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Healthcare Reference Materials

Annuitants and Compensationers

Eligibility for Health Benefits After Retirement

Requirements

You are eligible to continue health benefits coverage, upon retirement, if you meet all of the following requirements:

  • you are entitled to retire on an immediate annuity under a retirement system for civilian employees (including FERS MRA + 10 retirements); and
  • you 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).

When you elect not to enroll or cancel your enrollment, you certify by your signature on the Health Benefits Election form (SF 2809) that you understand the effect this has on your eligibility to carry coverage into retirement.

MRA + 10

If you are a separating employee covered under FERS and you qualify for an immediate annuity under the Minimum Retirement Age (MRA) + 10 provision, you can continue your enrollment when your annuity starts, as long as you meet the requirements for continuing coverage.

If you postpone receipt of your annuity, your enrollment will terminate when you separate from your employment. You will be eligible for temporary continuation of coverage (TCC)  or to convert to an individual contract. You may choose to resume FEHB coverage on the date you select for your annuity to begin.

Service

For purposes of continuing FEHB coverage into retirement, "service" means time in a position in which you were eligible to be enrolled. You are not required to have been an enrollee continuously, but you must have been continuously covered by an FEHB enrollment. This includes:

  • time you are covered as a family member under another person's FEHB enrollment;
  • time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE or CHAMPUS) as long as you were covered under an FEHB enrollment at the time of your retirement. (You must enroll in FEHB within 60 days after you lose coverage under the Uniformed Services Health Benefits Program for that time to be considered as part of continuous FEHB coverage.)

Coverage under Medicare does not count in determining continuous coverage.

Service as a Non-appropriated Fund employee does not count in determining continuous coverage since it is not Federal service and not subject to FEHB coverage.

Break in Service

Breaks in service are not counted as interruptions when the 5 years of service requirement is determined, as long as you reenroll within 60 days after your return to Federal service.

Example 1

Joan elected FEHB coverage on February 11, 2007, and had a break in service from January 1, 2011 through January 1, 2013. Upon her return to service, she again elected to enroll. She retires on December 31, 2014. She is eligible to continue her health benefits coverage into retirement, since she has been continuously enrolled for the 5 years of service prior to retirement.

Example 2

Eduardo elected not to enroll in the FEHB Program upon his employment. He left Federal service in 2011. He was rehired in 2011, and elected to enroll. When he retired in 2014, he was not eligible to continue health benefits into retirement since he was not covered for the five years of service before his retirement. His 2011 rehire date does not count as his first opportunity to be insured because of his prior employment in which he elected not to enroll.

Late Election

You are considered to have been continuously enrolled when you are allowed to make a late election because your employing office determined that you weren't able to timely enroll for reasons beyond your control.

Example

Anne's employing office notified her on March 20, 2011 that she could make a late election to enroll in the FEHB Program. She promptly enrolled, and on January 1, 2016, she retired. She is able to continue her health benefits coverage into retirement, since March 20, 2011, is considered to be her first opportunity to enroll.

Service with an International Organization

If you transfer to an International Organization and elect to continue FEHB coverage, the service with the International Organization is included in determining whether the 5 years of service requirement is met. If you don't elect to continue your FEHB coverage or drop your enrollment before you return to Federal service, the time with the International Organization without FEHB coverage is not included in determining whether the 5-year requirement was met.

Eligibility as a Temporary Employee

Your decision not to enroll as a temporary employee eligible for coverage under 5 U.S.C. 8906a doesn't affect your future eligibility to continue coverage as a retiree. Only service for which the Government contributes toward the cost of your health benefits counts in determining whether you meet the 5 years of service (or first opportunity) requirements to continue coverage as a retiree. Since the Government doesn't share in the cost of a temporary employee's enrollment, eligibility to enroll under 5 U.S.C. 8906a is not considered your first opportunity for purposes of continuing health benefits coverage into retirement.

Eligibility under Temporary Continuation of Coverage

Your enrollment or eligibility for enrollment as a former employee under the temporary continuation of coverage (TCC) provisions is not considered in determining whether you meet the 5 years of service requirement for continued coverage as a retiree, since you are not a Federal employee at that time. However, time that you were an employee eligible to enroll but were covered as a family member under the TCC enrollment of another person does count toward the 5 years of service requirement.

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Eligibility for Health Benefits After Retirement

Who Makes the Determination?

At retirement, your employing office will tentatively determine if you are eligible to continue your enrollment. OPM's Office of Retirement Programs (or your retirement system) will review your retirement and health benefits documents and make a final determination of your eligibility to continue your FEHB enrollment into retirement.

Waiver of 5-Year Enrollment Requirement

Public Law 99-251 gave OPM the authority to waive the 5 years of service requirement when, in its sole discretion, it determines that it would be against equity and good conscience not to allow a person to be enrolled in the FEHB Program as an annuitant.

Your failure to satisfy the 5-year requirement must be due to exceptional circumstances. If you request a waiver, you must provide OPM with evidence that:

  • you had intended to have FEHB coverage as a retiree;
  • the circumstances that prevented you from meeting the 5-year requirement were essentially outside your control; and
  • you acted reasonably to protect your right to continue FEHB coverage into retirement. (This includes reading and acting on information provided and requesting information if none is given automatically.)

How OPM Applies Its Waiver Authority

OPM's approval of your waiver request depends on the extent to which you could have controlled the events leading to the loss of coverage at retirement. When OPM reviews a waiver request, it considers:

  • whether you had a compelling reason to believe you were covered as a family member of another person enrolled in FEHB during the time in question;
  • evidence that your employing office would not allow you to enroll;
  • the extent to which you could have controlled the events that led up to the loss of the right to continued FEHB coverage;
  • whether you had acted to gain FEHB coverage at the earliest opportunity after learning of the loss of benefits or possible loss of future rights;
  • whether you had substantial FEHB coverage during your career even though there was a break in continuity during the last 5 years of service.

