HEALTH BENEFITS
III. QUESTIONS ABOUT SWITCHING PLANS
Another plan has some extra services that I can't get in my
own plan. When is the next time I can change plans?
You can change plans at open season and whenever
certain events -- such as marriage -- occur. Becoming aware that
a plan that has better benefits, even if you didn't expect to
want the extra benefits when you had a chance to change plans before, does not qualify
as an "event" that allows you to change plans.
I'm interested in changing to either a health maintenance organization
(HMO) or a Point-of-Service plan. How can I find out where their
providers are located?
The plans print their provider directories and have
them available during open season. If your agency has an open
season health fair this fall, the plans probably will be there
to hand out their brochures and provider directories. You can
also call the plan at the number listed in the Federal Employees
Health Benefits Program Guide.
If I join a plan because my doctor is a participating doctor
or specialist and then my doctor drops out of my plan's network
in the middle of the year, can I switch plans or do I need to
wait until open season?
You would need to wait for open season. It is not
uncommon for providers to leave plans mid-year. Other plan providers
will be available to provide care.
I have a pre-existing heart condition. Can I change plans without
worrying about a waiting period?
Yes, you can. There are no exclusions or waiting
periods for pre-existing conditions in any plan in the Federal
Employees Health Benefits Program.
When I leave the Federal Employees Health Benefits Program,
I understand I will get a certification that I had group coverage
that I can use to get new coverage with my private industry employer.
Is my agency or my plan supposed to certify my insurance coverage?
Your plan will certify your coverage.