Unexpected accidents and illnesses can be expensive. Even routine doctor visits and prescriptions can add up. The Federal Employees' Health Benefits (FEHB) insurance is designed to protect you and your eligible family members against the cost of illness and accidental injury. FEHB is a voluntary program where you have a choice of several types of health plans with varying benefits and costs. However, each available plan provides comprehensive coverage for you, your spouse, and your children under age 26.

If you are an eligible employee and you decide to enroll, you and Smithsonian will share the cost of biweekly premiums. Your biweekly payroll deductions will be taken from your pay on a pre-tax basis (unless waived). This feature of the plan is called, "Premium Conversion." For a premium rate comparison for FEHB plans, click here and select "non-postal rates."

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. Those who do not currently meet the eligibility requirements may be eligible to enroll in FEHB when they meet the Affordable Care Act (ACA) eligibility regulations.

However, you may go to the Marketplace to evaluate coverage options, including eligibility for coverage through the Marketplace and its cost. Please visit www.healthcare.gov for more information including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

There are several plan types available in the FEHB program. The plans differ in cost and benefits. You should carefully review the brochures on the plans available to you, taking into consideration your family's health care needs before selecting your plan. For a description of and information about each plan type, visit the FEHB website.

• Fee-for-Service (FFS) with a Preferred Provider Organization (PPO)
• Health Maintenance Organization (HMO)
• Point-of-Service (POS)
• Consumer-Driven Health Plan (CDHP)
• High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) or Health Reimbursement Account (HRA)

For a premium rate comparison for FEHB plans, click here.

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.

Your participation in the FEHB is voluntary. New federal employees must enroll or waive coverage within 60 days of their entrance on duty date by completing Standard Form 2809. No verbal enrollments and enrollment changes (including cancellations) will be accepted. Plan brochures are available online at the OPM health care website or at the SAO Benefits Office.

Future changes that you make due to a Qualifying Life Event (QLE) must be made by completing a new SF 2809. Annual Open Season changes should be made online via the Employee Personal Page (EPP) at www.nfc.usda.gov. Please refer to the MyEPP navigation guide.

For new federal employees, the effective date of health insurance coverage will be the first day of the pay period after your accurately completed election (SF 2809) is received in the SAO Benefits Office (MS17). Open Season changes are effective on the first day of the first pay period of the new calendar year. For a change made in conjunction with the birth or adoption of a child, or the 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. A newborn child is automatically covered at birth if you already have a family plan. Otherwise, a change in plan type is required and a new SF 2809 must be completed with the newborn's information.

You may choose either self only, self-plus-one, or self and family coverage. Self-plus one is an enrollment type that allows enrollees to cover themselves and one eligible family member they designate to be covered. Family member eligibility for self-plus-one enrollment is the same as for a self and family enrollment, which includes an eligible spouse OR an eligible child under age 26. A child age 26 or over who is deemed incapable of self-support because of a mental or physical disability that existed prior to age 26 is also an eligible family member.

If you waive initial enrollment or become dissatisfied with the health plan you chose, you may make a new election during annual Open Season that usually occurs in mid-November through mid-December and becomes effective the following January. You should notify the SAO Benefits Office at SAO-Benefits@cfa.harvard.edu if you are considering changing enrollment. Keep in mind that Open Season changes must be done online, as previously stated.

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 period of time, 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-plus-one or from self-plus-one to self only at any time.

Changes in Family Status. If you are enrolled under a health benefit plan, you may change your enrollment from Self only to self-plus-one or self and family within 60 days after any change in the family status (e.g., the birth of a child). A newborn child is automatically covered at birth if you already have a family plan. Employees can change from self and family or self-plus-one coverage with an appropriate life event. Employees not participating in premium conversion (the pre-tax benefit) can change at any time. For health benefit purposes, eligible family members include:

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

Changes 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 prior to 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. Note: Dual enrollment in FEHB program is prohibited.

Change Due to Children's Health Insurance Program (CHIP) Reauthorization Act of 2009. Effective April 1, 2009, eligible employees and dependents who are or become eligible under CHIP (Chgildren's Health Insurance Program) or Medicaid may enroll in the FEHB plan. Enrollment must occur within 60 days of: (1) the termination of Medicaid or CHIP coverage resulting from a loss of eligibility; or (2) becoming eligible for premium assistance under Medicaid or CHIP program.

Termination of 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 of the termination of your coverage. 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.

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.

You may continue your FEHB coverage after retirement if you: (1) receive an immediate annuity; (2) retire on disability; and (3) were enrolled in the health benefits program during all of your service from the time of your first opportunity to join, OR were enrolled for the 5 years of service immediately before retirement.

When an enrolled employee or annuitant dies, the members of the family are eligible to continue their coverage, provided at least one of them is eligible for a survivor annuity under the retirement system.

During non-pay status, you may elect to continue your coverage for up to one year, unless you enter military service for more than 30 days. Employees deployed for military service greater than 30 days can continue their coverage for up to 24 months. After 24 months, coverage is terminated and the employee can elect Temporary Continuation Coverage (TCC).

Employees who use Leave Without Pay (LWOP) are responsible for repaying the employee share of the paid premiums and will be billed directly for these premiums by the National Finance Center (NFC), Smithsonian's Payroll Administrator, when returned to duty or upon separation from employment.

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 be equal to 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 (Smithsonian'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 for instructions should you anticipate a qualifying event.

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

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 for you and your family. You are not required to enroll in the FEHB Program to be able to enroll in dental and/or vision coverage through FEDVIP. Premiums are deducted from your pay on a pre-tax basis.

New employees have 60 days to enroll; all other eligible employees may enroll during the annual Open Season or after a qualifying life event occurs that allows for enrollment outside of Open Season. FEHB and FEDVIP are separate programs; while your health plan benefits may offer dental and/or vision benefits as part of their coverage, only those carriers contracted through OPM are FEDVIP plans.

Eligible employees and/or retirees may enroll in a plan for self only, self-plus-one, or self and family coverage. Eligible family members include an employee's spouse and unmarried, dependent children under age 22, or if age 22 or older, the dependent child must be incapable of self-support because of mental or physical disability that existing before age 22. Health Care Reform does NOT extend coverage for children until age 26 or provide coverage for married dependent children under the FEDVIP program.

Please refer to the "HELP" section of the BENEFEDS Portal at www.BENEFEDS.com. 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. To speak with a Customer Service representative contact the Customer Service Center at 1-877-888-FEDS (1-877-888-3337) (TTY 1-877-889-5680) Monday through Friday from 9:00 am to 7:00 pm Eastern time.

The following individuals are not eligible for enrollment in FEDVIP:

• Deferred Annuitants
• Former spouses of employees or annuitants
• FEHB Temporary Continuation of Coverage (TCC) enrollees
• Temporary employees serving under an appointment limited to one year or less and have not completed at least one year of current continuous employment, excluding breaks in service of 5 days or less
• Intermittent employees (those who do not have a prearranged regular tour of duty)
• Seasonal or occasional employees.

There are four nationwide and several regional carriers under dental coverage and all vision plans are nationwide plans.

Dental plan options are available here, and premium rates for dental plans may be viewed here.

Vision plan options are available here, and premium rates for vision plans may be viewed here.

Questions about health benefits should be directed to the SAO Benefits Office at SAO-Benefits@cfa.harvard.edu.