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Healthcare Reference Materials

Table of Permissible Changes
Federal Employees Receiving Premium Conversion Tax Benefits

Table of Permissible Changes in FEHB Enrollment and Premium Conversion Election

Premium Conversion allows employees who are eligible for FEHB the opportunity to pay for their share of FEHB premiums with pre-tax dollars. Premium conversion plans are governed by Section 125 of the Internal Revenue Code, and IRS rules govern when a participant may change his or her election outside of the annual Open Season. All employees who enroll in the FEHB Program automatically receive premium conversion tax benefits, unless they waive participation. When an employee experiences a qualifying life event (QLE) as described below, changes to the employee's FEHB coverage (including change to Self Only and cancellation) and premium conversion election may be permitted, so long as they are because of and consistent with the QLEs. For more information about premium conversion, please visit OPM HealthCare.

Employee
Qualifying Life Events (QLEs) that May Permit Change in FEHB Enrollment or Premium Conversion ElectionFEHB Enrollment Change that May Be PermittedPremium Conversion Election Change that May Be PermittedTime Limits in which Change May Be Permitted
CodeEventFrom Not Enrolled to EnrolledFrom Self Only to Self and FamilyFrom One Plan or Option to AnotherCancel or Change to Self Only1ParticipateWaiveWhen You Must File Health Benefits Election Form With Your Employing Office
1 Employee electing to receive or receiving premium conversion tax benefits
1A Initial opportunity to enroll, for example:
  • New employee
  • Change from excluded position
  • Temporary employee who completes 1 year of service and is eligible to enroll under 5 USC 8906a
Yes N/A N/A N/A Automatic Unless Waived Yes Within 60 days after becoming eligible
1B Open Season Yes Yes Yes Yes Yes Yes As announced by OPM
1C Change in family status that results in increase or decrease in number of eligible family members, for example:
  • Marriage, divorce, annulment
  • Birth, adoption, acquiring foster child or stepchild, issuance of court order requiring employee to provide coverage for child
  • Last dependent child loses coverage, for example, child reaches age 26 or marries, stepchild moves out of employee's home, disabled child becomes capable of self-support, child acquires other coverage by court order
  • Death of spouse or dependent
Yes Yes Yes Yes Yes Yes Within 60 days after change in family status
Employees may enroll or change beginning 31 days before the event.
1D Any change in employee's employment status that could result in entitlement to coverage, for example:
  • Reemployment after a break in service of more than 3 days
  • Return to pay status from nonpay status, or return to receiving pay sufficient to cover premium withholdings, if coverage terminated (If coverage did not terminate, see 1G.)
Yes N/A N/A N/A Automatic Unless Waived Yes Within 60 days after employment status change
1E Any change in employee's employment status that could affect cost of insurance, including:
  • Change from temporary appointment with eligibility for coverage under 5 USC 8906a to appointment that permits receipt of government contribution
  • Change from full time to part-time career or the reverse
Yes Yes Yes Yes Yes Yes Within 60 days after employment status change
1F Employee restored to civilian position after serving in uniformed services.2 Yes Yes Yes Yes Yes Yes Within 60 days after return to civilian position
1G Employee, spouse or dependent:
  • Begins nonpay status or insufficient pay3 or
  • Ends nonpay status or insufficient pay if coverage continued
  • (If employee's coverage terminated, see 1D.)
  • (If spouse's or dependent's coverage terminated, see 1M.)
No No No Yes Yes Yes Within 60 days after employment status change
1H Salary of temporary employee insufficient to make withholdings for plan in which enrolled. N/A No Yes Yes Yes Yes Within 60 days after receiving notice from employing office
1I Employee (or covered family member) enrolled in FEHB health maintenance organization (HMO) moves or becomes employed outside the geographic area from which the FEHB carrier accepts enrollments or, if already outside the area, moves further from this area.4 N/A Yes Yes N/A
(See 1M)
No
(See 1M)
No
(See 1M)
Within 60 days after employment status change
1J Transfer from post of duty within a State of the United States or the District of Columbia to post of duty outside a State of the United States or District of Columbia, or reverse. Yes Yes Yes Yes Yes Yes Within 60 days after arriving at new post
Employees may enroll or change beginning 31 days before leaving the old post of duty.
1K Separation from Federal employment when the employee or employee's spouse is pregnant. Yes Yes Yes N/A N/A N/A During employee's final pay period
1L Employee becomes entitled to Medicare and wants to change to another plan or option.5 No No Yes (Changes may be made only once.) N/A
(See 1M)
N/A
(See 1M)
N/A
(See 1M)
Any time beginning on the 30th day before becoming eligible for Medicare
1M Employee or eligible family member loses coverage under FEHB or another group insurance plan including the following:
  • Loss of coverage under another FEHB enrollment due to termination, cancellation, or change to Self Only of the covering enrollment
  • Loss of coverage due to termination of membership in employee organization sponsoring the FEHB plan6
  • Loss of coverage under another federally-sponsored health benefits program, including: TRICARE, Medicare, Indian Health Service
  • Loss of coverage under Medicaid or similar State-sponsored program of medical assistance for the needy
  • Loss of coverage under a non-Federal health plan, including foreign, state or local government, private sector
  • Loss of coverage due to change in worksite or residence (Employees in an FEHB HMO, also see 1I.)
Yes Yes Yes Yes Yes Yes Within 60 days after loss of coverage
Employees may enroll or change beginning 31 days before the event.
1N Loss of coverage under a non-Federal group health plan because an employee moves out of the commuting area to accept another position and the employee's non-Federally employed spouse terminates employment to accompany the employee. Yes Yes Yes Yes Yes Yes From 31 days before the employee leaves the commuting area to 180 days after arriving in the new commuting area
1O Employee or eligible family member loses coverage due to discontinuance in whole or part of FEHB plan.7 Yes Yes Yes Yes Yes Yes During Open Season, unless OPM sets a different time
1P Enrolled employee or eligible family member gains coverage under FEHB or another group insurance plan, including the following:
  • Medicare (Employees who become eligible for Medicare and want to change plans or options, see 1L.)
  • TRICARE for Life, due to enrollment in Medicare.
  • TRICARE due to change in employment status, including: (1) entry into active military service, (2) retirement from reserve military service under Chapter 67, title 10.
  • Medicaid or similar State-sponsored program of medical assistance for the needy
  • Health insurance acquired due to change of worksite or residence that affects eligibility for coverage
  • Health insurance acquired due to spouse's or dependent's change in employment status (includes state, local, or foreign government or private sector employment).8
No No No Yes Yes Yes Within 60 days after QLE
1Q Change in spouse's or dependent's coverage options under a non-Federal health plan, for example:
  • Employer starts or stops offering a different type of coverage (If no other coverage is available, also see 1M.)
  • Change in cost of coverage
  • HMO adds a geographic service area that now makes spouse eligible to enroll in that HMO
  • HMO removes a geographic area that makes spouse ineligible for coverage under that HMO, but other plans or options are available(If no other coverage is available, see 1M)
No No No Yes Yes Yes Within 60 days after QLE
1R Employee or eligible family member becomes eligible for assistance under Medicaid or a State Children's Health Insurance Program (CHIP) Yes Yes Yes Yes9 Yes Yes Within 60 days after the date the employee or family member becomes eligible for assistance.

