Reemployment in the Federal Service
If you are reemployed in the Federal service under conditions which terminate your entitlement to annuity, your health benefits enrollment will be transferred to your employing agency and premiums will be withheld from your salary. If your annuity continues during your reemployment, your coverage as a retiree will continue.
If You Have Medicare and Federal Employees Health Benefits Coverage
The monthly premium for your health benefits enrollment is not reduced if you or your spouse have Medicare coverage. In most cases, Medicare is the primary payer of your health benefits expenses, unless you are reemployed in the Federal service. When Medicare is the primary payer of benefits, it will generally pay its allowable covered benefits in full and your health benefits plan will pay a reduced benefit as the secondary payer. You will not receive duplicate payment for the same covered charges from Medicare and your FEHB carrier. You are responsible for paying any expenses either not covered or in excess of the total amounts allowed by Medicare and your FEHB carrier.
Consult your Medicare handbook (available from the Social Security Administration) and your FEHB plan brochure for information about covered and noncovered expenses. (Your FEHB brochure also provides information about whether Medicare or your FEHB plan is primary or secondary payer of your health benefits expenses.) Any questions concerning Medicare coverage and premiums, or whether Medicare is the primary or secondary payer of health benefits expenses, should be referred to the Social Security Administration, not OPM.
Note: When Medicare is the primary payer of your health benefits expenses, you must first submit your claim for services to Medicare. Always submit the Explanation of Benefits you receive from Medicare to your FEHB plan along with your claim. (When your FEHB plan is the secondary payer of medical expenses, it cannot process any claims until after Medicare has paid any covered expenses.)
If you and your spouse have both parts of Medicare (Part A Hospital Insurance and Part B Medical Insurance) and you are also in a high option (or in a plan with only one option); you may be paying for more coverage than you need. You may wish to consider changing to a less expensive plan or option.
Events Which Allow You to Change Your Enrollment
You may voluntarily cancel or change from Self and Family to Self Only at any time. If you cancel your enrollment, you generally cannot reenroll in the FEHB Program. [See Note (a) below for exception.] You may make other changes in your enrollment only on specified occasions and within certain time limits, as shown below. Except for an open season enrollment change, the effective date will usually be the first day of the month after the month in which we receive your request. To make any of these changes, write to OPM, Insurance Services Branch, P.O. Box 14172, Washington, DC 20044, stating exactly the change you wish to make, the event which permits the change, and the date on which that event occurred. For changes in marital status, or family status include a copy of the marriage certificate, divorce decree or birth certificate. Be sure to sign your request and provide your CSA number.			
Description of Event Which Permits Change	Prom Self-Only to Family	Prom One Plan or Option to Another	Time Limit in Which Election to Change Must Be Piled with OPM
Open Season.	YES	YES	As announced by OPM.
Your marital status changes (by marriage, divorce, annulment, or death of your spouse).	YES	YES	From 31 days before the change in marital status to 60 days after.
Your family status changes (for example, birth of a child).	YES	NO	Within 60 days after the change in family status.
You are enrolled in a prepaid plan (CMP/HMO) and you move or a covered family member moves from the area it serves.	YES	YES	If you or a covered family member present OPM with written notification of a change of address outside the plan's service area.
Your enrollment in an employee organization plan is terminated because the plan terminates your membership.	NO	YES	Within 31 days after your enrollment terminates. CO ===== c ■ j j 2
You separate from military service which was not limited to 30 days or less.	YES	YES	Within 31 days after separation from military service. 3
Your plan stops participating in the FEHB Program.	YES	YES	As announced by OPM at that time. ~ §
Your Federally employed spouse is enrolled for FEHB Self Only coverage but loses this coverage because his or her agency terminates the enrollment.	YES	NO	Within 31 days after your spouse's enrollment terminates, 1 • *
You become eligible for Medicare.	NO	YES	30 days before you become eligible for Medicare or any time thereafter.
Your eligible child(ren) loses coverage under someone else's FEHB enrollment.	YES	NO	Within 31 days after the child(ren) loses coverage.
Your spouse involuntarily loses non-Federal coverage or coverage for your spouse's dependents; or your eligible child loses non-Federal coverage under the other parent's health plan because the other parent involuntarily loses coverage for dependents.	YES	NO	Within 31 days before or after spouse's or dependent's loss of coverage or within 31 days before or after child's loss of coverage.
