Insurance Services Programs

FEHB Handbook

Termination, Conversion and Temporary Continuation of Coverage
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31-DAY EXTENSION OF COVERAGE AND CONVERSION (Continued)

• Extension of Coverage
• Conversion Rights
• Benefits Under a Conversion Contract
• Conversion for Family Members
• Conversion for Enrollees
• Late Conversion
• Effective Date of Conversion Contract
• Reinstatement of Enrollment after Conversion

If a family member loses coverage under your enrollment (including as a result of your change to self only), he/she is also entitled to convert to an individual policy offered by the carrier of your plan. Your family member is not required to provide evidence of insurability.

Exception: your family member is not entitled to convert to an individual policy if you voluntarily canceled your enrollment or your plan was discontinued.

It is the responsibility of you or your family member to know when he/she is no longer eligible for coverage and to apply for a conversion contract in a timely manner. Your employing office is not obligated to inform you of your family member's conversion rights when he/she is no longer eligible for coverage. Your employing office may, from time to time, publish reminders of family members' right to convert in internal publications.

To apply for conversion, you or your family member must make a written request to the carrier of your plan. You or your family member must apply for conversion within 31 days after his/her coverage as a family member terminated.

Conversion for Enrollees

When your enrollment terminates, your employing office must give you a notice of your right to convert to an individual policy on the Notice of Change in Health Benefits Enrollment form (SF 2810). Your employing office should provide you with this notice immediately upon your enrollment termination, but no later than 60 days from the termination date.

To apply for conversion, complete the back of your copy of the SF 2810 and take or mail it to the carrier of your plan within 31 days from the date of your employing office's notice to you (part H of SF 2810), but no later than 91 days from the date your enrollment terminates (Part A, item 8 of SF 2810).

Late Conversion

When your employing office doesn't give you the required conversion notice within 60 days, or you aren't able to request conversion on time for reasons beyond your control, you can request a late conversion by writing directly to the carrier of your plan.

You must send your request within six months after the date your enrollment terminated. Your request must:

• include some documentation that your enrollment has terminated (for example, an SF 50 showing separation from service);
• include proof that you were not notified of the enrollment termination and the right to convert (for example, a letter from your employing office confirming that it did not provide timely notice of the conversion option), and were not otherwise aware of it, or
• include proof that you weren't able to convert because of reasons beyond your control.

If six months or more have passed since the date you became eligible to convert, the carrier of your plan is not required to accept a request for conversion.

If the carrier accepts your request for a late conversion, you must enroll and pay your first premium within 31 days of the carrier's notice. If you don't convert within this time period, you are considered to have waived your conversion rights, unless the carrier determines that you did not convert for reasons beyond your control. If the carrier determines that your failure to convert was within your control, you may request that OPM review its decision. To request an OPM review, write to U.S. Office of Personnel Management, Retirement and Insurance Service, Office of Insurance Programs, P.O. Box 436, Washington, D.C. 20044.

Effective Date of Conversion Contract

Your or your family member's conversion contract becomes effective at the end of the 31-day extension of coverage, even when you or your family member are an inpatient in a hospital on the 31^st day of extended coverage.

Reinstatement of Enrollment after Conversion

If you converted to an individual contract after your enrollment terminated, and your enrollment is later reinstated retroactive to the effective date of your termination (e.g., you were removed and later ordered restored to duty with full restitution of back pay; or you retire with an annuity starting date made prior to your enrollment termination because of 365 days in leave without pay status), you may get a refund of all the premiums you paid on the conversion contract. You must apply in writing to the carrier of your plan for the refund. If you received benefits when your conversion contract was in effect, you are entitled to an adjustment of the difference between the benefits paid by the carrier under the conversion contract and the benefits payable under your FEHB enrollment.

TERMINATION OF ERRONEOUS ENROLLMENT

• If Withholdings were Made
• If Withholdings were not Made

If your position is excluded from FEHB coverage but you were erroneously allowed to enroll, your employing office must terminate or void your coverage as soon as the error is discovered. Your employing office must explain to you why you are not eligible for coverage and the effect of the termination.

If Withholdings were Made

If you were erroneously enrolled and premium withholdings and contributions were made, your employing office must terminate your coverage and discontinue withholdings and contributions at the end of that pay period. No adjustments are made for contributions and withholdings that already have been made. You and your covered family members are entitled to full plan benefits during the time you were erroneously enrolled. You are entitled to convert to an individual contract the same as any other employee whose enrollment is terminated.