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(If you are a United States Postal Service employee, these rules may be different. Consult your employing office or information provided by your agency.)

1. Employees may change to Self Only outside of Open Season only if the QLE caused the enrollee to be the last eligible family member under the FEHB enrollment. Employees may cancel enrollment outside of Open Season only if the QLE caused the enrollee and all eligible family members to acquire other health insurance coverage.

2. Employees who enter active military service are given the opportunity to terminate coverage. Termination for this reason does not count against the employee for purposes of meeting the requirements for continuing coverage after retirement. Additional information on the FEHB coverage of employees who return from active military service is available in the Frequently Asked Questions section of the FEHB website.

3.Employees who begin nonpay status or insufficient pay must be given an opportunity to elect to continue or terminate coverage. A termination differs from a cancellation as it allows conversion to nongroup coverage and does not count against the employee for purposes of meeting the requirements for continuing coverage after retirement.

4.This code reflects the FEHB regulation that gives employees enrolled in an FEHB HMO who change from Self Only to Self and Family or from one plan or option to another a different timeframe than that allowed under 1M. For change to Self Only, cancellation, or change in premium conversion status, see 1M.

5.This code reflects the FEHB regulation that gives employees enrolled in FEHB a one-time opportunity to change plans or options under a different timeframe than that allowed by 1P. For change to Self Only, cancellation, or change in premium conversion status, see 1P.

6.If employee's membership terminates (e.g., for failure to pay membership dues), the employee organization will notify the agency to terminate the enrollment.

7.Employee's failure to select another FEHB plan is deemed a cancellation for purposes of meeting the requirements for continuing coverage after retirement.

8.Under IRS rules, this includes start/stop of employment or nonpay status, strike or lockout, and change in worksite.

