Open Season - its time to review your health insurance plan

Even though you may be out of work receiving workers compensation from OWCP, you still need to stay on top of your health insurance enrollment. OWCP, and the federal government in general, no longer mail out brochures. You need to research any changes you might need to make and get your forms from the OPM website. A good place to start is here:

https://www.opm.gov/healthcare-insurance/open-season/

Please keep in mind that if you become eligible for Medicare, that is now considered your primary insurance and you need to change to a version of your health insurance plan that takes into account that you have Medicare as primary and health insurance as secondary. Otherwise you are paying too much for your health insurance. I have a client who reduced her health insurance premium from $800 per month to $200 per month by making this change. This is not a change that is limited only to Open Season. Becoming eligible for Medicare is an event that allows you to immediately change your health insurance enrollment without waiting for Open Season. The OPM website explains:

Can I Change My FEHB Enrollment When I Become Eligible for Medicare? 

Yes, you may change your FEHB enrollment to any available plan or option at any time beginning 30 days before you become eligible for Medicare. You may use this enrollment change opportunity only once. You may also change your enrollment during the annual Open Season, or because of another event that permits enrollment changes (such as a change in family status).

Another change is that beginning this coming year every plan must include an option for self plus one in addition to the previous choices of individual and family; this includes dental insurance.

Note that if your agency transferred your health insurance enrollment responsibility to OWCP,  you must send your completed SF2809 to the OWCP District Office handling your case. If you are not sure, send it to both your agency and OWCP.

Be sure to go to the OPM website to get started:

https://www.opm.gov/healthcare-insurance/open-season/

Senator Tom Carper is no friend of working people

Senator Tom Carper (D-DE) has once again introduced legislation to "reform" the Post Office by blowing it up. While this is presented as fixing problems, what it really does is radically destroy the working wages that USPS employees depend upon to support their families. In addition, this legislation once again contains stealth provisions that will radically change FECA benefits for ALL federal employees not just Postal Employees. It must be very difficult to keep your billionaire friends happy without showing them that you will make life harder for working people.

Interactions between FECA benefits and SSA benefits for OWCP claimants

When a federal employee draws workers compensation wage loss benefits and is also receiving social security disability benefits there is an offset that frequently occurs that results in a reduction of the amount of the social security disability check. If you begin to receive BOTH your workers compensation check from OWCP and a social security disability check from SSA, be sure to provide SSA with documentation that you are receiving workers compensation or you may end up with a significant overpayment from SSA.

When you attain the age that entitles you to regular SSA retirement, SSA automatically switches you over and starts paying the full amount of the retirement annuity instead of the reduced disability amount. Most people receive a letter some months in advance of that happening. At the moment that SSA switches someone from disability to retirement, you must notify OWCP of this immediately as the offset flips, and now there is a reduction of the amount of workers compensation pay that is calculated based upon the amount of the SSA retirement check that arises from contributions to SSA while working in a federal job and contributing to the FERS pension system. I have seen many overpayments that arise in this situation. Be sure to notify OWCP as soon as your social security disability becomes a retirement benefit.

Another issue that arises when someone is determined to be disabled or retired by SSA is that they will eventually become eligible for Medicare. Once approved, Medicare is automatically considered your primary health insurance and your regular health insurance is then considered your secondary health insurance. At that time, you need to switch from the regular, more expensive version of your health plan, to a cheaper version of the same plan that "wraps" around the Medicare. These are sometimes referred to as a wrap plan. There will be a code number for the version of your plan that takes into account that you are receiving Medicare and you will need to submit the paperwork to change your health plan enrollment. There can be a significant savings in the cost of your health insurance so you should not ignore this issue.

The information and forms you need to change your health benefit enrollment can be found on the Office of Personnel Website: www.opm.gov

OWCP continues to move towards transition to ICD-10 effective October 1, 2015

The implementation of ICD-10 continues to approach. Effective October 1, 2015 OWCP will transition coding in FECA cases to use the new coding standard for injuries and will update old codes to reflect the new standard. There is an announcement on their website regarding this as well:
http://www.dol.gov/owcp/dfec/ICD10transition.htm

Access to ACS and CQS is offline

The Office of Personnel Management hack has triggered another victim. OWCP claimants and their representatives and medical providers are no longer able to access the ACS web bill processing portal to look at the status of bills, authorizations, etc. The CQS portal is also gone. As it was explained to me, OWCP has locked down external log ins to their system due to the continuing concerns about hacking. This has sent OWCP back to the 1990s with all inquiries regarding the status of anything in the case reverting to telephone.

