FEHB Handbook

Annuitants and Compensationers
Page 4 of 6

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EMPLOYING OFFICE PROCEDURES Continued

If Your Enrollment Terminates after 365 Days in Leave Without Pay Status

If your enrollment terminates because of 365 days in leave without pay status, it will be reinstated if your retirement application is approved with an annuity starting date before the end of the 365 days of leave without pay status. Your employing office should follow the procedures described in "If You Appear Eligible to Continue Your Enrollment" if you otherwise would be eligible to continue your enrollment. It will send the Notice of Change in Health Benefits Enrollment (SF 2810) that terminated your enrollment to the retirement system along with your other documents.

If your enrollment terminates after 365 days in leave without pay status and you have a pending disability retirement application, you should convert to an individual contract. If your disability retirement application is approved later, the retirement system will reinstate your enrollment, retroactive to the starting date of your annuity (as long as you meet the requirements to continue your enrollment).

If You Separate and Later Retire

When you are eligible for an immediate annuity, but don't apply for retirement, your employing office will terminate your enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810) upon your separation. Also, your enrollment will terminate when you are separated while your application for retirement (such as for disability) is pending in a retirement system.

You should enroll under the temporary continuation of coverage (TCC) provisions even though you plan to apply for retirement later or have a disability retirement pending in a retirement system. If your retirement application is approved later, your retirement system will reinstate the enrollment, retroactive to the starting date of your annuity (as long as you meet the requirements to continue your enrollment). Your employing office will refund the premiums you paid for the TCC coverage when you provide documentation showing the retroactive coverage as a retiree.

FERS MRA + 10 BENEFITS

If you are a separating FERS employee eligible for an immediate annuity under the minimum retirement age and 10 years of service (MRA + 10) provision, you may receive the benefits immediately or you may postpone receiving your annuity to lessen the age reduction applicable to persons under age 62.

If you are eligible for an MRA+10 annuity and are not applying for retirement at the time of separation, your employing office will terminate your enrollment on the Notice of Change in Health Benefits Enrollment form (SF 2810). It will notify you of your right to enroll under temporary continuation of coverage (TCC) or convert to an individual contract. If you meet the requirements for continuing health benefits as a retiree, you may reenroll when you decide to allow your annuity to begin.

If you are applying for retirement and appear eligible to continue your enrollment, your employing office will follow the procedures in "Nondisability Retirement."

If you apply for an immediate annuity under the MRA + 10 provisions and later decide to postpone your annuity starting date, OPM will notify your employing office that it must offer you the opportunity to elect TCC coverage.

When You Apply for MRA + 10 Annuity

If you are requesting that your annuity begin under the MRA + 10 provision, you may enroll in any plan for which you are eligible within 60 days after OPM notifies you of your eligibility. If you die before the end of this 60 day period, your survivors entitled to an annuity may enroll within 60 days after OPM's notification to your survivor of his/her eligibility.

Your enrollment is effective the first day of the month after the month that OPM receives your request, or on the starting date of your annuity, whichever is later. Your survivor's enrollment is effective on the first day of the month after the month that OPM receives his/her request for enrollment.

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OPPORTUNITIES FOR ANNUITANTS TO ENROLL OR CHANGE ENROLLMENT

• Effective Date
• Late Elections
• Election by Proxy
• Change to Self Only
• Open Season
• Change in Family Status
• When Coverage under Medicare Managed Care Plan or Medicaid Ends
• Upon Restoration of Disability Annuity
• Loss of Coverage under FEHB or Another Group Insurance Plan
• When Your Plan is Discontinued
• Move from an HMO's Service
• Retirement from Overseas Duty Post
• Return from Military Service
• You become Eligible for Medicare
• Annuity Insufficient to Pay Withholdings

Effective Date

Unless otherwise specified, enrollment changes take effect on the first day of the month that follows your retirement system's receipt of your enrollment change request.

Late Elections

If you were unable, for reasons beyond your control, to make an enrollment election or change within the required time limits, your retirement system may allow you to make a late election. You must make your election within 60 days after you were notified of the retirement system's determination.

Election by Proxy

Your retirement system may permit your representative to make an enrollment election or change for you with your written authorization.

Change to Self Only

You may change your enrollment from self and family to self only at any time under the same conditions as an active employee.

Open Season

If you are an enrolled annuitant, you may change plans, options, or type of enrollment during Open Season.

If you are a nonenrolled annuitant, you are not permitted to enroll during an Open Season unless you had canceled your FEHB enrollment:

• to join, and have subsequently voluntarily disenrolled from, a Medicare managed care plan; or
• because you furnished proof of eligibility for Medicaid (or a similar State-sponsored program of medical assistance for the needy) and you wish to reenroll in FEHB for reasons other than involuntary loss of that other coverage.

Your enrollment change or reenrollment (including a belated enrollment change) is effective on the first day of the first pay period that begins in January of the next year (January 1 for most annuitants).

Change in Family Status

You may change plans, options, or type of enrollment when you have a change in family status under the same conditions as an active employee (but you can't enroll if you aren't already enrolled). There are different rules for an enrolled survivor annuitant.

