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Health Benefits Overview

Health Benefits Overview

Federal employees enjoy a highly competitive health insurance program called the Federal Employee Health Benefits Program (FEHB). This program offers many unique and enticing features that set it apart from many private health insurance programs. These features are listed below:

A Government Contribution 

The government pays 72 percent of the average premium toward the total cost of the your premium, but not more than 75 percent of the total premium for any plan.

Continued Group Caverage

They provide you and your family with coverage provided that you were covered in the FEHB program for five years. This includes coverage for your family if you transfer, move, enter the military. Your family, including your divorced spouse, is entitled to coverage in the event of your death.

Coverage After FEHB Ends

The FEHB Program offers either temporary continuation of FEHB coverage (TCC) or conversion to non-group (private) coverage. This includes coverage for you and your family if you leave federal service, for your dependents after they turn 22 or marry, and for your former spouse.

Types of Plans

Fee-For-Service Plans

Health coverage in which doctors and other providers receive a fee for each service such as an office visit, test, procedure, or other health care service. The plan will either pay the medical provider directly or reimburse you for covered services after you have paid the bill and filed an insurance claim. When you need medical attention, you visit the doctor or hospital of your choice.

Point of Service Plans

A product offered by an HMO or FFS plan that has features of both. In an HMO, the POS product lets you use providers who are not part of the HMO network. However, there is a greater cost associated with choosing these non-network providers. You usually pay deductibles and coinsurances that are substantially higher than the payments when you use a plan provider. You will also need to file a claim for reimbursement, like in an FFS plan. The HMO plan wants you to use its network of providers, but recognizes that sometimes enrollees want to choose their own provider.

Health Maintenance Organizations

A health plan that provides care through contracted or employed physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detection of illness. Your eligibility to enroll in an HMO is determined by where you live or, in some plans, where you work.

Source: Working for the Federal Government – Benefits, Office of Personnel Management

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