OPM would approve these types of waiver requests:

Examples

Sean drops coverage in the FEHB Program for a period of time, but reenrolls later. He is later forced to retire because of a disability before meeting the 5-year participation requirement. (Employees who retire voluntarily although they have a medical condition that would make them eligible for disability retirement are considered as disability retirees for the purpose of granting waivers.)

Lilly does not meet the participation requirement, but had been covered under FEHB for a substantial number of years during her career, including 3 years immediately before retirement. She is forced to retire because of an involuntary separation.

Jill had a break in coverage during the 5 years of service immediately before retirement because her Federally employed spouse changed from a Self and Family enrollment to a Self Only enrollment without telling her. She enrolled at the first opportunity after learning of the loss of coverage.

When OPM Does Not Grant a Waiver

OPM generally doesn't grant a waiver if it is within your control to complete the eligibility requirements for continued coverage. In the case of a voluntary early retirement, you can choose instead to remain in Federal service to complete the eligibility requirements. In this case, you generally can't qualify for a waiver unless some circumstance other than an early retirement makes it impossible to complete the participation requirement (but see "Current Waiver Policy" for exceptions).

OPM generally wouldn't approve these types of waiver requests:

Examples

Keesha loses non-Federal coverage, enrolls for FEHB at the earliest opportunity thereafter, and then retires voluntarily before meeting the participation requirement.

Jim does not meet the 5-year participation requirement. Although his employing office didn't specifically inform him that FEHB coverage wouldn't continue after retirement, it did prepare a Notice of Change in Health Benefit Enrollment (SF 2810) terminating his enrollment at retirement.

Sara doesn't meet the 5-year participation requirement and retires under an early optional retirement authority.

Robert claims to be unaware of the 5-year participation requirement.

Where to Send a Waiver Request

If you are a retiring employee and want to ask OPM to waive the participation requirement in your case, you should send your waiver request to:

Office of Personnel Management, Retirement Benefits Branch
1900 E Street NW
Washington, D.C. 20415-3532.

Previous Waiver Policies

Waiver Policy for Retirements on and after March 30, 1994

Public Law 103-226, the Federal Workforce Restructuring Act of 1994 (FWRA), authorized certain Federal agencies to offer voluntary separation incentive payments (VSIPs) or buyouts to their employees who retired during the period from March 30, 1994, to March 31, 1995. Congress instructed OPM to consider the widespread use of early voluntary retirement authorizations and VSIPs as exceptional circumstances that warrant the use of its waiver authority.

OPM granted a waiver to any Executive agency employee who received a VSIP during this time period (or if the employing office retained the employee due to its need, not later than March 31, 1997). During the same period, OPM also granted waivers to any employee authorized a buyout by similar legislation (such as the Department of Defense program) for the period beginning March 30, 1994 and ending at the termination of the buyout period applicable to the agency. To be eligible for a pre-approved waiver, you must have been enrolled in FEHB as of March 30, 1994.

During the same period, OPM also granted a waiver if you:

  • Took early optional retirement as a result of early-out authority in your agency, or
  • Took a discontinued service retirement based on an involuntary separation due to reduction in force, directed reassignment, reclassification to a lower grade, or abolishment of position.

Waiver Policy for Retirements On and After October 1, 1996

OPM revised the waiver policy on October 1, 1996 to cover VSIPs authorized by Public Law 104-208. Under the revised policy, OPM granted a pre-approved waiver to any Executive agency employee who separated for retirement on or after October 1, 1996, who was covered under the FEHB Program on and after October 1, 1996, and who:

  • received a voluntary incentive payment under P.L. 104-208; or
  • during the statutory buyout period (October 1, 1996, through December 30, 1997), took early optional retirement as a result of early out authority in the agency; or
  • during the statutory buyout period (October 1, 1996, through December 30, 1997), took a discontinued service retirement based on an involuntary separation due to reduction in force, directed reassignment, reclassification to a lower grade, or abolishment of position.

To the extent that these statutes allowed a postponement of your departure, if you separated after the statutory buyout period and received a buyout, you were eligible for a waiver under this policy. If you separated after the statutory buyout period and didn't receive a buyout, you weren't eligible for a waiver under this policy.

Current Waiver Policy

While Public Laws 103-226 and 104-208 authorized Government-wide voluntary separation incentive payments (VSIPs), more recently, Congress has been authorizing buyouts for individual agencies. Each agency's VSIP legislation specifies different beginning and ending dates.

OPM's current waiver policy provides pre-approved waivers for any employee who has been covered under the FEHB Program continuously since October 1, 1996, or the beginning date of an agency's latest statutory buyout authority, whichever is later.

To be eligible for a pre-approved waiver, you must:

  • retire during your agency's statutory buyout period; and
  • receive a buyout under the agency's statutory buyout authority; or
  • take early optional retirement as a result of early-out authority in your agency; or
  • take a discontinued service retirement based on an involuntary separation due to reduction in force, directed reassignment, reclassification to a lower grade, or abolishment of position.

If you meet these requirements, you do not need to write a letter requesting a waiver. Instead, your agency must attach a memorandum to your retirement application stating that you meet the requirements for a pre-approved waiver by OPM as set forth in Benefits Administration Letter (BAL) 00-220. The memorandum should provide the number of the Public Law granting your agency VSIP authority and the beginning and the ending dates of your agency's statutory buyout period.

If You Do Not Qualify for a Pre-approved Waiver

Some employees who retire during a buyout period will not be eligible for a pre-approved waiver. This includes employees who retire on a regular optional retirement but do not qualify for a VSIP.

If you do not qualify for a pre-approved waiver, you may ask OPM to waive the participation requirements in your case. OPM will consider each case on its own merits, based on the criteria that are applied to all other retiring employees. You should explain why you believe OPM should consider you for a waiver (e.g. why you are unable to meet the 5-year requirement or why meeting it would be harmful to you) and send your waiver request to the following address:

Office of Personnel Management
Office of Retirement Programs
Retirement Services Branch - Waiver Request
Washington, DC 20415-3532

When an Agency has Separate Buyout Authority

Some agencies, such as the Departments of Defense and Agriculture, have separate buyout authority. If you retired before October 1, 1996 from an agency that has separate buyout authority, your employing office should follow the waiver policy for retirements on or after March 30, 1994. If you separated for retirement on or after October 1, 1996, your employing office should follow the waiver policy for retirements on and after October 1, 1996.

