General Insurance Program Information

Eligibility  

Participation in the FAES sponsored health plan is open to:

  1. NIH stipend paid trainees who work at least 30 hours per week
  2. Any entity that directly supports NIH stipend paid trainees at NIH facilities AND has at least 80% of the voting members of their board occupied by current NIH employees

The following categories of family members are eligible to be included if family coverage is elected by an eligible subscriber: spouse, domestic partner, dependent children through their twenty-sixth birthday, overage dependent children who are disabled.

Late Enrollment Exceptions: If you lose eligibility for previously held coverage, and you provide FAES with a certificate of coverage, you may be eligible to enroll past your initial thirty day period. Please contact the Business Office for more details.

Enrollment 

Minimum Enrollment Period: You must have at least a 3-month award period* and work at least 30 hours per week. The Voluntary Dental Program enrollment period is through the end of the calendar year.

Election of Health Insurance through FAES

Initial Enrollment:

Page 1: Fellowship recipient’s signature and fellowship sponsors signature

Page 2: Election of health insurance

Page 3: Election of health insurance must be signed by fellow

Single page: FAES election form

Single page: Understanding FAES (For your records) 

If you are on a J1 visa please submit NIH 829-6

Effective Date  

Your health insurance will be effective the date of commencement/start date or from the date of signature for electronically returned forms. Your effective date cannot precede your date of hire. All forms must be completed and received by FAES in order to complete the enrollment process. Do NOT cancel your existing insurance until you have confirmation of enrollment from FAES.

Changes to Coverage:

You are responsible for reporting any change (e.g. marriage, address, birth of a baby, adoption, loss of previous coverage) to FAES within 30 days of the event, and complete the required form(s).  If not reported within 30 days, then the change may be made during the next Open Season.  FAES Open Season is held during the month of November with a January 1 effective date of the following year.    

Break in Service 

If an employee (permanent / temporary) separates from NIH without being enrolled in FAES' insurance program and returns to work for or at NIH within 90 days of separation they are ineligible to participate in FAES' health insurance program until the next Open Enrollment. If applicable, they may qualify for private reimbursement through their position. Contact your Administrative Officer at your institute for further information.

If an employee (permanent / temporary) separates from NIH; terminates his/her FAES health insurance coverage without electing COBRA coverage, subsequently returns to NIH, and wants to enroll again in a FAES plan, the employee must personally pay the premiums for each month from the termination of coverage if there was less than a 90 day break from NIH. If the separation period is greater than 90 days, the employee may re-enroll into FAES' insurance program as a "new subscriber." Please contact FAES' business office for further information.

Open Season Enrollment  

If an individual does not enroll in the FAES insurance program when initially eligible, or wishes to make changes to coverage, or terminates his/her FAES health insurance, but remains at NIH with health insurance coverage provided through an outside company, the individual may enroll in an FAES plan during the programs annual Open Season held during the month of November. The effective date will be January 1st of the following year. A waiting period for pre-existing conditions may be applicable.

Renewal/Extension of Fellowship 

Health insurance coverage is NOT automatically renewed. Renewal of health insurance coverage corresponds directly with the renewal of your fellowship. Fellowship Award forms are valid for 365 days or less.  Fellows must renew their health insurance as needed by providing FAES with new Election of Health Insurance forms before the last day of the month of the renewal month.  Forms can be obtained from his/her Administrative Officer. If renewal paperwork is not provided in timely manner health insurance will terminate as of the end of the month. Once paperwork is received, FAES will reinstate coverage back to the date of termination.

When changing from one institute to another, FAES requires timely notification of termination from the former institute, and a new Election of Health Insurance form from the new institute. If the new appointment does not start the following day after the previous award, the fellow will be responsible for providing alternate proof of insurance coverage or paying for the lapse in insurance coverage. If the fellow can demonstrate that they were outside of the U.S. during the lapse in coverage, FAES can waive this premium. Contact FAES for more information.

Unpaid Absences 

Unpaid absences may be approved by the sponsor with agreement from respective Lab/Br/Office Chief. In such cases, continuation of health insurance coverage during the unpaid absence will be required unless the period of absence exceeds 90 days. The Fellow will personally pay for coverage which starts on the first day of the month of unpaid absence. Contact FAES for more information.

