Eligibility | Back to Top
The FAES Insurance Program is open to people who work for or at NIH in full-time (at least 32 hours per week) positions (i.e. contractors, guest researchers, temporary positions, special volunteers, exchange scientists, summer positions etc...) who are not eligible for Government benefits. If you are unsure of whether or not you meet the above criteria, please call our office during normal business hours for further assistance. The applicant must enroll in the insurance program within the first 30 days of entrance to duty or wait until the next Open Season, which is during the month of November each year, with a January 1st effective date. The minimum participation period is three months. FAES Health Insurance is not effective until the required enrollment forms have been completed at the FAES Business Office. To make an appointment, call: 301-496-8063. The Business Office is located in Building 10, Room B1C18. We are open Monday through Friday, 8:30 a.m. to 4:00 p.m.
The following categories of family members are eligible to be included if family coverage is elected by an eligible subscriber: spouse, legally dependent children through their eighteenth year, overage dependent children who are full-time students at an accredited school of higher education through their twenty third year (annual certificate required), and overage dependent children who are disabled, and therefore financially dependent.
Late Enrollment Exceptions: If you lose eligibility for previously held coverage, and you provide documentation of dates, you may be eligible to enroll past your initial thirty day period. Please contact the Business Office for more details.
Enrollment | Back to Top
Minimum Enrollment Period: You must have at least a 3-month award period* and work at least 32 hours per week. The Voluntary Dental Program enrollment period is through the end of the calendar year. Dental benefits may only be terminated for reimbursement upon separation from NIH and on a case by case basis. If you lose eligibility for any reason, please contact the Business Office for information in regard to extending your coverage through C.O.B.R.A.
*[except for summer students, who have a 6 week participation minimum]
Break in Service | Back to Top
If an employee (permanent / temporary), fellow, contractor, guest researcher, etc...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), fellow, contractor, guest researcher, etc...separates from NIH; terminates his/her FAES health insurance coverage; subsequently returns to NIH; and wants to enroll again in a FAES plan; the employee must personally pay the premiums for each month since 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.
Effective Date | Back to Top
Your health insurance will be effective the date you meet with FAES and all forms are completed by both parties. Do NOT cancel your existing insurance until you have met with FAES, as we cannot guarantee availability of appointments.
Documentation
Funded Participants | Back to Top
NIH Fellows [such as IRTAs, CRTAs, Visiting Fellows, etc.] must bring the Election of Health Insurance form to the enrollment appointment. If you meet the eligibility requirements, and enroll within the above stated time periods, your health insurance coverage will be paid from Institute funds up to the standard allowable amount. Please see the Comparison of Benefits for up to date premium information.
Cash Participants | Back to Top
Non-NIH Fellows [such as Guest Researchers, Exchange Scientists, Special Volunteers, contractors, temporary workers etc.] must bring a memorandum from their sponsor/supervisor on institute/company letter-head documenting their position, date of entrance to duty, expected duration of duty, and hours worked per week (must work at least 32 hours per week) to their enrollment appointment. Please be aware that premiums are due on the first of the month for the following months coverage (i.e. January 1 for February coverage) and there is three month minimum participation period. If working for only three months, premiums must be collected for all three months at the time of enrollment.
Changes to Coverage | Back to Top
A change from family to individual may be made if the dependent(s) have left the country, are deceased, recently divorced or separated, etc..; changing from individual to family coverage is subject to special limitations. In all cases, documentation will be required. You must report any change (e.g. marriage, birth of new baby, dependents arriving from foreign country, loss of previous coverage) to FAES within 30 days of the event, and complete the required forms. If not reported within 30 days, then the change may be made at the next Open Enrollment Season. Please contact FAES for more information or if you are unsure whether or not you meet the above criteria..
Open Season Enrollment | Back to Top
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 | Back to Top
In order to avoid termination of insurance, FAES must review, and sign, your paperwork prior to your renewal/extension date. Participants may personally bring their renewal forms, fax their forms to the FAES Business Office (301.480.2003) or may ask their personnel office to have the courier hand carry the form - please include your current building and room number - to FAES; by the 24th day of the month that their award is to expire. Off-site participants may mail the hard copy to FAES at: One Cloister Court, Suite 230, Bethesda, MD 20814. If the paperwork is not ready, and you wish to keep your insurance coverage in force, you must pay for the coverage which starts on the first day of the month following the end of the period of award for which we have documentation. Contact FAES for more information.
Changing Institutes | Back to Top
When changing from one institute to another, FAES requires timely notification of termination from the old institute, and a new Election of Health Insurance form from the new one. If dates of appointment are not contiguous, the Fellow may be responsible for payment of health insurance premiums. Contact FAES for more information.
Unpaid Absences: For compelling circumstances, unpaid absences may be approved by the sponsor with concurrence from respective Lab/Br/Office Chief. In such cases, continuation of health insurance coverage during the unpaid absence will be required. 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 | Back to Top
The NIH will privately reimburse for outside 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 attaining their Election of Private Health Insurance forms and renewal forms from their Administrative Officer.
**Institute requirements and conditions:
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 in force prior to accepting their NIH position.
If upon arrival the NIH employee opts 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 their plan does not result in a premium change, the NIH will not pay for that policy.
Leaving NIH | Back to Top
Local Fellows with FAES health insurance coverage should hand carry the Termination Notice Form to Building 10, Room B1C18 or fax to 301.480.2003. FAES will advise you in regard to extending your coverage through C.O.B.R.A.
Information for J-1 Visa Holders | Back to Top
Your health insurance will be effective the date you meet with FAES and all forms are completed by both parties. As we cannot guarantee immediate availability of appointments, you should not cancel your travelers insurance until you have met with FAES. 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. It must define coverage maximums, deductibles and exclusions, the dates of the period of coverage, and the cost of the policy amount in U.S. Dollars. Please be sure to bring the J-1 certification form, and your IAP-66 to your enrollment interview. The J-1 form must be endorsed by FAES personnel in order for it to be valid. 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 | Back to Top
Appointments are available on a first come first served basis. After a Fellow has arrived and the proper documentation is completed, please have the Fellow contact our office (301)496-8063, in order to make an appointment. Insurance coverage is effective as of the date the Fellow meets with FAES and all forms are completed by both parties. Please notify Fellows NOT to cancel existing insurance until they have met with FAES.
Election of Health Insurance Through FAES (Choice 1): This form is for use when the Institute will be paying FAES for the health insurance premium. Dates on the form must not exceed one calendar year. If the fellowship is for more than 365 days, a renewal election form will need to be prepared one month prior to the expiration of the previous form.
Election of Health Insurance for a Private Company (Choice 2): If a fellow does not opt to participate in the FAES insurance program, they may be reimbursed for their privately held coverage via this form. Please refer to the Private Insurance Reimbursement section for details
In either case, your copy of the election form will be returned to your office via inter-office mail. Please be sure to put your 'return to' [name, bldg/rm] information on the form. If the fellow's insurance is being funded through any other mechanism, or if they are responsible for their own premiums, please do not issue a form. Please see the paragraph referring to documentation for cash participants.
Termination: When a Fellow leaves the sponsoring institute, please make sure that FAES is provided with a copy of the form to facilitate appropriate coverage measures [institute transfer, C.O.B.R.A. or termination of coverage]. If the Fellow does not hand carry the termination form through the FAES Business Office, please fax a copy to 301-480-2003. |