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Qualifying Retirement Systems

Type of System

For FEHB purposes, you must retire under a civilian retirement system for Federal or District of Columbia Government employees.

Qualifying Systems

Civilian systems include, but are not limited to, the following:

  • Civil Service Retirement System (CSRS)
  • Federal Employees Retirement System (FERS)
  • Board of Governors of the Federal Reserve System
  • CIA Retirement System
  • District of Columbia Courts Judges Retirement System
  • Federal Judiciary Retirement System [28 U.S.C. 371(a)]
  • Financial Institutions Retirement Fund System
  • Foreign Service Pension System
  • Foreign Service Retirement System
  • Judiciary of the Territories Retirement System (28 U.S.C. 373)
  • Lighthouse Retirement System
  • Military Court of Appeals Judges Retirement System
  • National Oceanic and Atmospheric Administration System
  • Nonappropriated Fund Retirement System
  • Officers of the Public Health Service System
  • Policemen and Firemen of the District of Columbia Retirement System
  • Public School Teachers of the District of Columbia System
  • Teachers Insurance Annuity Association and Collegiate Retirement Equities Fund Retirement System
  • U.S. Court of Veterans Appeals Judges Retirement System
  • U.S. Tax Courts Judges Retirement System

For health benefits purposes, the Social Security system is not a retirement system for Federal civilian personnel.

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Benefits and Cost

As an annuitant, you are entitled to the same benefits and Government contribution as non-Postal active employees enrolled in the same plan. Your share of the enrollment cost also continues to be the same as for a non-Postal employee and is deducted from your annuity payments.

If your annuity is not large enough to cover your share of the premiums for your plan, you may either change to a lower-cost plan or option (one in which your share of the premium is low enough to be withheld from your annuity) or choose to pay your premiums directly to your retirement system. Even if your employing office thinks that your annuity will not cover your share of the premiums, it will transfer your existing enrollment to your retirement system. Your retirement system will notify you of your options and take whatever actions you request.

Direct Premium Payments

If you decide to pay your share of premiums directly to your retirement system, your retirement system will establish a payment schedule for you. You must continue to make premium payments directly for the length of your enrollment even if your annuity increases enough to cover your premiums.

Nonpayment of Premiums

If you are making direct payments and your retirement system doesn't receive your premium payment by the due date, it must notify you in writing that you must make payment within 15 days (45 days if you live overseas) for your coverage to continue. If you don't make payment, your retirement system will terminate your enrollment 60 days (90 days if you live overseas) after the date of the notice. Your coverage will be terminated retroactive to the end of the last pay period in which you made the payment. You may not reenroll, unless nonpayment was for reasons beyond your control.

If you weren't able to make timely payment for reasons beyond your control, you may write to your retirement system to ask that your coverage be reinstated. You must file the request within 30 days from the date your enrollment was terminated and provide proof that the nonpayment was beyond your control. Your retirement system will determine if you are eligible for reinstatement of coverage. If it decides to allow reinstatement, it will be restored retroactive to the termination date. If your request is denied, you may request that your retirement system reconsider its initial decision.

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Procedures for Retiring Employees

If You Want to Continue Your Health Benefits Coverage

If you meet all the requirements, you don't need to do anything to have your same health benefits enrollment continue after your retirement.

If You Want to Cancel or Change Your Health Benefits Coverage

If you don't want to continue your health benefits enrollment upon your retirement, you must cancel it on the Health Benefits Election form (SF 2809) or other appropriate request. This must be your action; your employing office must not initiate the termination of your enrollment unless you aren't eligible to continue it after your retirement.

When you cancel your FEHB enrollment as an annuitant, you will never be able to reenroll unless you had canceled it to enroll in a Medicare managed care plan or you had furnished proof of eligibility for Medicaid.

If you are a retiring employee and you submit a request to cancel or change your enrollment, but the cancellation or change can't become effective until after the starting date of your annuity, your employing office will note on part H of your request the date it received the form, and will send all copies of your request to your retirement system with your other health benefits and retirement records.

Your retirement system will make the cancellation effective on the last day of the pay period in which your employing office received your request. If you requested an enrollment change, it will be made effective as indicated in "Opportunities to Enroll or Change Enrollment." Even though you have requested a cancellation or change, your retirement system needs information on the enrollment in effect on the day of your retirement, since this enrollment may remain in effect during a part of your retirement.

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Employing Office Procedures

General

At your retirement, your employing office will tentatively determine whether you are eligible to continue your health benefits enrollment. Your retirement system will make the final determination after it reviews all of your retirement and health benefits documents. Your employing office must take the appropriate action described below.

If You Appear Eligible to Continue Your Enrollment

Nondisability Retirement

Your employing office will document your health benefits status on your retirement application (Section A, item 6 of the Agency Checklist). It will attach a separate memorandum to note any circumstances that would be helpful for the retirement system to know when it determines your eligibility for continued coverage (such as information that you were covered as a family member before your own enrollment).

It will note your plan's enrollment code in the Remarks space on the Individual Retirement Record (SF 2806 for the Civil Service Retirement System and SF 3100 for the Federal Employees Retirement System). For other retirement systems, it should follow the same procedures.

It will send the following to the retirement system along with the Individual Retirement Record, the retirement application and any other retirement papers:

  • all Notice of Change in Health Benefits Enrollment forms (SF 2810), and
  • All Health Benefits Election forms (SF 2809) or other enrollment requests, with any attached medical certificates or other documentation, filed in your Official Personnel Folder (including any on which you elected not to enroll or to cancel, or that are marked VOID).

Disability Retirement

Your employing office will note your current plan's enrollment code in the Remarks section of the preliminary Individual Retirement Record. It will not send any health benefits forms from your Official Personnel Folder to the retirement system with the preliminary Individual Retirement Record, even if you are enrolled and eligible to continue the enrollment.

