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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.
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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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Restoration of annuity or compensation (OWCP) payments; for example:
Annuitant or eligible family member loses coverage under FEHB or another group insurance plan; for example:
Enrollee or eligible family member loses coverage under FEHB or another group insurance plan; for example:
QLEs That Permit Enrollment or Change
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
Employees Who Are Not Participating In Premium Conversion
Initial opportunity to enroll.
Within 60 days after becoming eligible.
As announced by OPM.
Change in family status; for example: marriage, birth or death of family member, adoption, legal separation, or divorce
From 31 days before through 60 days after event.
Change in employment status; for example:
Within 60 days of employment status change.
Separation from Federal employment when the employee is or employee's spouse is pregnant.
Enrollment or change must occur during final pay period of employment.
Transfer from a post of duty within the United States to a post of duty outside the United States, or reverse.
From 31 days before leaving old post through 60 days after arriving at new post.
Employee or eligible family member loses coverage under FEHB or another group insurance plan; for example:
From 31 days before through 60 days after loss of coverage.
Enrollee or eligible family member loses coverage due to the discontinuance, in whole or part, of an FEHB plan.
During Open Season, unless OPM sets a different time.
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.
From 31 days before the employee leaves the commuting area through 180 days after arriving in the new commuting area.
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.
Upon notifying the employing office of the move or change of place of employment.
On becoming eligible for Medicare(This change may be made only once in a lifetime.)
At any time beginning on the 30th day before becoming eligible for Medicare.
Temporary employee completes one year of continuous service in accordance with 5 U.S.C. Section 8906a.
Salary of temporary employee insufficient to make withholdings for plan in which enrolled.
Within 60 days after receiving notice from employing office.