Note: (a) If you, as an annuitant or survivor annuitant, cancel your enrollment, you (c) If your spouse loses coverage under your family enrollment due to divorce but is eligible cannot later reenroll in an FEHB plan unless you have had continuous FEHB to enroll under the Spouse Equity provisions of the law, he or she must contact OPM within coverage under another person's enrollment during the time between your 60 days after the divorce or 60 days after you elect a survivor annuity for him or her. Certain cancellation and reenrollment or you dropped your Medicare - sponsored former spouses of employees who retired before May 7,1985, may be subject to a different prepaid health plan enrollment and wish to reenroll See the next page. time limit and should contact OPM. (b) If a family member, covered under your Self and Family enrollment, is also a Federal employee and loses coverage under your enrollment for any reason, he or she may be eligible to enroll in an FEHB plan and should contact his or her employing agency for information.			
DoC■
ft 75°^/Information for Retirees
About the
Federal Employees Health Benefits DOC.	Program
PM 1.10: '
RI 75-4/993 Keep this for your records
Whenever you find it necessary to write to the Office of Personnel Management (OPM), be sure to sign your name and give us your retirement claim number (CSA number).
If someone is writing to OPM on your behalf, we still must have your signature in order to provide information about your health benefits coverage or to take any action regarding your enrollment. However, if you become unable to manage your affairs due to a mental or physical disability, your guardian or other person responsible for your care and custody should immediately notify OPM, being sure to provide your CSA number.
If you retired under the Cjvil, Service Retirement System, the address is: i;	^4\/\//\
n'BhliP'sffy of
Retirement Operations Center '
Boyers, PA 16017 ' , r3ry
If you retired under the Federal Employees Retirement System, the address is: J ^1 c' ! w *
fak PR 1 9 1993
ImfiY OF ILLINOIS
----RBANA-CHAMPAIGN
If your mailing address changes, you should immediately notify OPM, Change-of-Address Section, P.O. Box 45, Boyers PA, 16017-0045. We must have your current address to provide you with information about the health benefits Open Season which occurs every year. You should also notify your health insurance plan of any address change.
This leaflet reflects legislation and regulations in effect through January 1993.
United S iff Personnel
United States Office of Personnel Management
Previous editions are usable.
Rl 75-4
Revised January 1993Your enrollment in a plan under the Federal Employees Health Benefits (FEHB) Program has been continued into retirement. Premiums are withheld from your monthly annuity payment. The premiums are for coverage for the previous month (for example, premiums withheld from the payment dated February 1 are for the month of January). As a retiree enrolled under this program, you are entitled to:
•	Continuation of the Government's contribution toward the cost of your plan. (The Government's contribution for postal retirees is less than for active postal employees.)
•	Continued protection, after your death, for your eligible family members (if at the time of your death you have a Self and Family enrollment and at least one person is entitled to a survivor annuity).
•	Continued opportunities to change your enrollment during Open Season or due to a change in marital or family status, etc., as explained in the chart titled "Events Which Allow You to Change Your Enrollment."
•	31-day extension of coverage without cost to you if your enrollment or coverage of a family member is terminated. However, if you voluntarily cancel your enrollment, there will be no extension of coverage for you or affected family members. See the information above the "events" which permit change for important information about cancellation.
•	Opportunities to continue your enrollment or to reenroll in the FEHB Program as explained in the chart titled "Events Which Allow You to Continue Your Enrollment or Reenroll."
You should refer to your plan's brochure for detailed information about your health benefits coverage.
You should continue to use the identification card you now have. If you lose this card, write directly to your plan to ask for a new one. OPM does not provide health benefits identification cards or claim forms.
Send all claims for benefits to your plan—not to OPM. The address of your plan is listed in the
UNIVERSilY OF ILLINOIS LIBRARY AT URBANA-CHAMPAIGN BOOKSTACKC
brochure which explains the benefits of the plan. Please do not write to OPM concerning claims for benefits.
If your claim is denied, your plan will reconsider its denial if you submit a written request for reconsideration within one year after the date of the notice denying your claim—refer to your brochure for complete instructions.