9. Employees may change to Self Only outside of Open Season only if the QLE caused all eligible family members to acquire other health insurance coverage. Employees may cancel enrollment outside of Open Season only if the QLE caused the enrollee and all eligible family members to acquire other health insurance coverage.

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Tables of Permissible Changes in FEHB Enrollment for Individuals Who Are Not Participating in Premium Conversion

Annuitant (includes Compensationer)
QLEs That Permit Enrollment or ChangeChange PermittedTime Limits
Code Event From Not Enrolled to Enrolled From Self Only to Self and Family From One Plan or Option to Another When You Must File Health Benefits Election Form With Your Employing Office
2 Annuitant (Includes Compensationers) Note for enrolled survivor annuitants: A change in family status based on additional family members can only occur if the additional eligible family members are family members of the deceased employee or annuitant.
2A Open Season No Yes Yes As announced by OPM.
2B Change in family status; for example: marriage, birth or death of family member, adoption, legal separation, or divorce. No Yes Yes From 31 days before through 60 days after the event.
2C Reenrollment of annuitant who cancelled FEHB enrollment to enroll in a Medicare-sponsored plan, Medicaid, or similar State-sponsored program and who later was involuntarily disenrolled from the Medicare-sponsored plan, Medicaid, or similar State-sponsored program. May Reenroll N/A N/A From 31 days before through 60 days after disenrollment.
2D Reenrollment of annuitant who cancelled FEHB enrollment to enroll in a Medicare-sponsored plan, Medicaid, or similar State-sponsored program and who later voluntarily disenrolls from the Medicare-sponsored plan, Medicaid, or similar State-sponsored program. May Reenroll N/A N/A During Open Season.
2E

Restoration of annuity or compensation (OWCP) payments; for example:

  • Disability annuitant who was enrolled in FEHB, and whose annuity terminated due to restoration of earning capacity or recovery from disability, and whose annuity is restored;
  • Compensationer whose compensation terminated because of recovery from injury or disease and whose compensation is restored due to a recurrence of medical condition;
  • Surviving spouse who was covered by FEHB immediately before survivor annuity terminated because of remarriage and whose annuity is restored;
  • Surviving child who was covered by FEHB immediately before survivor annuity terminated because student status ended and whose survivor annuity is restored;
  • Surviving child who was covered by FEHB immediately before survivor annuity terminated because of marriage and whose survivor annuity is restored.
Yes N/A N/A Within 60 days after the retirement system or OWCP mails a notice of insurance eligibility.
2F Annuitant or eligible family member loses FEHB coverage due to termination, cancellation, or change to Self Only of the covering enrollment. Yes Yes Yes From 31 days before through 60 days after date of loss of coverage.
2G

Annuitant or eligible family member loses coverage under FEHB or another group insurance plan; for example:

  • Loss of coverage under another federally-sponsored health benefits program;
  • Loss of coverage due to termination of membership in the employee organization sponsoring the FEHB plan;
  • Loss of coverage under Medicaid or similar State-sponsored program (but see events 2C and 2D);
  • Loss of coverage under a non-Federal health plan.
Yes Yes Yes From 31 days before through 60 days after loss of coverage.
2H Annuitant or eligible family member loses coverage due to the discontinuance, in whole or part, of an FEHB plan. N/A Yes Yes During Open Season, unless OPM sets a different time.
2I Annuitant or covered family member in a Health Maintenance Organization (HMO) moves or becomes employed outside the geographic area from which the carrier accepts enrollments, or if already outside this area, moves or becomes employed further from this area. N/A Yes Yes Upon notifying the employing office of the move or change of place of employment.
2J Employee in an overseas post of duty retires or dies. No Yes Yes Within 60 days after retirement or death.
2K An enrolled annuitant separates from duty after serving 31 days or more in a uniformed service. N/A Yes Yes Within 60 days after separation from the uniformed service.
2L On becoming eligible for Medicare.
(This change may be made only once in a lifetime.)
N/A No Yes At any time beginning on the 30th day before becoming eligible for Medicare.
2M Annuitant annuity is insufficient to make withholdings for plan in which enrolled. N/A No Yes Employing office will advise annuitant of the options.