If your disability retirement application is denied, your employing office doesn't need to take any further action unless you are separated.

If your disability retirement application is approved, your employing office will then follow the same procedures as for a nondisability retirement.

If You Appear Ineligible to Continue Your Enrollment

If you don't meet all the requirements for continuing your enrollment into retirement, your employing office will document your retirement application (Section A, item 6 of the Agency Checklist) and note in the Remarks column of the Individual Retirement Record (both the preliminary and final Record in disability retirement cases): "Not eligible to continue health benefits" and state the reason (e.g., "not enrolled since first opportunity" or "not enrolled 5 years"). Your employing office will terminate your enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810) and transmit all of your health benefits documents to the retirement system, where a final decision on your eligibility to continue your FEHB enrollment will be made.

If you are unable to continue your regular FEHB enrollment into retirement, you may be eligible to temporarily continue your health benefits coverage through the Temporary Continuation of Coverage (TCC) provision of the FEHB law. Contact your employing office for information on TCC.

If You Aren't Enrolled

If you aren't enrolled in the FEHB Program, your employing office will document your retirement application (Section A, item 6 of the Agency Checklist) and note in the Remarks column of the Individual Retirement Record (both the preliminary and final Record in disability retirement cases): "Not enrolled for health benefits." It will retain your health benefits forms in your Official Personnel Folder. It doesn't need to take any other action on your health benefits, unless your enrollment terminated after 365 days in leave without pay status.

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Employing Office Procedures

If Your Enrollment Terminates after 365 Days in Leave Without Pay Status

If your enrollment terminates because of 365 days in leave without pay status, it will be reinstated if your retirement application is approved with an annuity starting date before the end of the 365 days of leave without pay status. Your employing office should follow the procedures described in "If You Appear Eligible to Continue Your Enrollment" if you otherwise would be eligible to continue your enrollment. It will send the Notice of Change in Health Benefits Enrollment (SF 2810) that terminated your enrollment to the retirement system along with your other documents.

If your enrollment terminates after 365 days in leave without pay status and you have a pending disability retirement application, you should convert to an individual contract. If your disability retirement application is approved later, the retirement system will reinstate your enrollment, retroactive to the starting date of your annuity (as long as you meet the requirements to continue your enrollment).

If You Separate and Later Retire

When you are eligible for an immediate annuity, but don't apply for retirement, your employing office will terminate your enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810) upon your separation. Also, your enrollment will terminate when you are separated while your application for retirement (such as for disability) is pending in a retirement system.

You should enroll under the temporary continuation of coverage (TCC) provisions even though you plan to apply for retirement later or have a disability retirement pending in a retirement system. If your retirement application is approved later, your retirement system will reinstate the enrollment, retroactive to the starting date of your annuity (as long as you meet the requirements to continue your enrollment). Your employing office will refund the premiums you paid for the TCC coverage when you provide documentation showing the retroactive coverage as a retiree.

FERS MRA + 10 Benefits

If you are a separating FERS employee eligible for an immediate annuity under the minimum retirement age and 10 years of service (MRA + 10) provision, you may receive the benefits immediately or you may postpone receiving your annuity to lessen the age reduction applicable to persons under age 62.

If you are eligible for an MRA+10 annuity and are not applying for retirement at the time of separation, your employing office will terminate your enrollment on the Notice of Change in Health Benefits Enrollment form (SF 2810). It will notify you of your right to enroll under temporary continuation of coverage (TCC) or convert to an individual contract. If you meet the requirements for continuing health benefits as a retiree, you may reenroll when you decide to allow your annuity to begin.

If you are applying for retirement and appear eligible to continue your enrollment, your employing office will follow the procedures in "Nondisability Retirement."

If you apply for an immediate annuity under the MRA + 10 provisions and later decide to postpone your annuity starting date, OPM will notify your employing office that it must offer you the opportunity to elect TCC coverage.

When You Apply for MRA + 10 Annuity

If you are requesting that your annuity begin under the MRA + 10 provision, you may enroll in any plan for which you are eligible within 60 days after OPM notifies you of your eligibility. If you die before the end of this 60 day period, your survivors entitled to an annuity may enroll within 60 days after OPM's notification to your survivor of his/her eligibility.

Your enrollment is effective the first day of the month after the month that OPM receives your request, or on the starting date of your annuity, whichever is later. Your survivor's enrollment is effective on the first day of the month after the month that OPM receives his/her request for enrollment.

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Opportunities for Annuitants to Enroll or Change Enrollment

Effective Date

Unless otherwise specified, enrollment changes take effect on the first day of the month that follows your retirement system's receipt of your enrollment change request.

Late Elections

If you were unable, for reasons beyond your control, to make an enrollment election or change within the required time limits, your retirement system may allow you to make a late election. You must make your election within 60 days after you were notified of the retirement system's determination.

Election by Proxy

Your retirement system may permit your representative to make an enrollment election or change for you with your written authorization.

Change to Self Only

You may change your enrollment from Self and Family to Self Only at any time under the same conditions as an active employee with one exception. An annuitant who, as an employee, was subject to a court or administrative order at the time he or she retired cannot:

  • cancel or suspend his or her enrollment,
  • change to Self Only;
  • or change to a comprehensive medical plan that does not serve the area where his or her children live.

This remain true after retirement as long as the court or administrative order is still in effect and the annuitant has at least one child identified in the order who is still eligible under the FEHB Program, unless the annuitant provides documentation to the retirement system that he or she has other coverage for the child or children.

Open Season

If you are an enrolled annuitant, you may change plans, options, or type of enrollment during Open Season.

If you are a nonenrolled annuitant, you are not permitted to enroll during an Open Season unless you had canceled your FEHB enrollment:

  • to join, and have subsequently voluntarily disenrolled from, a Medicare managed care plan; or
  • because you furnished proof of eligibility for Medicaid (or a similar State-sponsored program of medical assistance for the needy) and you wish to reenroll in FEHB for reasons other than involuntary loss of that other coverage.