If Withholdings were not Made

If no premium withholdings and contributions were made before your erroneous enrollment is discovered, your employing office must void your enrollment. In addition, your employing office will note in the Remarks section of the payroll office copy of the Health Benefits Election Form (SF 2809) (which is sent to the carrier): "Erroneous enrollment--enrollee responsible for any benefits provided." You will be responsible for any claims paid during your erroneous enrollment. Your carrier will contact you to recover any payment it made.

TEMPORARY CONTINUATION OF COVERAGE

• Law
• Eligibility
• Employing Office Responsibilities
• Notification Requirements for Separating Employees
• Time Limits for Electing Temporary Continuation of Coverage
• Effective Date of Coverage
• Length of Temporary Continuation of Coverage
• Premium Payments
• Nonpayment of Premiums
• Sample Notice for Delinquent Premiums
• Effective Date of Enrollment Change
• Opportunities to Change Your TCC Coverage
• Termination of TCC Enrollment or Coverage
• Denial of TCC because of Involuntary Separation for Gross Misconduct
• General Guidelines for Gross Misconduct Determinations
• Removal must Result from Gross Misconduct
• Notification Requirements
• Response
• Coordination with the Office of Workers' 
• Compensation Programs (OWCP)
• Coordination with Spouse Equity Provisions
• Health Benefits File
• When You have TCC Coverage and You Become Employed by the Federal Government

If you lose your FEHB coverage because you separate from Federal service, you may enroll under the Temporary Continuation of Coverage (TCC) provision of the FEHB law to continue your coverage for up to 18 months. Exception: you are not eligible for TCC if your separation is due to gross misconduct.

Your family members who lose coverage because they are no longer eligible family members may enroll under TCC to continue FEHB coverage for up to 36 months.

Law

Title II of Public Law 100-654, effective January 1, 1990, established the temporary continuation of coverage provision for the FEHB Program.

Eligibility

• Employee
• Child
• Former Spouse
• Persons not Eligible

An employee, a child, and a former spouse are eligible for temporary continuation of coverage based on specific qualifying events.

Employee

You are eligible for temporary continuation of coverage when you:

• separate from service, voluntarily or involuntarily, unless your separation is due to gross misconduct; and
• you would not otherwise be eligible to continue FEHB coverage (not counting the 31-day extension of coverage).

You are eligible for temporary continuation of coverage when you separate for retirement and are not eligible to continue FEHB coverage as an annuitant.

Child

Your child is eligible for temporary continuation of coverage when he/she:

• has been covered as an unmarried dependent child under your enrollment as an employee, former employee, or annuitant; and
• stops meeting the requirements for being considered your unmarried dependent child; and
• would not otherwise be eligible to continue FEHB coverage (not counting the 31-day extension of coverage).

This includes a child who:

• Marries before reaching age 22;
• Loses coverage because he/she reaches age 22;
• No longer meets coverage requirements as a stepchild, foster child, or a recognized natural child;
• Was covered as a disabled child age 22 and older, and marries, recovers from his/her disability, or becomes self-supporting;
• Loses FEHB coverage upon the death of an employee or annuitant because he/she does not qualify for a survivor annuity;
• Loses FEHB coverage because his/her survivor annuity as a dependent of the deceased stops (for any reason, including because he/she is no longer a full-time student).

Former Spouse

Your former spouse is eligible for temporary continuation of coverage when he/she has been covered as a family member at some time during the 18 months before your marriage ended, but does not meet the remaining requirements for coverage under the spouse equity provisions of the FEHB law because he/she:

• remarried before reaching age 55; or
• is not entitled to a portion of your annuity benefits or a survivor benefit based on your service.

Persons not Eligible

You are not eligible for temporary continuation of coverage (TCC) when:

• you transfer to a position that is excluded from FEHB coverage by law;
• you lose coverage after 12 months in a leave without pay status;
• you are a compensationer and you lose coverage because your compensation terminates;
• you are a family member who loses coverage when the enrollee changes to a self only enrollment, cancels coverage, or separates from service and does not elect TCC;
• you are a spouse who loses coverage because of the death of an employee or annuitant (most surviving spouses can continue regular coverage as survivor annuitants, and so don't need TCC);
• you are a surviving spouse whose annuity terminates;
• you are a child who enters military service (you are still considered an eligible dependent child).

In some cases, a child who would ordinarily be covered as a family member may want TCC coverage instead. This may happen when your unmarried child has a child and wants to provide health benefits coverage for this child. Usually, your grandchild is not eligible for coverage as a family member under your enrollment, unless he/she qualifies as a foster child. For your child to enroll through TCC and cover his/her child, you must prove that he/she is no longer a dependent.

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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

 

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