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Former Spouse Under the Spouse Equity Provisions
QLEs That Permit Enrollment or ChangeChange PermittedTime Limits
CodeEventFrom Not Enrolled to EnrolledFrom Self Only to Self and FamilyFrom One Plan or Option to AnotherWhen You Must File Health Benefits Election Form With Your Employing Office
3 Former Spouse Under The Spouse Equity Provisions Note: Former spouse may change to Self and Family only if family members are also eligible family members of the employee or annuitant.
3A Initial opportunity to enroll. Former spouse must be eligible to enroll under the authority of the Civil Service Retirement Spouse Equity Act of 1984 (P.L. 98-615), as amended, the Intelligence Authorization Act of 1986 (P.L. 99-569), or the Foreign Relations Authorization Act, Fiscal Years 1988 and 1989 (P.L. 100-204). Yes N/A N/A Generally, must apply within 60 days after dissolution of marriage. However, if a retiring employee elects to provide a former spouse annuity or insurable interest annuity for the former spouse, the former spouse must apply within 60 days after OPM''s notice of eligibility for FEHB. May enroll any time after employing office establishes eligibility.
3B Open Season. No Yes Yes As announced by OPM.
3C Change in family status based on addition of family members who are also eligible family members of the employee or annuitant. No Yes Yes From 31 days before through 60 days after change in family status.
3D Reenrollment of former spouse who cancelled FEHB enrollment to enroll in a Medicare-sponsored plan, Medicaid, or similar State-sponsored program and who later was involuntarily disenrolled from the Medicare-sponsored plan, Medicaid, or similar State-sponsored program. May Reenroll N/A N/A From 31 days before through 60 days after disenrollment.
3E Reenrollment of former spouse who cancelled FEHB enrollment to enroll in a Medicare-sponsored plan, Medicaid, or similar State-sponsored program and who later voluntarily disenrolls from the Medicare-sponsored plan, Medicaid, or similar State-sponsored program. May Reenroll N/A N/A During Open Season.
3F Former spouse or eligible child loses FEHB coverage due to termination, cancellation, or change to Self Only of the covering enrollment. Yes Yes Yes From 31 days before through 60 days after date of loss of coverage.
3G Enrolled former spouse or eligible child loses coverage under another group insurance plan; for example:
  • Loss of coverage under another federally-sponsored health benefits program;
  • Loss of coverage due to termination of membership in the employee organization sponsoring the FEHB plan;
  • Loss of coverage under Medicaid or similar State-sponsored program (but see events 3D and 3E);
  • Loss of coverage under a non-Federal health plan.
N/A Yes Yes From 31 days before through 60 days after loss of coverage.
3H Former spouse or eligible family member loses coverage due to the discontinuance, in whole or part, of an FEHB plan. N/A Yes Yes During Open Season, unless OPM sets a different time.
3I Former spouse or covered family member in a Health Maintenance Organization (HMO) moves or becomes employed outside the geographic area from which the carrier accepts enrollments, or if already outside this area, moves or becomes employed further from this area. N/A Yes Yes Upon notifying the employing office of the move or change of place of employment.
3J On becoming eligible for Medicare
(This change may be made only once in a lifetime.)
N/A No Yes At any time beginning the 30th day before becoming eligible for Medicare.
3K Former spouse's annuity is insufficient to make FEHB withholdings for plan in which enrolled. No No Yes Retirement system will advise former spouse of options.

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Temporary Continuation of Coverage (TCC) for Eligible Former Employees, Former Spouses, and Children
QLEs That Permit Enrollment or ChangeChange PermittedTime Limits
Code Event From Not Enrolled to Enrolled From Self Only to Self and Family From One Plan or Option to Another When You Must File Health Benefits Election Form With Your Employing Office
4 Temporary Continuation of Coverage (TCC) For Eligible Former Employees, Former Spouses, and Children. Note: Former spouse may change to Self and Family only if family members are also eligible family members of the employee or annuitant.
4A Opportunity to enroll for continued coverage under TCC provisions:   Within 60 days after the qualifying event, or receiving notice of eligibility, whichever is later.
  • Former employee
Yes Yes Yes
  • Former spouse
Yes N/A N/A
  • Child who ceases to qualify as a family member
Yes N/A N/A
4B Open Season:   As announced by OPM.
  • Former employee
No Yes Yes
  • Former spouse
No Yes Yes
  • Child who ceases to qualify as a family member
No Yes Yes
4C Change in family status (except former spouse); for example, marriage, birth or death of family member, adoption, legal separation, or divorce. No Yes Yes From 31 days before through 60 days after event.
4D Change in family status of former spouse, based on addition of family members who are eligible family members of the employee or annuitant. No Yes Yes From 31 days before through 60 days after event.
4E Reenrollment of a former employee, former spouse, or child whose TCC enrollment was terminated because of other FEHB coverage and who loses the other FEHB coverage before the TCC period of eligibility (18 or 36 months) expires. May Reenroll N/A N/A From 31 days before through 60 days after the event. Enrollment is retroactive to the date of the loss of the other FEHB coverage.
4F