Your enrollment change or reenrollment (including a belated enrollment change) is effective on the first day of the first pay period that begins in January of the next year (January 1 for most annuitants).

Change in Family Status

You may change plans, options, or type of enrollment when you have a change in family status under the same conditions as an active employee (but you can't enroll if you aren't already enrolled). There are different rules for an enrolled survivor annuitant.

When Coverage under Medicare Managed Care Plan or Medicaid Ends

If you were enrolled (or eligible to enroll) in the FEHB Program as an annuitant and:

  • you suspended your FEHB enrollment to enroll in a Medicare managed care plan or because you furnished proof of eligibility for Medicaid (or a similar State-sponsored program of medical assistance for the needy); and
  • your enrollment in the Medicare managed care plan or Medicaid ends involuntarily,

you can immediately reenroll in any available plan at any time from 31 days before to 60 days after your coverage in the Medicare managed care plan or Medicaid ends. The reenrollment is effective on the date following the involuntary loss of coverage as shown in documentation from the Medicare managed care plan or Medicaid. An involuntary loss of coverage includes when the Medicare managed care plan ceases to be offered, you move from the area served by the Medicare managed care plan, or you lose eligibility for Medicaid.

If you voluntarily disenroll from the Medicare managed care plan or Medicaid, you may reenroll in the FEHB Program during the following Open Season.

Upon Restoration of Disability Annuity

If you were receiving a disability annuity and:

  • your disability annuity was terminated because you were found restored to earnings capacity or recovered from your disability;
  • you were enrolled in an FEHB plan immediately before your disability annuity was terminated; and
  • your disability annuity is later restored,

you may reenroll in a health benefits plan within 60 days from OPM's notice of your eligibility to reenroll. Your reenrollment is effective on the first day of the month after OPM receives your enrollment request.

Loss of Coverage under FEHB or Another Group Insurance Plan

If you are an annuitant eligible to enroll, but you are covered as a family member under another FEHB enrollment, you may enroll in your own name if you lose coverage under the other enrollment.

If you are an enrolled annuitant, you may change plans, options, or from Self Only to Self and Family when you lose coverage under another group health benefits plan or when an eligible family member loses coverage under FEHB or another group health benefits plan.

Some examples of loss of coverage are:

  • You or your family member lose FEHB coverage because the covering enrollment was terminated, canceled, or changed to Self Only;
  • You or your family member lose coverage under another federally-sponsored program;
  • Your membership ends in the employee organization that sponsors your health benefits plan;
  • You are enrolled in a plan that is discontinued;
  • You or your family member lose coverage under Medicaid or a similar program;
  • You or your family member lose coverage under a non-Federal health plan.

When Your Plan is Discontinued

You may change to another plan when you are enrolled in a plan that is discontinued in whole or in part. You may enroll in the new plan for either Self Only or Self and Family coverage. If your plan is discontinued at the end of a contract year, you must change your enrollment during Open Season unless OPM establishes a different time.

Normally, a plan that terminates its participation in the FEHB Program will terminate as of December 31 of a given year. The plan will continue to provide benefits until the new coverage takes effect. When a plan is discontinued at any time other than at the end of a contract year, OPM will issue special instructions about the proration of premiums and the effective date of subsequent enrollment changes.

If you don't change to another plan when:

  • The plan that is discontinued has only one option, you are considered to have enrolled in the standard option of the Blue Cross and Blue Shield Service Benefit Plan.
  • One option of a two-option plan is discontinued, you are considered to have enrolled in the remaining option of the plan.
  • Both options of a two-option plan are discontinued, you are considered to have enrolled in the same option of the Blue Cross and Blue Shield Service Benefit Plan. Exception: when your annuity is insufficient to pay the premiums of the high option of the Blue Cross and Blue Shield Service Benefit Plan, you are considered to have enrolled in the Blue Cross and Blue Shield Service Benefit Plan standard option.

Move from an HMO's Service Area

If you are enrolled in an HMO, and you or an enrolled family member move or become employed outside the HMO's service area, or, if already outside of this area, move or become employed further from this area, you may change your enrollment under the same conditions as an active employee.

Retirement from Overseas Duty Post

You may change plans, options, and type of enrollment within 60 days of your retirement from a post of duty outside the United States. Your eligible survivors may also make these changes if you were stationed outside the United States at the time of your death.

Return from Military Service

You may change plans, options, and type of enrollment within 60 days after separation from at least 31 days of duty in a uniformed service.

You become Eligible for Medicare

You may change your enrollment to any option of any available plan at any time beginning on the 30th day before you become eligible for Medicare. You may make an enrollment change under this event only once.

Annuity Insufficient to Pay Withholdings

If your annuity is not sufficient to pay your plan's premiums, your retirement system must notify you of the plans available at a cost that doesn't exceed your annuity. You may either pay your premiums directly to your retirement system or you may enroll in another plan where the cost is no greater than your annuity. Coverage under your new plan is effective immediately upon termination of your old plan's coverage.

If you don't take either of these actions and you are enrolled in the high option of a plan, you are considered to have enrolled in the standard option of the same plan (unless your annuity is insufficient to pay the standard option premiums).

If you don't take either of these actions and your enrollment is terminated, you may apply to your retirement system for reinstatement of your enrollment in any available plan or option.

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Reemployed Annuitants

If You Aren't Enrolled

If you are an annuitant not enrolled under the FEHB Program and you become reemployed in a position that doesn't exclude you from coverage, you must make an election the same as any other new employee. You can continue your enrollment after separation from reemployment if you meet all the requirements that any other retiring employee must meet. (The immediate annuity requirement is met if you receive a supplemental annuity when you separate from the reemployment.)

Exception: If you are reemployed under the authority of section 108 of the Federal Employees Pay Comparability Act (FEPCA) of 1990 to meet emergency hiring needs or because of severe recruiting difficulties, you aren't considered an employee for retirement purposes. Although you may enroll in FEHB with your employing office if you don't have coverage as an annuitant, you don't earn eligibility toward continuing coverage as an annuitant during your reemployment under FEPCA.

