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Changes You Can Make Outside of Open Season

Changes You Can Make Outside of Open Season

Important Notice: Generally, if you choose to make a change to your enrollment, you must make the change within 60 days of the event.

Outside of Open Season, you can enroll in the FEHB Program, change your enrollment, change to Self Only or cancel coverage only in connection with certain events called qualifying life events (QLEs).

The major QLEs that permit enrollment or change in enrollment are:

A change in family status:

  • marriage
  • birth or adoption of a child
  • acquisition of a foster child
  • legal separation
  • divorce
  • death of a spouse or dependent

A change in employment status:

  • you are reemployed after a break in service of more than 3 days
  • you return to pay status after your coverage terminated during leave without pay status or because you were in leave without pay status for more than 365 days
  • your pay increases enough for premiums to be withheld
  • you are restored to a civilian position after serving in the uniformed services
  • you change from a temporary appointment to an appointment that entitles you to a Government contribution
  • you change to or from part-time career employment

You or a family member lose FEHB or other coverage:

  • under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to Self Only
  • when enrolled in a prepaid health maintenance organization (HMO) and you or a covered family member move or change worksite outside of the HMO's enrollment area
  • under another federally-sponsored health benefits program
  • under Medicaid or similar State-sponsored program for the needy
  • under CHAMPVA, TRICARE, or TRICARE-for-Life
  • when you had previously suspended your FEHB coverage to participate in one of these programs
  • when your membership in the employee organization sponsoring the FEHB plan terminates
  • under a non-Federal health plan

When one of these events occurs, you may:

  • enroll
  • increase you enrollment
  • switch your designated family member under a Self Plus One enrollment when the current designated family member experiences certain QLEs
  • change your enrollment to another FEHB plan or option
  • decrease your enrollment*
  • cancel your enrollment*

* A decrease to Self Only may be made only if the QLE causes the enrollee to be the last eligible family member under the FEHB enrollment. A decrease to Self Plus One may be made only if the QLE leaves only one eligible family member covered in addition to the enrollee. A cancellation may be made only if the enrollee can show that as a result of the QLE, he or she and all eligible family members now have other health insurance coverage.

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