Enrollee or eligible family member loses coverage under FEHB or another group insurance plan; for example:

  • Loss of coverage under another FEHB enrollment due to termination, cancellation, or change to Self Only of the covering enrollment (but see event 4E);
  • Loss of coverage under another federally-sponsored health benefits program;
  • Loss of coverage due to termination of membership in the employee organization sponsoring the FEHB plan;
  • Loss of coverage under Medicaid or similar State-sponsored program;
  • Loss of coverage under a non-Federal health plan.
No Yes Yes From 31 days before through 60 days after loss of coverage.
4G Enrollee or eligible family member loses coverage due to the discontinuance, in whole or part, of an FEHB plan. N/A Yes Yes During Open Season, unless OPM sets a different time.
4H Enrollee or covered family member in a Health Maintenance Organization (HMO) moves or becomes employed outside the geographic area from which the carrier accepts enrollments, or if already outside this area, moves or becomes employed further from this area. N/A Yes Yes Upon notifying the employing office of the move or change of place of employment.
4I On becoming eligible for Medicare.
(This change may be made only once in a lifetime.)
N/A No Yes At any time beginning on the 30th day before becoming eligible for Medicare.

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Employees Who Are Not Participating In Premium Conversion

QLEs That Permit Enrollment or Change

Change Permitted

Time Limits

Code

Event

From Not Enrolled to Enrolled

From Self Only to Self and Family

From One Plan or Option to Another

When You Must File Health Benefits Election Form With Your Employing Office

5

Employees Who Are Not Participating In Premium Conversion

5A

Initial opportunity to enroll.

Yes

N/A

N/A

Within 60 days after becoming eligible.

5B

Open Season.

Yes

Yes

Yes

As announced by OPM.

5C

Change in family status; for example: marriage, birth or death of family member, adoption, legal separation, or divorce

Yes

Yes

Yes

From 31 days before through 60 days after event.

5D

Change in employment status; for example:

  • Reemployment after a break in service of more than 3 days;
  • Return to pay status following loss of coverage due to expiration of 365 days of LWOP status or termination of coverage during LWOP;
  • Return to pay sufficient to make withholdings after termination of coverage during a period of insufficient pay;
  • Restoration to civilian position after serving in uniformed services;
  • Change from temporary appointment to appointment that entitles employee receipt of Government contribution;
  • Change to or from part-time career employment.

Yes

Yes

Yes

Within 60 days of employment status change.

5E

Separation from Federal employment when the employee is or employee's spouse is pregnant.

Yes

Yes

Yes

Enrollment or change must occur during final pay period of employment.

5F

Transfer from a post of duty within the United States to a post of duty outside the United States, or reverse.

Yes

Yes

Yes

From 31 days before leaving old post through 60 days after arriving at new post.

5G

Employee or eligible family member loses coverage under FEHB or another group insurance plan; for example:

  • Loss of coverage under another FEHB enrollment due to termination, cancellation, or change to Self Only of the covering enrollment;
  • Loss of coverage under another federally-sponsored health benefits program;
  • Loss of coverage due to termination of membership in the employee organization sponsoring the FEHB plan;
  • Loss of coverage under Medicaid or similar State-sponsored program;
  • Loss of coverage under a non-Federal health plan.

Yes

Yes

Yes

From 31 days before through 60 days after loss of coverage.

5H

Enrollee or eligible family member loses coverage due to the discontinuance, in whole or part, of an FEHB plan.

N/A

Yes

Yes

During Open Season, unless OPM sets a different time.

5I

Loss of coverage under a non-Federal group health plan because an employee moves out of the commuting area to accept another position and the employee is non-federally employed spouse terminates employment to accompany the employee.

Yes

Yes

Yes

From 31 days before the employee leaves the commuting area through 180 days after arriving in the new commuting area.

5J

Employee or covered family member in a Health Maintenance Organization (HMO) moves or becomes employed outside the geographic area from which the carrier accepts enrollments, or if already outside the area, moves or becomes employed further from this area.

N/A

Yes

Yes

Upon notifying the employing office of the move or change of place of employment.

5K

On becoming eligible for Medicare
(This change may be made only once in a lifetime.)

N/A

No

Yes

At any time beginning on the 30th day before becoming eligible for Medicare.

5L

Temporary employee completes one year of continuous service in accordance with 5 U.S.C. Section 8906a.

Yes

N/A

N/A

Within 60 days after becoming eligible.

5M

Salary of temporary employee insufficient to make withholdings for plan in which enrolled.

N/A

No

Yes

Within 60 days after receiving notice from employing office.

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Control Panel