Annuity Terminated by Reemployment

If you are enrolled under the FEHB Program as an annuitant and are reemployed under conditions that terminate your annuity, your employing office must notify your retirement system that you are reemployed and transfer in your enrollment. Your employing office must then determine whether you are eligible to continue your enrollment during reemployment using the same criteria as for other employees that transfer from one payroll office to another, and must either allow your enrollment to continue or terminate it, as appropriate.

When you separate from service, your employing office will follow the procedures that apply to other employees being separated or retired. It will either terminate your enrollment or transfer the enrollment back to your retirement system.

Annuity Continued during Reemployment

If you are enrolled under the FEHB Program as an annuitant and are reemployed under conditions that do not terminate your annuity, your employing office needs to transfer your enrollment from your retirement system to your employing agency. Your FEHB premiums will be deducted from your pay as an employee, not from your annuity. (This applies only if you want to participate in premium conversion; see below.)

Can Reemployed Annuitants Participate in Premium Conversion?

Yes, effective with the first pay period beginning on or after October 1, 2000, you will be covered automatically by premium conversion, provided you are employed:

  • In a position that conveys FEHB eligibility; and
  • By an agency covered by premium conversion.

Your employing office will contribute the employer share of the FEHB premium in the same manner as that for other employees.

You may waive participation in premium conversion within 60 calendar days from the date you become eligible for premium conversion. The waiver will be effective on the first day of the first pay period after the date your employing office receives it. In this case, you will keep your FEHB coverage as an annuitant and your premiums will be deducted on an after-tax basis.

Your participation in premium conversion ends on the last day of the last pay period as an employee. When you separate from active service, your FEHB enrollment must be transferred back from your employing agency to your retirement system.

Your right to continue FEHB as an annuitant following your period of reemployment is unaffected.

Annuity Suspended during Reemployment

If you are a disability annuitant under age 60 who:

  • has been found to be recovered or restored to earning capacity; and
  • become reemployed in a position not subject to the retirement system before being dropped from the annuity roll,

your employing office must notify your retirement system that you are reemployed (so your annuity can be suspended). Your employing office must then transfer in your enrollment. When you separate from service, your retirement system must then transfer in your enrollment.

Open Season Opportunities for Reemployed Annuitants

If you are a reemployed annuitant not enrolled for health benefits, you may enroll during an Open Season the same as any eligible employee. If you are enrolled, during an Open Season you may change enrollment regardless of the type of your appointment. You will submit your Open Season change to your employing office, if that office is administering your enrollment. If your retirement system administers your enrollment, follow the directions provided by the retirement system.

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Survivor Annuitants

Continued Enrollment for Your Family Members

If you die while enrolled for Self and Family, and all the requirements are met, your enrollment will continue for your eligible family members who become survivor annuitants under a qualifying retirement system.

Benefits and Cost

If the enrollment continues, your eligible survivors are entitled to the same benefits and Government contribution as active and retired employees enrolled in the same plan. The survivor annuitant's share of the premiums normally is deducted from his/her annuity payments.

Action by Survivor

Your survivors don't need to take any action to continue your enrollment if they meet all the requirements.

If they don't want to continue your enrollment, they must send to the retirement system a letter or a Health Benefits Election form (SF 2809) canceling the enrollment. Your survivors must take this action; your employing office will not terminate your enrollment when you die unless it appears that you have no survivors eligible to continue it.

Requirements for Continuing Enrollment

For your surviving family members to continue your health benefits enrollment after your death, all of the following requirements must be met:

  • You must have been enrolled for Self and Family at the time of your death; and
  • At least one family member must be entitled to an annuity as your survivor.

All of your survivors who meet the definition of "family member" can continue their health benefits coverage under your enrollment as long as any one of them is entitled to a survivor annuity. If the survivor annuitant is the only eligible family member, the retirement system will automatically change the enrollment to Self Only.

Under FERS, your surviving spouse who is entitled to a basic employee death benefit, or your surviving children whose benefits are offset by Social Security, may continue your health benefits enrollment by paying premiums directly to OPM.

If the survivor annuity is not large enough to cover the enrollee share of the premiums for your plan, your survivors may either change to a lower-cost plan or option (one in which the enrollee share of the premium is low enough to be withheld from the annuity) or choose to pay the premiums directly to the retirement system. Even if your employing office thinks that the survivor annuity will not cover the enrollee share of the premiums, your retirement system will transfer in the enrollment. The retirement system will notify your survivors of their options and take whatever actions they request.

When your surviving spouse will not receive any survivor benefits because your former spouse has a court-ordered entitlement to a survivor annuity, your surviving spouse can continue FEHB coverage if you had a Self and Family enrollment. The retirement system will notify your surviving spouse of his/her options and take whatever actions are requested.

Employing Office Procedures

At your death, your employing office will tentatively determine your survivors' eligibility for continued health benefits enrollment. The retirement system will make the final determination of their eligibility after it reviews all of your retirement and health benefits records. Your employing office will take one of the following actions, as appropriate:

If Your Survivors Appear Eligible to Continue the Enrollment

If your survivors appear eligible to continue your enrollment, your employing office will note your plan's enrollment code in the Remarks section of the Individual Retirement Record.

It will send the following to the retirement system along with the Individual Retirement Record, the retirement death claim (if any) and any other retirement papers:

  • all Notice of Change in Health Benefits Enrollment forms (SF 2810),
  • all Health Benefits Election forms (SF 2809) or other appropriate requests, with any attached medical certificates or other documentation, filed in your Official Personnel Folder (including any on which you elected not to enroll or to cancel, or that are marked VOID), and
  • a memorandum giving any information regarding your health benefits that is not evident from the other documents.

If No Survivors are Eligible to Continue the Enrollment

If you have no survivors eligible to continue your enrollment (e.g., you had a Self Only enrollment), your employing office will note in the Remarks section of the Individual Retirement Record: "No survivor eligible to continue health benefits." It will terminate your enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810), note in the Remarks section: "Enrollee died (date)," and leave all health benefits documents in your Official Personnel Folder.

