FEHB Handbook

Termination, Conversion and Temporary Continuation of Coverage
Page 5 of 6

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Premium Payments

• Nonpayment of Premiums
• Sample Notice for Delinquent Premiums

There is no Government contribution towards the premiums charged for a Temporary Continuation of Coverage (TCC) enrollment. If you are a TCC enrollee, you must pay the full premium charge (both employee and Government shares) plus a 2 percent administrative charge. Premium charges, and your TCC coverage, begin on the day after the free 31-day extension of coverage ends. If you elect TCC after the 31-day extension of coverage, you will be billed for premiums retroactive to the effective date of coverage.

Exception: certain Department of Defense employees who have TCC based on a separation due to reduction in force as described in 5 U.S.C.8905a(d)(4) continue to receive a Government contribution towards premiums.

Each payment is due after the pay period in which you are covered according to the schedule established by your servicing employing office. Your servicing employing office submits the premium payments it collects along with its regular health benefits payments to OPM.

Unlike most enrollments, the beginning and ending dates of TCC enrollments are not always the same as the beginning and ending date of a pay period. In this case, your servicing employing office must prorate the premium charge. It must determine a daily premium rate by multiplying the monthly premium rate (including the administrative charge) by 12 and dividing the result by 365.

Nonpayment of Premiums

If your servicing employing office does not receive your premium payment by the due date, it must notify you in writing that you must make payment within 15 days (45 days if you live overseas) for your coverage to continue. If you don't make payment within this time frame, you are considered to have voluntarily canceled your enrollment effective with the last day that you paid your premiums. If you don't make any payments within 60 days (90 days if you live overseas) after the date of the notice, your enrollment ends, effective with the end of the last pay period that you paid your premiums.

If your coverage is canceled because you didn't pay your premiums, you aren't entitled to the 31-day extension of coverage and you can't convert to an individual contract. You may not reenroll or be reinstated unless you were unable to make payment within the specified time frames for reasons beyond your control.

Sample Notice for Delinquent Premiums

Your employing office may use the following sample notice for enrollees who do not make payments on time:

Dear (name):

We have not received your payment for health benefits coverage in the amount of $ that was due on (date), and represents payment for coverage for the month of (month, year). If we do not receive the payment with 15 days after the date you receive this letter, your health benefits will be terminated, effective (last day of coverage for which premiums were paid).

Termination of health insurance because of nonpayment of premiums is considered to be a voluntary cancellation by the enrollee. If your enrollment is canceled, you may not enroll again nor be reinstated (except as explained in the following paragraph). In addition, you will not be entitled to convert your coverage to an individual contract with your insurance carrier or to have the 31-day temporary extension of coverage.

If your coverage is canceled, it may be reinstated only if you were prevented by circumstances beyond your control from making the payment within the time frame specified above. You may request reinstatement by writing to the following address: (enter employing office address).

Sincerely,

(Name of appropriate agency official)

Effective Date of Enrollment Change

Generally, an enrollment change that you make while you are covered under Temporary Continuation of Coverage (TCC) is effective on the first day of the first pay period that begins after the date your servicing employing office receives your Health Benefits Election Form (SF 2809).

When your servicing employing office determines that you were unable, for reasons beyond your control, to change your enrollment within the specified time limits, you may do so within 60 days after your employing office tells you of its determination.

At your servicing employing office's discretion, a person with your authorization to take health benefits actions may enroll or change your enrollment on your behalf.

Opportunities to Change Your TCC Enrollment

• Change to Self Only
• Open Season
• Change in Family Status
• Reenrollment under TCC
• Loss of FEHB Coverage or Coverage under Another
• Group Insurance Plan
• Move from an HMO's Service Area
• You Become Eligible for Medicare

When you make a change based on one of the following events, your servicing employing office will follow the same procedures as for employees enrolled under regular FEHB coverage.

Change to Self Only

You may change your enrollment from self and family to self only at any time. Generally, the change is effective on the first day of the first pay period that begins after the date your servicing employing office receives your request to change your enrollment. Your employing office may make a change to self only retroactive to the first day of the pay period after the one in which you no longer had any eligible family members. This type of retroactive change will be made only if you request it and your employing office is satisfied that the last family member lost eligibility for coverage.

Open Season

During Open Season, you may change your enrollment from self only to self and family, from one plan or option to another, or make any combination of these changes. Exception: if you are an enrolled former spouse, you may change from one plan or option to another, but you cannot change from self only to self and family unless you are covering a child of both you and the employee or annuitant on whose service your coverage was based.

Your Open Season enrollment change is effective on the first day of the pay period that begins in January of the next year. If your servicing employing office accepts a late Open Season change from you, the effective date is the same date it would have been if submitted timely, even if that means it is effective retroactively.

Change in Family Status

If you are an enrolled former employee or child, you may change your enrollment from self only to self and family, from one plan or option to another, or make any combination of these changes, when you have a change in family status. You must make the enrollment change during the period beginning 31 days before and ending 60 days after the date of the change in family status.

If you are an enrolled former spouse, you may change your enrollment from self only to self and family, from one plan or option to another, or make any combination of these changes within the period beginning 31 days before and ending 60 days after the birth or acquisition of a child of both you and the employee or annuitant on whose service your coverage was based.

A change that you make because of the birth or acquisition of a child is effective on the first day of the pay period in which your child is born or becomes an eligible family member.

Reenrollment Under TCC

If your TCC enrollment ended because you acquired regular FEHB coverage (as an employee or family member), you may reenroll if your regular FEHB coverage ends before your 18- to 36-month eligibility period ends (however, you may be eligible for a new TCC enrollment period). Your coverage does not extend beyond your original eligibility period. The effective date of your reenrollment is the day following the date that your regular FEHB coverage ended.

Loss of FEHB Coverage or Coverage under Another Group Insurance Plan

You may change your enrollment from self only to self and family, from one plan or option to another, or make any combination of these changes when you lose other FEHB coverage or your eligible family member loses FEHB coverage or coverage under another group health plan. Except as noted, you must change your enrollment within the period beginning 31 days before and ending 60 days after the loss of coverage. Some examples of loss of coverage are:

• loss of coverage under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to self only
• loss of coverage under another Federally-sponsored health benefits program
• loss of coverage under the Medicaid program or a similar State-sponsored program of medical assistance for the needy
• loss of coverage under a non-Federal health plan
• loss of coverage because of termination of membership in an employee organization sponsoring or underwriting an FEHB plan
• loss of coverage because the FEHB plan is discontinued.

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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