Self and family enrollments—If you have a Self and Family enrollment, your "family" includes your spouse and your unmarried dependent children under age 22 (see below for information about disabled children). Your stepchildren and foster children (including grandchildren) also are included if they live with you in a parent-child relationship. For a grandchild, the parent-child relationship is satisfied (whether or not a natural parent lives in the home) if you provide evidence that your grandchild lives with you, is financially dependent on you, and you expect to raise the grandchild into adulthood. Any new eligible family member (such as a new spouse) is automatically covered by your Self and Family enrollment. You do not need to tell OPM about the new family member, but your plan may ask you for more information.
Disabled children age 22 and over—An unmarried child incapable of self support because of a disability incurred before age 22 and which is expected to last at least one year may continue to be covered as a family member after reaching age 22. If you have a child so disabled and have already established this fact with your former employing office, you need take no further action unless OPM asks for another medical certificate. If you have a child so disabled but have not yet established this fact, you should inform OPM, Insurance Services Branch, PO Box 14172, Washington, DC 20044, no sooner than 120 days before the child's 22nd birthday or as soon as possible thereafter. We will send you a two-part questionnaire. The dependent or the person applying on behalf on the dependent must complete Part A and sign in the space provided. The dependent's physician must answer the questions and provide the information requested in Part B. After you provide this information, OPM will make an eligibility determination.
When a Family Member Loses Coverage Under Your Self & Family Enrollment
Your spouse - upon divorce or annulment of marriage.
Child - upon marriage or reaching age 22.
Disabled child age 22 or older - upon marriage, recovery, or becoming capable of self support.
If your family member loses eligibility for any of the above reasons, his or her coverage will continue for 31 days after the terminating event. During the 31-day period, the family member can convert to a nongroup contract by applying to your plan. The family member also may be eligible for temporary continuation of coverage (see below). Note: No one will notify you or the family member when he or she loses coverage.
If you become the only person eligible for coverage, you should notify OPM immediately so your enrollment can be changed to the less expensive Self Only coverage.
Temporary Continuation of Health Benefits Coverage
Children who lose FEHB coverage as family members and former spouses who lose coverage because of divorce or annulment and are not eligible to enroll in the FEHB Program under the Spouse Equity law on or after January 1, 1990, may, under certain circumstances, qualify for temporary continuation of coverage for up to 36 months after the qualifying event occurs. OPM must receive a request for the continued coverage within 60 days after the date of the qualifying event. The cost of temporary coverage is the full health benfits premium (there is no Government contribution) plus an additional administrative charge of 2% of the total premium.
If temporary continuation of coverage is desired for a child, you must contact us within 60 days after the event. In the case of a former spouse, you or the former spouse must contact us within 60 days after the event. The correspondence must include the name and address of the child or former spouse, as well as your name and claim number. Write to:
U.S. Office of Personnel Management Temporary Continuation of FEHB Coverage P.O. Box 14172 Washington, DC 20044
ooc.
Events Which Allow You to Continue Your Enrollment or Reenroll ex i
Description of Event Which Allows Continuation or Reenrollment	Continuation or Reenrollment	From Self Only to Self and Family	From One Plan or Option to Another	Time Limit in Which Continuation or Reenrollment Must Be Filed with OPM
You retire from overseas post of duty and are eligible to continue enrollment.	Continuation*	YES	YES	Within 60 days after retirement.
You are covered as a family member under another's FEHB enrollment and lose coverage other than by cancellation or change to Self Only of the covering enrollment.	Continuation*	Does not apply	Does not apply	Within 31 days after termination.
You are covered as a family member under another's FEHB enrollment and lose coverage due to cancellation or change to Self Only of the covering enrollment.	Continuation*	Does not apply	You must enroll in the same plan and option as that from which coverage is lost.	Within 31 days after cancellation or change to Self Only.
You qualify as a former spouse under spouse equity but you are covered as a family member under another's FEHB enrollment and lose coverage because of change of the covering enrollment from Family to Self Only.	Continuation for Self Only*	Does not apply	Does not apply	Within 31 days after change of covering enrollment has been filed.
Your enrollment in a Medicare-sponsored prepaid health plan ends for any reason.	Reenrollment	YES	YES	Involuntary loss of coverage: At any time beginning 31 days before and ending 31 days after loss of Medicare coverage. Voluntary loss of coverage: Only during next available open season.
*	You must have retired on an immediate annuity and at that time have been covered by an FEHB enrollment for 5 years or since your first opportunity.
☆ U.S. GOVERNMENT PRINTING OFFICE: 1993-0-338-886
This publication was printed on Recycled Paper