Your employing office will send the enrollee copy of the SF 2810 to your nearest living relative or to the representative of your estate. However, if it appears that a survivor who has been covered as a family member may be eligible for conversion, it will send the SF 2810 to him/her.

If No Surviving Spouse Annuity is Payable because of a Former Spouse Benefit

When your surviving spouse will not receive any survivor benefits because your former spouse has a court-ordered entitlement to a survivor annuity, your surviving spouse can continue FEHB coverage if you had a Self and Family enrollment. Your employing office should follow the procedures in "If Your Survivors Appear Eligible to Continue the Enrollment."

If You Were Not Enrolled

If you weren't enrolled for health benefits at your death, your employing office will note in the Remarks section of the Individual Retirement Record: "Not enrolled for health benefits." It will leave all health benefits documents in your Official Personnel Folder and take no further action on your health benefits.

When You are Eligible Both as an Employee and a Survivor Annuitant

If you are an employee eligible for health benefits who is covered as a family member under your spouse's Self and Family enrollment, and:

you may cancel your enrollment as an annuitant and enroll as an employee because you had a change in family status (death of spouse). Or, you may continue the enrollment as a survivor annuitant. However, if you want to participate in premium conversion, you must be enrolled as an employee.

If you enroll as an employee on this basis, and you later separate under conditions not entitling you to continued enrollment, your employing office must terminate your enrollment. If you are still a survivor annuitant, you may apply to the retirement system for reinstatement of your enrollment as a survivor annuitant, and for health benefits deductions to be made from your annuity.

If the retirement system receives your application within 60 days after your separation from employment, it will reinstate your enrollment retroactive to the day after it was terminated by your employing office. If it receives your application more than 60 days after your separation, it will reinstate your enrollment effective on the first day of the month after the month that it received the application.

If you are enrolled as an employee with a Self and Family enrollment and you become a survivor annuitant upon your spouse's death (or, if both you and your spouse were enrolled in Self Only enrollments) and you later separate but cannot continue your enrollment as a retiree, you can enroll as a survivor annuitant. You must make the change from coverage as an employee to coverage as a survivor annuitant within 30 days of separation from service.

If you decided to continue the survivor annuitant enrollment and later lose entitlement to a survivor annuity, you may enroll as an employee.

Deferred Annuity

Since you generally are not eligible for FEHB coverage when you are receiving a deferred annuity, your surviving spouse is not eligible for FEHB coverage as a survivor annuitant even if he/she had FEHB coverage as an employee. If he/she loses coverage as an employee, it can't be transferred to the survivor annuity.

If you are receiving a deferred annuity, your former spouse may be eligible for FEHB coverage under the Spouse Equity provisions.

If You Die Before Receipt of MRA+10 Annuity

If you die before your postponed MRA+10 annuity begins, your surviving spouse is considered to be the surviving spouse of an annuitant. Your surviving spouse is eligible for FEHB coverage under the same conditions as any other survivor annuitant and may enroll under FEHB when his/her survivor annuity begins.

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Opportunities for Survivor Annuitants to Change Enrollment

Enrolled survivor annuitants have the same opportunities to change enrollment as other annuitants, except when there is a change in family status because of the acquisition of a child.

Change in Family Status Due to Acquisition of an Eligible Child

A survivor annuitant's enrollment change based on the acquisition of a child can only be made when the child is an eligible family member of the deceased employee or annuitant. The enrollment can be changed from Self Only to Self and Family, from one plan or option to another, or any combination of these changes from 31 days before to 60 days after the acquisition of the child, and will be effective on the first day of the pay period in which the child is born or becomes an eligible family member.

Restoration of Survivor Annuity

Spouse

If your surviving spouse's:

  • survivor annuity or basic employee death benefit was terminated because he/she remarried;
  • he/she was covered under an FEHB enrollment immediately before his/her annuity or death benefit terminated; and
  • his/her survivor annuity or death benefit is later restored,

he/she may enroll in a health benefits plan within 60 days from OPM's notice of eligibility to enroll.

The restored survivor annuity enrollment is effective on the later of:

  • the first day of the month after OPM receives his/her enrollment request; or
  • the date the survivor annuity is restored.

The basic employee death benefit enrollment can only be restored when your surviving spouse's remarriage ends and he/she provides OPM with a certified copy of the death notice or the court order terminating the remarriage. The restored enrollment is effective on the first day of the month after OPM receives his/her enrollment request and documentation of the end of the marriage.

Child

If your surviving child's:

  • survivor annuity was terminated because he/she married or ceased being a student;
  • he/she was covered under an FEHB enrollment immediately before his/her annuity terminated; and
  • his/her survivor annuity is later restored,

he/she may enroll in a health benefits plan within 60 days from OPM's notice of eligibility to enroll. The enrollment is effective on the later of:

  • the first day of the month after OPM receives his/her enrollment request; or
  • the date the survivor annuity is restored.

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Compensationers

Requirements for Continued Coverage

Your health benefits enrollment will continue when you enter on the compensation rolls of the Office of Workers' Compensation Programs (OWCP) and the Secretary of Labor determines that you are unable to return to duty. If your compensation lasts fewer than 29 days, OWCP won't transfer your enrollment. Instead, your enrollment will remain with your employing office.

If you are receiving compensation, your enrollment may continue during the first 365 days in leave without pay status. After that period, you must meet the same participation requirements as for continuing an enrollment after retirement. You must meet the requirements as of the date you started receiving compensation. OWCP, not your employing office, is responsible for determining your eligibility.

Transferring Your Enrollment to OWCP

Your enrollment will be transferred to the Office of Workers' Compensation Programs (OWCP) when:

OWCP normally does not request an enrollment transfer unless it expects your compensation to continue for 90 days or longer.

OWCP will make withholdings when your compensation lasts more than 28 days, whether or not your enrollment has been transferred to OWCP.

Withholdings and Contributions

The Office of Workers' Compensation Programs (OWCP) makes health benefits withholdings regardless of whether your enrollment is transferred to OWCP. Withholdings begin on the later of:

  • the date your compensation begins, or
  • the date following the day your employing office stops making withholdings and contributions.

