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Healthcare Eligibility

 

Overview

Basic FEHB Eligibility

As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions. This chapter in the FEHB Handbook explains these provisions.

Retirees and Survivor Annuitants

Federal retirees and their surviving spouses retain their eligibility for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement) and must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.

Temporary Continuation of Coverage (TCC)

Temporary Continuation of Coverage is a feature of the FEHB Program that allows certain people to temporarily continue their FEHB coverage after regular coverage ends. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative charge.

FEHB for Dependents

Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. Your employing office will look at the child's relationship to you as the enrollee to determine whether the child is a covered family member. In determining whether the child is a covered family member, your employing office will look at the child's relationship to you as the enrollee.

Former Spouses

Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.

CHAMPUS, TRICARE and Tricare-for-Life

OPM has issued a final rule to allow TRICARE and CHAMPVA eligible FEHB Program annuitants, survivors, and former spouses to suspend their FEHB enrollments, and then return to the FEHB Program during the Open Season, or return to FEHB coverage immediately if they involuntarily lose this non-FEHB coverage.

Civilian Employees on Active Military Duty

Federal employee reservists who are placed in a leave without pay status when called to active duty for more than 30 days can keep their FEHB coverage for up to 24 months. The reservist is responsible for paying the enrollee share of the premium during the first 12 months, and the agency pays the agency's share.

Temporary Firefighters and Fire Protection Personnel

OPM has issued regulations to extend coverage under the Federal Employees Health Benefits (FEHB) program to temporary firefighters and fire protection personnel working on wildland fires across the country. Coverage became available beginning on July 17, 2012. Please find copies of the regulations and additional material explaining the new regulations by going to the Temporary Firefighters Eligibility page.

FEHB for Employees

As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses employee eligibility and explains the special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions.

FEHB for Retirees and Survivor Annuitants

Federal retirees and their surviving spouses retain their eligibility for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement); and you must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.

Information for Retirees and Survivor Annuitants

The web version of our print pamphlet Information for Retirees and Survivor Annuitants, RI 79-2, summarizes the principal FEHB requirements and benefits from the retiree's viewpoint.

Frequently Asked Questions

The questions that we are most asked by annuitants and their families.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses the special FEHB considerations for annuitants and compensationers.

FEHB for Dependents

Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. Your employing office will look at the child's relationship to you as the enrollee to determine whether the child is a covered family member.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses family members' eligibility for coverage.

Frequently Asked Questions

The questions we are most asked about family coverage.

FEHB Coverage for Former Spouses

Under the Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615), as amended, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the Federal Employees Health Benefits (FEHB) Program.

You are eligible to enroll under Spouse Equity provisions if:

  • you are divorced from a Federal employee or annuitant during his/her employment or receipt of annuity;
  • you were covered as a family member under an FEHB enrollment at least one day during the 18 months before your marriage ended (Note: This requirement is also met when both you and the Federal employee or annuitant have FEHB enrollments);
  • you are entitled to a portion of the Federal employee's annuity or to a former spouse survivor annuity; and
  • you have not remarried before age 55.

Former spouse enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium).

Detailed Guidance

Frequently Asked Questions

The comprehensive set of questions and answers about coverage for former spouses.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses coverage for former spouses in detail.

FEHB Guide for Temporary Continuation of Coverage (TCC) and Former Spouse Enrollees 

The FEHB Guide for Temporary Continuation of Coverage and Forcer Spouse Enrollees contains comprehensive information on current plan availability, cost, and benefits for people who are eligible to enroll in the FEHB Program but do not receive a Government contribution.

Temporary Continuation of Coverage (TCC) Program

Former spouses may also be eligible to temporarily continue their FEHB coverage under the Temporary Continuation of Coverage (TCC) program. This page links to detailed guidance on the TCC program.

A Handbook for Attorneys on Court-ordered Retirement, Health Benefits and Life Insurance

This handbook for attorneys and others who are involved in the preparation of divorce and separation agreements that involve a current or former employee, including an annuitant of the Federal Government who is or was covered by CSRS or FERS. Includes statutes and regulations describing the conditions under which a former spouses's FEHB coverage may be continued after a divorce.

Coverage for Federal Civilian Employees Called to Military Duty

If you are enrolled in the Federal Employee's Health Benefits (FEHB) Program and are called to military duty, you may continue your coverage for up to 24 months or elect to have it terminate. The authority for your agency to pay your premiums is available for employees who meet certain requirements, including serving in support of a contingency operation.

Employees who serve in support of a contingency operation

FEHB law gives your agency authority to continue your coverage and pay your premiums if you are called or ordered to active duty on or after September 14, 2001, and are:

  1. enrolled in an FEHB plan;
  2. a member of a reserve component of the armed forces;
  3. called or ordered to active duty in support of a contingency operation (as defined in section 101(a)(13) of title 10);
  4. placed on leave without pay or separated from service to perform active duty; and
  5. serving on active duty for a period of more than 30 consecutive days.

Employees who do not serve in support of a contingency operation

If you do not meet all of the above requirements of FEHB law, the authority for continuation of your FEHB coverage comes from the Uniformed Services Employment and Reemployment Rights Act (USERRA), now codified at section 4317 of title 38, United States Code.

Your agency has no authority to pay your premiums while you are on military duty. You are responsible for the enrollee share of the premium during the first 12 months, and your agency will pay its share. For the continued FEHB coverage of up to 12 months, you are responsible for paying both the employee and agency shares of the premium, plus an additional 2% administrative fee.

Note: If you were called to military duty and you elected to continue your FEHB coverage before the USERRA law was amended on December 10, 2004, you can continue your enrollment for 18 months.

Suspension of Federal Employees Health Benefits (FEHB) Program Coverage to Use TRICARE, Medicare/Medicaid, or Certain State Sponsored Medical Assistance Plans

The Office of Personnel Management has issued a final rule to allow TRICARE and CHAMPVA eligible FEHB Program annuitants, survivors, and former spouses to suspend their FEHB enrollments, and then return to the FEHB Program during the Open Season, or return to FEHB coverage immediately if they involuntarily lose this non-FEHB coverage. The intent of this rule is to allow eligible beneficiaries to avoid the expense of continuing to pay FEHB Program premiums while they are using the non-FEHB coverage, without endangering their ability to return to the FEHB Program in the future.

The rule also clarifies a similar situation involving FEHB-covered annuitants, survivors, and former spouses. The rule allows an individual who drops FEHB coverage when he or she enrolls in a Medicare-sponsored plan, or in Medicaid or a similar State-sponsored program of medical assistance for the needy, to return to FEHB coverage during the annual Open Season or immediately upon being involuntarily disenrolled from the non-FEHB coverage.

Temp Firefighters

Firefighters Health Insurance

OPM has issued new regulations to extend coverage under the Federal Employees Health Benefits (FEHB) program to temporary firefighters and fire protection personnel working on wildland fires across the country. Coverage became available beginning on July 17, 2012. Please find copies of the regulations and additional material explaining the new regulations below.

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