Health Coverage When Injured at Work
(This article appeared in the May/June 2013 edition of The American Postal Worker)
Sue Carney, Director Human Relations Dept.
Employees who are injured on duty and placed on the rolls of the Office of Workers Compensation Programs (OWCP) remain eligible for health benefits, provided they are enrolled in one of the Federal Employee Health Benefit (FEHB) plans for five years preceding the start of compensation. Employees with less than five years of service must be enrolled continuously from their first opportunity to participate.
Family members of deceased employees are also eligible to continue coverage, provided the employee was enrolled in a “self-and-family” option at the time of death and at least one of the covered family members receives compensation as a surviving beneficiary under the Federal Employees’ Compensation Act.
When an employee who meets the criteria for continuing health coverage receives compensation for six months or longer, the administration of health benefits is transferred from the USPS to OWCP. Until the transfer is made, an employee receiving compensation but no salary is treated as any other employee in a non-pay status.
After 365 days, enrollment is terminated if the employee is ineligible to be transferred to OWCP. When the employee returns to a pay status, the administration of health benefits shifts back to the agency, provided the employee remains eligible to continue enrollment.
Whether OWCP requests the transfer of administrative responsibility or not, it withholds employee premiums and makes employer contributions for health benefits from the date compensation begins, or immediately following the date the employer stops making them, whichever occurs later.
OWCP does not make withholdings and contributions when wage loss compensation is paid for less than 29 days. In these circumstances, employees are responsible for paying their share of the premiums. If an employee is deemed ineligible, enrollment is terminated and withholdings and contributions cease.
Health Benefits Refund Program
Deductions for premiums are made at the USPS rate during the first compensable year and at the standard federal employee rate thereafter. Because the Office of Personnel Management (OPM) rate is higher, Postal Service employees may be due a refund.
To be eligible, employees must be in a leave without pay/injured-on-duty status. Employees who have been separated from the USPS are ineligible. Employees must be receiving OWCP compensation payments with health benefits premiums deducted at the federal employee rate and at least one year must have elapsed since they were initially placed on OWCP compensation.
Generally, the refund is automatically generated by the Postal Service. The employee is not required to take any action. Health and Resource Management submits the required forms to the Scanning and Imaging Center, and obtains the District Manager’s approval. (Copies of PS Form 202, Health Benefits Refund Payment Authorization, should be given to the employee.) USPS Accounting Services will issue the refund to the employee.
However, in the past year there have been two system failures. The first affected employees who changed service providers. The employees received a dual refund — one for each service provider — resulting in an overpayment. The second occurred when OPM attempted to recover the erroneous payments. As a result, refunds were delayed or possibly omitted. According to the Postal Service, all districts were directed to take corrective action, but some have not.
If you are still waiting for your health benefit refund, contact your local APWU representative to secure a remedy at the district level. Representatives who are unsuccessful should contact the Human Relations Department at (202) 842-4270 with the employee’s name, claim number, refund period, and district contact.
To learn more about how being injured at work can affect health insurance coverage, review Section 525 of the Employee and Labor Relations Manual (ELM).