OWCP does not make withholdings when you receive compensation for fewer than 29 days. In this case, you must pay your share of the premiums and your employing office must pay its share.

(While OWCP is making the withholdings from compensation, its contributions are made from the Congressional appropriation authorized for the payment of Government contributions for retirees and compensationers.)

Reporting Your Enrollment to OWCP

When your employing office reports your compensable injury or illness on OWCP Form CA 7, it will show whether you were enrolled for health benefits on the date your pay stopped, your plan's enrollment code, and the ending date of the last pay period that insurance withholdings were made.

If OWCP determines that your compensation will continue for at least 6 months, it will normally request that your employing office transfer your enrollment to OWCP.

If you are separated before your employing office receives OWCP's request to transfer your enrollment, your employing office must check with OWCP to determine the status of your compensation claim. If your compensation is to continue beyond the date of separation, it will transfer your enrollment to OWCP.

If you make any permissible change in enrollment before your employing office receives OWCP's request for transfer, your employing office must promptly notify OWCP by letter of the change and its effective date.

If you are separated after your enrollment is transferred to OWCP, your employing office must notify OWCP by letter so it will know how to handle your enrollment if compensation payments end.

Transferring Your Enrollment at OWCP's Request

Your employing office will transfer your enrollment by attaching to the request form all Health Benefits Election Forms (SF 2809), Notice of Change in Health Benefits Enrollment forms (SF 2810), and any other related health benefits documentation and returning it to OWCP. Your employing office must keep a copy of the request form (and back-up copies of all other health benefits documentation) in your Official Personnel Folder to show that OWCP has the health benefits documentation. When OWCP receives the health benefits documentation, it must complete an SF 2810 transferring your enrollment to OWCP.

Transferring Your Enrollment when OWCP hasn't Requested it

If you are being separated or you have been in leave without pay status for 10 months and OWCP hasn't requested that your enrollment be transferred, your employing office must check with OWCP on the status of your OWCP claim. If compensation will continue beyond your separation date or beyond the 365th day of continuous leave without pay status, your employing office must transfer your enrollment to OWCP by sending all Health Benefits Election forms (SF 2809), Notice of Change in Health Benefits Enrollment forms (SF 2810), and any other related health benefits documentation to OWCP by letter, explaining the reason for the action. When OWCP receives the documentation, it must complete an SF 2810 transferring your enrollment to OWCP.

When Compensation Ends and You Return to Duty

If your compensation ends and you return to duty, OWCP will transfer your enrollment back to your employing office by letter, transmitting the health benefits documentation and giving the date compensation ended. If you are eligible for continued coverage, your employing office will transfer your enrollment in to the agency by completing a Notice of Change in Health Benefits Enrollment (SF 2810). The effective date of the transfer is the day after your compensation terminated.

If you aren't eligible for continued coverage, your employing office will complete an SF 2810 terminating your enrollment effective with the date your compensation ended. A copy of OWCP's letter transferring the enrollment back to your employing office must be attached to the carrier copy of the SF 2810.

When you return to duty on a part-time basis and compensation payments continue, OWCP will keep your enrollment and continue to make withholdings and contributions for you.

When Compensation Ends but You Don't Return to Duty

If your compensation ends, but you don't return to pay status, your enrollment terminates at midnight on the last day of the pay period in which your compensation terminates.

When You Return to Duty before Compensation Ends

If you return to duty on a full-time basis before OWCP terminates your compensation payments, your employing office must notify OWCP using OWCP Form CA 3. In the Remarks section, it will show the beginning and ending dates of the pay period in which you returned to work. Since OWCP will discontinue withholdings as of the beginning date of the pay period in which you return to full-time pay and duty status, your employing office will resume withholdings and contributions effective with the first pay period in which you return to pay status. If your enrollment had been transferred to OWCP, it will be transferred back to your employing office.

When You Elect Retirement

If you elect to retire and receive an annuity instead of compensation and your enrollment had been transferred to OWCP, the retirement system will ask OWCP to transfer your enrollment to the retirement system. If you are still in leave without pay status, your employing office will note under Remarks on the Individual Retirement Record: "Health benefits enrollment transferred to OWCP," and send it to the retirement system.

Restoration of Compensation Payments

If you were receiving compensation and:

  • your compensation was terminated because OWCP determined that you had recovered from your injury or disease;
  • you were enrolled in an FEHB plan immediately before your compensation was terminated; and
  • your compensation is later restored because your disability recurred,

you may reenroll in a health benefits plan within 60 days from OWCP's notice of your eligibility to reenroll. Your reenrollment is effective on the first day of the pay period after OWCP receives your enrollment request.

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Survivors of Compensationers

Requirements for Continued Coverage

If you die while a compensationer, your family members can continue your enrollment if you were enrolled for Self and Family at the time of your death and at least one of your covered family members receives compensation as a surviving beneficiary under the Federal Employees' Compensation law.

If Your Enrollment Wasn't Transferred to OWCP

If your enrollment had not been transferred to the Office of Workers' Compensation Programs (OWCP) before your death, your employing office must determine whether any surviving family members appear eligible to continue your enrollment. Your employing office will terminate your enrollment if it appears that you have no eligible survivors.

If it appears that your survivors are eligible to continue your enrollment, your employing office will send your health benefits documentation to the retirement system as if you had died in service. If your survivors elect to receive compensation rather than survivor benefits, the retirement system will transfer the enrollment to OWCP.

If Your Enrollment Was Transferred to OWCP

If your enrollment was transferred to OWCP before your death, your employing office must note in the Remarks section of your Individual Retirement Record, "Health benefits transferred to OWCP," and send it to the retirement system as usual. OWCP will determine whether you have any eligible survivors who want to continue your enrollment. If your survivors elect to continue to receive compensation, OWCP will continue or terminate your enrollment, as appropriate. If your survivors elect to receive survivor benefits instead of compensation, OWCP will transfer the enrollment to the retirement system.

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