When Coverage under Medicare Managed Care Plan or Medicaid Ends

If you were enrolled (or eligible to enroll) in the FEHB Program as an annuitant and:

• you suspended your FEHB enrollment to enroll in a Medicare managed care plan or because you furnished proof of eligibility for Medicaid (or a similar State-sponsored program of medical assistance for the needy); and
• your enrollment in the Medicare managed care plan or Medicaid ends involuntarily,

you can immediately reenroll in any available plan at any time from 31 days before to 60 days after your coverage in the Medicare managed care plan or Medicaid ends. The reenrollment is effective on the date following the involuntary loss of coverage as shown in documentation from the Medicare managed care plan or Medicaid. An involuntary loss of coverage includes when the Medicare managed care plan ceases to be offered, you move from the area served by the Medicare managed care plan, or you lose eligibility for Medicaid.

If you voluntarily disenroll from the Medicare managed care plan or Medicaid, you may reenroll in the FEHB Program during the following Open Season.

Upon Restoration of Disability Annuity

If you were receiving a disability annuity and:

• your disability annuity was terminated because you were found restored to earnings capacity or recovered from your disability;
• you were enrolled in an FEHB plan immediately before your disability annuity was terminated; and
• your disability annuity is later restored,

you may reenroll in a health benefits plan within 60 days from OPM's notice of your eligibility to reenroll. Your reenrollment is effective on the first day of the month after OPM receives your enrollment request.

Loss of Coverage under FEHB or Another Group Insurance Plan

If you are an annuitant eligible to enroll, but you are covered as a family member under another FEHB enrollment, you may enroll in your own name if you lose coverage under the other enrollment.

If you are an enrolled annuitant, you may change plans, options, or from Self Only to Self and Family when you lose coverage under another group health benefits plan or when an eligible family member loses coverage under FEHB or another group health benefits plan.

Some examples of loss of coverage are:

• You or your family member lose FEHB coverage because the covering enrollment was terminated, canceled, or changed to Self Only;
• You or your family member lose coverage under another federally-sponsored program;
• Your membership ends in the employee organization that sponsors your health benefits plan;
• You are enrolled in a plan that is discontinued;
• You or your family member lose coverage under Medicaid or a similar program;
• You or your family member lose coverage under a non-Federal health plan.

When Your Plan is Discontinued

You may change to another plan when you are enrolled in a plan that is discontinued in whole or in part. You may enroll in the new plan for either Self Only or Self and Family coverage. If your plan is discontinued at the end of a contract year, you must change your enrollment during Open Season unless OPM establishes a different time.

Normally, a plan that terminates its participation in the FEHB Program will terminate as of December 31 of a given year. The plan will continue to provide benefits until the new coverage takes effect. When a plan is discontinued at any time other than at the end of a contract year, OPM will issue special instructions about the proration of premiums and the effective date of subsequent enrollment changes.

If you don't change to another plan when:

• The plan that is discontinued has only one option, you are considered to have enrolled in the standard option of the Blue Cross and Blue Shield Service Benefit Plan.
• One option of a two-option plan is discontinued, you are considered to have enrolled in the remaining option of the plan.
• Both options of a two-option plan are discontinued, you are considered to have enrolled in the same option of the Blue Cross and Blue Shield Service Benefit Plan. Exception: when your annuity is insufficient to pay the premiums of the high option of the Blue Cross and Blue Shield Service Benefit Plan, you are considered to have enrolled in the Blue Cross and Blue Shield Service Benefit Plan standard option.

Move from an HMO's Service Area

If you are enrolled in an HMO, and you or an enrolled family member move or become employed outside the HMO's service area, or, if already outside of this area, move or become employed further from this area, you may change your enrollment under the same conditions as an active employee.

Retirement from Overseas Duty Post

You may change plans, options, and type of enrollment within 60 days of your retirement from a post of duty outside the United States. Your eligible survivors may also make these changes if you were stationed outside the United States at the time of your death.

Return from Military Service

You may change plans, options, and type of enrollment within 60 days after separation from at least 31 days of duty in a uniformed service.

You become Eligible for Medicare

You may change your enrollment to any option of any available plan at any time beginning on the 30^th day before you become eligible for Medicare. You may make an enrollment change under this event only once.

Annuity Insufficient to Pay Withholdings

If your annuity is not sufficient to pay your plan's premiums, your retirement system must notify you of the plans available at a cost that doesn't exceed your annuity. You may either pay your premiums directly to your retirement system or you may enroll in another plan where the cost is no greater than your annuity. Coverage under your new plan is effective immediately upon termination of your old plan's coverage.

If you don't take either of these actions and you are enrolled in the high option of a plan, you are considered to have enrolled in the standard option of the same plan (unless your annuity is insufficient to pay the standard option premiums).

If you don't take either of these actions and your enrollment is terminated, you may apply to your retirement system for reinstatement of your enrollment in any available plan or option.

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Handbook Contents

• Introduction
• Cost of Insurance
• Health Plans
• Eligibility for Health Benefits
• Enrollment
• Leave Without Pay Status and Insufficient Pay
• Termination, Conversion, and Temporary Continuation of Coverage
• Annuitants and Compensationers
• Military Service
• Family Members
• Former Spouses

Appendices

• Forms and Brochures
• Glossary
• Table of Permissible Changes
• Chapter 89 of title 5, United States Code
• Part 890 of title 5, Code of Federal Regulations

Other

• Search the Handbook
• Handbook Changes