should use the Health Benefits Registration Form, SF-2809 to enroll a new dependent. Please send the completed form to the SAO Benefits Office, MS17.

 

Cost

If you choose to enroll, your share of the premium depends on the plan you select. A substantial contribution to the premium is paid by Smithsonian. Your share of the premium will be deducted from your salary on a biweekly basis. The cost and coverage provided for part-time employees is the same as for full-time employees. For a premium rate comparison for FEHB plans, click here.

Your FEHB premiums will be deducted from your salary on a pre-tax basis, unless you opt out. This feature of the plan is called Premium Conversion.

 

Enrollment and Plan Changes

Please refer to the Guide to Federal Employees Health Benefits Plans for a listing of available health plans and biweekly costs. Employees must enroll within 31 days of initial appointment or eligibility date. The soonest coverage can become effective for a new employee is the first day of the pay period following the one in which employment begins.

Your participation in the FEHB Program is voluntary. However, you must complete a Health Benefits Registration Form, SF-2809, to enroll, elect to waive coverage, or make changes to a previous benefits election. You may choose either"self only" or "self and family" coverage. Enrollments or changes are effective the first day of the pay period after the completed SF-2809 is received in the SAO Benefits Office (MS17), except as noted below:

  1. Open Season changes are effective on the first day of the first pay period of the new calendar year.
  2. For a change made in conjunction with the birth or adoption of a child, or addition of a child as a new family member, the change is effective the first day of the pay period in which the child is born or becomes a family member.

Changing Health Plans

If you waive initial enrollment or become dissatisfied with the health plan you choose, you may make a new election during the annual Open Enrollment season that usually occurs in November and becomes effective the following January. You should notify the SAO Benefits Office at (617) 495-7371 if you are considering changing enrollment.

Qualifying Life Events

Events that permit enrollments or changes in enrollment are listed in the instruction pages of the SF-2809. Most permitted changes must be elected within a specified time period, so it is important that you notify the SAO Benefits Office as soon as you know the qualifying event will occur. You may change from "self and family" to "self only" at any time.

  1. Change in family status - If you are enrolled under a health benefit plan, you may change your enrollment to "self only" or to "self and family" within 60 days after any change in the family status (for example, the birth of a child). For health benefit purposes, eligible family members include:

    • The employee's spouse.
    • The employee's children, including legally adopted children, stepchildren, and foster children to age 26.
    • The employee's children with, or eligible for their own employer-provided health insurance are eligible up to age 26. The children's employer-provided health insurance will be the primary payer; FEHB will be the secondary payer.
    • The employee's married children (but not their spouse or their own children) are covered up to age 26.
    • A child who is incapable of self-support because of a mental or physical disability that began before age 26 are eligible to continue coverage. Contact the SAO Benefits Office for additional information.

  2. Change in marital status - You may change your enrollment if you change marital status, including marriage, death of a spouse, or divorce. The change may be submitted any time from 31 days before the event to 60 days after the event. Former spouses whose marriage dissolved before the employee's retirement and have a future entitlement to an annuity may be eligible to participate in health coverage.
  3. Termination of a family member from Federal plan coverage - If you are covered under a Federal health insurance plan by another member of your family and the policy is terminated for any reason, you may enroll in another Federal plan within 31 days after termination. If the new plan you elect is discontinued or the plan you elect is good only in an area from which you move, you may elect another plan.
  4. Loss of family member coverage under a non-Federal plan - You may enroll in or change to a family enrollment upon the loss of non-Federal health insurance coverage by another family member. The time period for doing so begins 31 days before and ends 31 days after the loss of coverage.
  5. Leave Without Pay (LWOP)

    Unless you cancel your coverage, your health insurance will remain in effect while you are on LWOP for up to one year. SAO will continue its contribution and your contribution during this period. You are responsible for repaying your share of the paid premiums and will be billed directly for these premiums by the National Finance Center (NFC) SAO's payroll administrator, when you return to duty or upon your separation from SAO.

     

    FEHB and Medicare Part D

    Please be aware that all FEHB health plan brochures include a Medicare Part D Disclosure Notice. This notice states that all FEHB plans have prescription drug coverage that is comparable to Medicare Part D prescription drug coverage. Click here to view a copy of this disclosure notice.

     

    Termination of Coverage

    Coverage of an enrolled employee continues for 31 days after the enrollment terminates, except in cases of retirement and voluntary cancellation.

    • Temporary Continuation of Coverage (TCC) - TCC is a provision of the FEHB program that allows employees and their covered dependents to temporarily continue their FEHB coverage after regular coverage ends. Separated employees may elect continuation of coverage for up to 18 months from the end of the pay period that separation from service occurred. Spouses and dependents of employees who lose coverage because of divorce, death of a covered employee, or loss of dependent status of a dependent child may enroll to continue coverage for 36 months. Premiums will equal 102% of the total monthly premium in effect at the time of the qualifying event and are remitted on a direct pay basis to the National Finance Center (SAO's payroll administrator). Premiums are subject to change annually.

      TCC must be elected no later than 60 days from the date of the qualifying event. If you do not exercise your rights within the allowed time period or if you fail to make the required premium payment, you will forfeit your right to continue coverage. You should contact the SAO Benefits Office without delay for instructions should you anticipate a qualifying event.

    • Conversion - If you leave Federal service before retirement, you or any member of your family has a temporary extension of 31 days during which a conversion may be made to a non-group contract. The provision is important to individuals who might not otherwise be able to qualify for a regular group policy due to a physical or pre-existing condition.

    • Coverage after Retirement - You may continue your coverage after retirement if you: (a) receive an immediate annuity, (b) retire on disability, (c) were enrolled in the health benefits program during all of your service from the time of your first opportunity to join, or (d) were enrolled for the five years of service immediately preceding retirement. When an enrolled employee or annuitant dies, the members of the family are eligible to continue their coverage, provided that at least one of them is eligible for a survivor annuity under the retirement system.

    Questions about health benefits should be directed to the SAO Benefits Office at (617) 495-7371.

 
 

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