Frequently Asked Questions About Continuation of Coverage
A. Temporary Continuation of Coverage (TCC) is available to: (1) employees who lose their FEHB Program coverage because they leave their Federal jobs, (2) children who lose their FEHB Program family member status because they become age 22 or marry, and (3) former spouses who lose their FEHB Program family member status because of divorce or annulment. TCC allows former employees to continue their FEHB Program coverage for up to 18 months, and former family members (children and former spouses) to continue FEHB Program coverage for up to 36 months. For more information about TCC, please review the TCC pamphlet at www.opm.gov/insure/health/TCC.
A. You must apply for Temporary Continuation of Coverage (TCC) with your agency Human Resources Office within 60 days from the date you separate from Federal service. TCC coverage becomes effective the day after the qualifying event. After your 31-day extension of your group coverage ends, you pay the full premium (the enrollee and Government shares) plus a 2 percent administrative fee. For more information, contact the agency Human Resources Office and review the TCC pamphlet at www.opm.gov/insure/health/TCC.
A. When children reach age 22, they are eligible to enroll in Temporary Continuation of Coverage (TCC). You contact your Human Resources Office and inform them that your child is turning age 22. It is not their responsibility to notify you. They will give you information about enrolling your child for TCC. You have 60 days from the 22nd birthday to notify your Human Resources Office that your child turned 22. Your child has 60 days from the later of (1) the 22nd birthday or (2) the date of the TCC notice from the Human Resources Office to request enrollment for TCC. For more information about TCC, please review the TCC coverage pamphlet at www.opm.gov/insure/health/TCC.
A. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal law that provides far-reaching health insurance reforms and medical privacy protections for all Americans. Title I of HIPAA offers important, though limited, Federal protections that improve the availability and continuity of health coverage for workers and their families. Under certain conditions, this law guarantees the availability of new health coverage with no exclusions for pre-existing conditions for individuals who lose employment-based health coverage due to changes in employment or family status. The Departments of the Treasury, Labor, and Health and Human Services are jointly responsible for Federal rules concerning health insurance portability and accessibility requirements. However, since HIPAA gives enforcement authority to the individual states and allows states to impose more generous protections than those under HIPAA, a key source of information for individuals is your State Insurance Commissioner.
A. The Centers for Medicare and Medicaid Services in the Department of Health and Human Services, offers two resources to help answer questions about HIPAA health insurance protections and individual eligibility. HIPAA OnLine is an interactive tool that provides information about HIPAA rights and protections based on the user's responses to questions about personal health coverage and life events. There is also a booklet entitled Protecting Your Health Insurance Coverage (see "publications" link on web site). Both resources are available on the Internet at http://www.hcfa.gov/medicaid/hipaa/. Single copies of the booklet are also available on request from 1-800-MEDICARE (1-800-633-4227), or TTY/TDD, at 1-877-486-2048.
HIPAA OnLine also has direct links to Federal and State contacts for information about health coverage protections under HIPAA. An Internal Revenue Service publication entitled Deciding Whether to Elect COBRA Health Care Continuation Coverage After the Enactment of HIPAA is available on the IRS web site at http://www.irs.ustreas.gov/prod/news/index.html. As explained in OPM pamphlet RI 79-27, Temporary Continuation of Coverage (TCC) under the FEHB Program (p.1), Federal employees must exhaust any TCC eligibility (which corresponds to COBRA provisions for private sector employees) as one condition for guaranteed access to individual health coverage under HIPAA.
A. We require FEHB carriers to issue certifications of prior coverage to enrollees. They issue certifications automatically whenever coverage terminates, whether it is termination of regular coverage, TCC coverage, or spouse equity coverage. If the plan does not certify your coverage, you should write to them and ask them to send you certification of coverage.