Presently there is no guidance as to how long this situation will continue. When trying to log in to the ACS portal you will get the following message:

Claimant Login

NOTICE Claimant access to ACS Web Bill Processing Portal has been temporarily taken offline . We are sorry for the inconvenience. In the interim, you may use the following information below for additional help. Bill information: In the meantime, claimants may obtain medical bill processing information related to their cases by calling the XEROX call center (844)-493-1966. Case information: Current federal employees may access their information via the National Financial Center (NFC) Employee Personal Page link. After logging into the Employee Page, the CQS link to access data can be found at the lower, left portion of the page. Claimants who are not serviced by NFC, or have separated from federal service and want to obtain information about their OWCP case such as case status, recent compensation payment, or status of their most recent CA7 Claim for Compensation, may do so by using OWCP's IVR phone system by calling their local district office.

Name Business Phone Business Address Boston District Office 1 (857) 264-4600 JFK Federal Building, Room E-260 New York District Office 1 (212) 863-0800 201 Varick Street, Room 740 Philadelphia District Office 1 (267) 687-4160 170 S. Independence Mall West Jacksonville District Office 1 (904) 366-0100 400 West Bay Street, Room 826 Cleveland District Office 1 (216) 902-5600 1240 East Ninth Street, Room 851 Chicago District Office 1 (312) 789-2800 230 South Dearborn Street, Eighth Floor Kansas City District Office 1 (816) 268-3040 2300 Main Street, Suite 1090 Denver District Office 1 (303) 202-2500 One Denver Federal Center, Bldg 53 San Francisco District Office 1 (415) 241-3300 90 Seventh St. Suite 15-100F Seattle District Office 1 (206) 470-3100 300 Fifth Avenue, Suite 1050 Dallas District Office 1 (214) 749-2320 525 South Griffin Street, Room 100 Washington District Office 1 (202) 513-6800 800 N. Capital Street, N.W., Room 800

Be sure to update your life insurance beneficiary(s)

I have many clients who unfortunately have serious disabling injuries that will prevent them from returning to work for the rest of their lives. In the madness that is living with a life altering injury and dealing with OWCP, people sometimes never get around to updating their life insurance beneficiary choice. Recently, a client passed away who had never updated his life insurance to list his wife of many years. Instead, his life insurance went to a cousin who had had little involvement with them for many years. The forms to select a beneficiary are available on the OPM website, complete the necessary form and follow the instructions for submitting the forms:
http://www.opm.gov/healthcare-insurance/life-insurance/designating-a-beneficiary/#url=Forms-for-Designations

New Director of OWCP

Leonard J. Howie, III, is the new director of OWCP replacing acting director Steinberg:

http://www.dol.gov/owcp/owcpdir.htm

FECA reform arises again, nothing here will benefit federal employees, just make an already harsh system worse...

And so it starts again. I would love to know what "federal managers" are actually pushing to eviscerate FECA benefits as opposed to private insurance companies taking a long view towards figuring out how to privatize and make money off of others' misfortune. As the Obama administration is on the record supporting the stripping of benefits from FECA, and with the changes in Congress in the last midterm elections, this could quickly gain traction. I will update as I learn more.

 

http://www.fedweek.com/federal-managers-daily-report/feca-proposals-repeated-2/

The federal workers compensation system administered by OWCP could certainly use some reform, but simply reducing the level of benefits and making it harder to receive benefits is not in the interest of federal employees, nor the unnamed "federal managers" who supposedly support this action, as opposed to private interests and their lobbying staffs who simply want to shrink the federal government any way possible.  

OWCP and reports from someone who is not considered a physician

In a federal workers compensation case, reports must be from a physician. A physician includes  a podiatrist for a foot condition, a psychologist who has a Ph.D., and a chiropractor ONLY for the condition of subluxation. The Employees Compensation Appeals Board has held that a report from a non-physician will be considered medical evidence if countersigned by a qualified physician. This is also found in the Procedure Manual, at Chapter 2.805.3a(1) (January 2013).