FEHB Enrollment Special Considerations

FEHB Changes Outside an Open Season

The annual open season in mid-November through mid-December is when most enrollment changes in the Federal Employees Health Benefits program occur, but certain changes are allowed at other times when an individual experiences a “qualifying life event.” The major events that permit enrollment or change in enrollment are:

  • A change in family status, including marriage, birth or adoption of a child, acquisition of a foster child, legal separation, divorce, or death of a spouse or dependent.
  • A change in employment status, meaning when you are reemployed after a break in service of more than three 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, or 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, under another federally sponsored health benefits program, under Medicaid or similar state-sponsored program for the needy, because your membership terminates in the employee organization sponsoring the FEHB plan, or under a non-federal health plan.

When one of these events occurs, you may enroll, change your enrollment (such as from self only to self plus one or to self and family, consistent with the event) change your enrollment to another FEHB plan or option, change your enrollment to a lower coverage option, or cancel your enrollment. As described above, those with self plus one coverage but with more than one family member eligible also may change the person to be covered under similar circumstances outside an open season.

A change to self only may be made only if the event causes the enrollee to be the last eligible family member under the FEHB enrollment. Also, a cancellation may be made only if the enrollee can show that as a result of the qualifying life event, he or she and all eligible family members now have other health insurance coverage.

Standard Form 2809, at www.opm.gov/forms, contains a chart outlining the available choices in varying situations for each category of enrollee.

Leave Without Pay and FEHB Coverage

If you are entering a period of LWOP (more than 31 days) you will have the option to terminate or continue your FEHB coverage. If you elect to continue your FEHB coverage, you must choose one of the options available to pay your share of the premium. These are the pay-as-you-go and catch-up options. In addition, under the IRS rules your agency may, but is not required to, offer a prepay option.

Under the pay-as-you-go option, you pay your share of the FEHB premium directly to your employing agency while on LWOP. These payments will generally be made with after-tax monies, since there is no pay from which to make deductions. Under the catch-up option, the agency remits your share of the FEHB premium to OPM while you are on LWOP. You incur an obligation to your employing agency and are required to repay it upon your return to pay status.

Under prepay, the amount of FEHB premiums you prepay in advance may either be deducted from your pay or paid directly “out-of-pocket” to your agency. Payments made “out-of-pocket” do not reduce taxable income. The amount of FEHB premiums that you prepay will be treated on a pre-tax basis, if it is deducted from your pay and you participate in premium conversion.

Canceling Your Enrollment

You may voluntarily cancel your enrollment at any time. However, if you do so, you and any family member(s) under your enrollment will not be able to convert to a nongroup contract or enroll for TCC (see FEHB Coverage sections here).

Note: Generally, voluntary cancellation of enrollment permanently bars reenrollment in the FEHB program. If you ask OPM to cancel your enrollment, OPM will give you a complete explanation of the effect of cancellation on your rights.

Suspending Your Enrollment

You may want to suspend your enrollment. Usually, enrollments are suspended because the enrollee wants to join a Medicare HMO or be covered as a family member under another person’s self and family FEHB program enrollment, or to enroll in the military Tricare for Life program.

To reactivate suspended coverage you need to contact OPM as soon as you decide to make the change so you will know the time limits that apply to you. To reactivate coverage after you lose coverage under someone else’s FEHB enrollment, contact OPM within 31 days after the event. Other situations have different time limits.

When Both Spouses Are Eligible To Enroll in FEHB

If one spouse is retired and eligible to continue FEHB enrollment in retirement and the other spouse is a federal employee eligible for FEHB enrollment (or both are retired and each is eligible for enrollment as a retiree), the couple may decide to have two self only enrollments or one self plus one enrollment. The cost of the plans probably will be the determining factor. Of course, if there are children, the decision probably will be for one spouse to cover everybody under a self and family enrollment.

How to Change Your FEHB Enrollment

To change your enrollment, contact OPM at (888) 767-6738 or go online to www.opm.gov/healthcare-insurance/healthcare. Be sure to have your retirement claim number or your survivor annuity claim number handy. If you are a former spouse of a federal employee and you are paying health benefits premiums directly to OPM, you also should provide your Social Security number. If you prefer, write to: OPM, Federal Employees Health Benefits Program, Room 3424, 1900 E St., NW, Washington, D.C. 20415-0001.

OPM needs to know the change you wish to make, the event that permits the change and the date on which that event occurred.

Before OPM can process a request to cancel your enrollment, it will send you a letter that must be signed and returned to OPM, unless your signed request includes a statement that you understand that you are not entitled to a 31-day extension of coverage and a statement that you understand you cannot reenroll in any plan under the FEHB program at a later date.

However, if you are suspending because you are covered under your spouse’s self and family enrollment or to join an MCCP plan, you may be eligible to reenroll.

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