Private Insurance Reimbursement 

The NIH will reimburse you for private insurance coverage if the individual is enrolled in a private health insurance plan that meets Institute requirements. If eligible, the Institute will issue the Election of Private Health Insurance forms to the individual. These forms should be provided to FAES for certification. In order to certify these documents for reimbursement from their Institute, FAES will need the following:

  • Proof of insurance coverage (ID card, letter from vendor on letterhead etc...)
  • Summary of benefits in English on company letterhead
  • Coverage maximums, deductibles if applicable, and plan exclusions
  • Dates of plan coverage
  • The cost in U.S. dollars
  • Proof of payment (credit card statement, returned check from bank, bank statement etc...)

If the insured is a J-1 Visa holder, their insurance must also include sufficient medical evacuation and repatriation coverage to satisfy their J-1 Visa requirements.

Certification of private insurance reimbursement should be brought in quarterly within the employee's award period. The employee is responsible for notifying FAES if there is a change in premium and for obtaining their Election of Private Health Insurance forms and renewal forms from their Administrative Officer.

 Private Insurance

If you are currently enrolled in private insurance but would like to elect health coverage under the Plan, you are given 30 days from the current date on your awards form to elect.

Institute requirements and conditions:
Application of the certified amount is at the discretion of the Administrative Officer. The insurance plan must be in the NIH employee's name or their spouse's name. If covered under the spouse, NIH will not reimburse for this coverage if the policy was already active prior to accepting their NIH position or if the spouse's coverage is active under another government agency. If upon arrival, the NIH employee decides to enroll under their spouse's plan rather than FAES' insurance program, the NIH will only reimburse for the additional cost incurred by the spouse to add them to their coverage. Please be aware that if adding the spouse to the plan does not result in a premium change, the NIH will not pay for that policy.

Leaving NIH  

All Fellows will need to provide a "Notification of Termination" to FAES prior to their departure. The form may be hand carried to Building 10, South Side, room 1N241 or faxed to 301.480.2003/301-480-3585 or emailed to faesinsurance@mail.nih.gov. Once received, the coverage will be terminated at 11:59 pm the last day the fellow is in pay status. Our third party administrator will send you information on how to continue health insurance coverage. Please note: If you are enrolled in Dental coverage you will need to contact Dominion Dental to terminate your dental insurance coverage. FAES will not be responsible for terminating your dental insurance.

Information for J-1 Visa Holders  

Your health insurance will be effective the date of commencement/start date and all forms are completed by both parties.  If you have purchased private insurance, sufficient proof of coverage must be provided. FAES will need a policy summary on company letterhead that is written in English. Per J-1 Visa requirements, it must define coverage maximums of no less than $50,000 per incident, deductibles of no more than $500, cover medical evacuation and repatriation of no less than $17,500. FAES will also need the dates of the period of coverage and the cost of the policy amount in U.S. Dollars.

The J-1 form must be endorsed by FAES personnel in order for it to be valid. If the policy does not meet the minimum requirements of the J1-VISA exchange program, FAES has the right to not endorse the policy. Recommendations will be made on how to satisfy the missing requirements.

In addition, if you have private health insurance that does not contain the required amount of Medical Evacuation and Repatriation of Remains, you may purchase a separate policy through FAES. Contact your Fogarty Immigration Specialist or FAES for more information.

Information for A.O/I.C. Personnel  

After a Fellow has arrived and after the fellow has met with the Division of International Services (if applicable), please have the Fellow contact our office at 301-496-8063 or email us at FAESinsurance@mail.nih.gov. Insurance coverage is effective as of the date of commencement/start date and all forms are completed by both parties. Fellows are NOT to cancel existing insurance until they have met with FAES.

Termination of Coverage

Termination of coverage occurs during Open Enrollment if you are coverage is for a spouse or a dependent. If you become ineligible to participate in the plan, for example: because you leave your position or, in the event of divorce, with respect to your covered spouse, benefits are terminated at 11:59 pm the last day the fellow is in pay status.. In addition, if you or your Administrative Officer (A.O.) fail to provide your renewal forms to our office your health insurance will be terminated.  When you or your covered spouse or dependent lose health coverage based on a termination of employment or the occurrence of certain other qualifying events, you will generally be eligible to elect continuation  of coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). You are given 60 days to elect C.O.B.R.A.  Once C.O.B.R.A. is elected your coverage is retroactive to the date on which your coverage would have initially terminated.  Please contact your Administrative Officer for additional information regarding the opportunity to elect COBRA coverage. Please note: If you are enrolled in Dental coverage you will need to contact Dominion Dental to terminate your dental insurance coverage. FAES will not be responsible for terminating your dental insurance.