Indian Tribes Indian Tribes FAQs

• Self Only                                                                                                                                                      
• Self and Family

Yes, Qualifying Life Events (QLE).

Yes, at a minimum, the tribal employer must contribute the same amount as most Federal agencies do for their Federal employees.  Tribal employers must pay approximately 70% of the premiums.  Please contact your tribal employer to see if they pay a larger portion of your premiums (up to 100%).

?FFS with Preferred Provider Organization (PPO) (overseas coverage available) ?HMO ?CDHP ?HDHP with an HSA or HRA

• If enrollment terminated, coverage is reinstated the day you return.
• You can waive reinstatement to use your transitional TRICARE benefits.

Tribal employees who are considered common law tribal employees and meet FEHB requirements for the type of employment are eligible to enroll in FEHB.  Tribal employees with eligibility questions should contact their tribal employer.

• Enroll in a plan in the FEHB Program, if not already enrolled
• Cancel FEHB enrollment
• Change type of enrollment (Self Only vs. Self and Family)
• Change from one plan or option to another

Complete and submit a Standard Form (SF) 2809 to your tribal employer. You can obtain an SF 2809 from the OPM’s website at www.opm.gov/forms/pdf_fill/sf2809.pdf or from your tribal employer. 

Yes, you can request reconsideration by the FEHB plan.  If you do not agree with the initial denial, you may request that OPM review the disputed claim.  See Section 8 of the plan brochure for details.

If you are a new tribal employee of a tribal employer that already participates in the FEHB Program, you have 60 days from the date of becoming eligible to enroll in it.

The first day of the first pay period that begins after your FEHB enrollment request is received and that follows a pay period during any part of which you were in pay status.  For example, your FEHB enrollment request is received on February 15th.  The pay period, in which you are in pay status, ends on February 25th.  Your coverage begins on February 26th.

If you participate in premium conversion, you can only cancel during Open Season or when experiencing a specific QLE.  If you do not participate in premium conversion, you can cancel at any time.

• Change in family status
• Change in employment status
• You or a family member lose FEHB or other health insurance coverage                                                                
• For more information, see SF 2809 for the Tables of Permissible Changes in Enrollment                                                                                                                                                                           

Family members may be eligible to continue coverage as described below:      - If you have a Self and Family FEHB enrollment with only a spouse, the spouse is eligible for conversion to non-group (private) coverage;      - If you have a Self and Family FEHB enrollment with a child or children, the child(ren) are eligible for TCC and may cover the spouse. Eligible family members may convert to non-group (private) coverage when TCC expires at the end of 36 months.

• A spouse, including a valid common law marriage (marriage means only a legal union between one man and one woman as husband and wife, as defined in the Defense of Marriage Act).
• Children under age 26 (including adopted children, recognized natural children or stepchildren; or foster children living with tribal employee in regular parent-child relationship)                                                                                              
• Children age 26 or older incapable of self-support, if disabling condition began before age 26

Which family members are not eligible?         

• Grandchildren, unless foster child requirements (as defined in the Handbook) are met                                                                                                  
• Parents                                                                                                                                                                                                  
• Siblings                                                                                                                                                                                                     
• In-laws

The Affordable Care Act (healthcare reform law) states that: (1) urban Indian organizations carrying out programs under Title V of the Indian Health Care Improvement Act and (2) Indian tribes or tribal organizations carrying out programs under the Indian Self-Determination and Education Assistance Act are entitled to purchase coverage, rights, and benefits of the FEHB program for their tribal employees.   OPM uses the term “tribal employer” to refer to Indian tribes, tribal organizations, and urban Indian organizations.

No.

• You can elect to continue enrollment or terminate. 
• If continuing, coverage terminates at the end of 24 months.
• If called up for contingency operation, tribal employer may pay employee’s share of the premiums. 
• If not in support of contingency operation, you are responsible for premiums.

Generally, 31 days before to 60 days after the QLE.