Decision-day is almost here. Monday is the last day of the federal health insurance open season.

During the open season, we've run many best-buys columns. Yesterday's was a condensed version of the advice supplied by Walton Francis and Bill Smith. Francis writes Checkbook's Guide to Year 2000 Health Insurance Plans for Federal Employees, which is in many area bookstores and drugstores (usually in the magazine section) for $8.95. Smith, the health benefits expert for the Alexandria-based National Association of Retired Federal Employees, helped run the health program when he was with the Office of Personnel Management.

To close out open season, here are some typical questions about the Federal Employees Health Benefits program, with answers supplied by Bill Smith. Several questions concern the federal program's five-year rule. In most cases, to be covered in retirement, feds must have been enrolled in one of the federal health plans (any one) for the five years immediately before retiring.

The first deals with a situation faced by many couples: One's a federal worker, one isn't. Ronald J. Landry writes: "I've been enrolled in the federal program, with family coverage, for 13 years. My wife, a Maryland state employee, has an excellent medical program. To save premium dollars, can I switch from family coverage to self-only coverage and switch back" to family coverage five years before retirement to carry family coverage into retirement?

Answer: "First, the five-year requirement is met with either either self-only or family enrollment. You can switch from family to self-only any time whether employed or retired. But you can switch to family only during an open season or when your wife loses her private-sector [or state] coverage. Another fact to keep in mind is that you have to have a family enrollment at the time of your death in order for her to continue the [federal] program."

Julie Bernt asks: My husband and I both work for the federal government. . . . He has Blue Cross standard-option family coverage. My question: A) If he dies before me while we are both working, will I still be covered, or will I have to get my own insurance? B) If I have to get my own, will I have to have it for five years before I retire? C) If we are both retired and he dies first, will I still be covered under his policy? If not, will I have to get my own and will that be a problem?"

Answer: A) You get to continue self-only coverage either as a survivor or in your own right as an employee. Your choice. B) No. The five-years you are covered by his family coverage counts the same as if you were enrolled on your own. C) Yes. It will automatically convert to a self-only policy for you.

Jim Greenwell asks another question concerning the five-year rule: "I am a military retiree currently covered under Tri-Care [which covers military personnel], also working as a civilian federal employee. Does Tri-Care count in the five-year rule as long as I take one of the federal plans prior to retirement?"

Answer: Yes.

Jim Travis asks: "I work for the federal government but get my medical support through Tri-Care as a spouse of a retired Army officer. Is Tri-Care considered one of the recognized federal health plans for purposes of the five-year rule?'

Answer: "Yes. But as noted above, you have to be enrolled in a Federal Employee Health Benefits Plan at time of retirement in order to count the Tri-Care time. You should enroll in this or a future open season in order to continue FEHBP coverage after retirement."

NYLCare to Aetna Yesterday, I confused the difference between a health plan leaving the federal program and merging with another plan in the program. NYLCare has been bought by Aetna US Healthcare. James Priestly, M. Lamb, Dane Hendrix, B.M. Jackman, Herb Traxler and Hillard Harrison, to name a few, noticed the error and set us straight.

Here's a short, but sweet, explanation from reader Kit Farwell: "You were in error when you said NYLCare was dropping out of the program and enrollees needed to select a new insurance company. Actually, NYLCare has been bought out by Aetna US Healthcare, so if you were formerly under NYLCare, you're automatically switched over [for coverage in 2000]. Aetna (and NYLCare) is one of the best insurance buys. You have the low prices of an HMO--which it is--but get to pick your own doctors from private practice."

Reader Jim Riedford notes that Aetna US Healthcare is the least-expensive plan available to feds in the Washington area. Next year, its self-only premium will be $490, compared with $590 for the Mail Handlers standard option, the least-expensive fee-for-service plan.

Bottom line: If you are in NYLCare and like it and do nothing, you will be covered by Aetna next year.

Mike Causey's e-mail address is

Thursday, Dec. 9, 1999