Federal Employees Health Benefits (FEHB) Program

RI 70-05 For TCC and Former Spouse Enrollees

What does this Program offer?

The FEHB Program offers a wide variety of types of plans and coverage to help you meet your health care needs. It is group coverage available to eligible employees, retirees and their dependents. Temporary Continuation of Coverage (TCC) is available to eligible former employees and former dependents of employees or retirees for a limited period. Spouse Equity coverage is available to certain former spouses of employees or retirees as long as they remain eligible. You can choose from among fee-for-service, health maintenance organizations, point-of-service products, high deductible, and consumer driven health plans.

Key FEHB facts

• The FEHB Program is part of the annual Federal Benefits Open Season.
• FEHB coverage continues each year. You do not need to reenroll each year. If you are happy with your current coverage, do nothing. Please note that your premiums and benefits may change.
• You can choose from Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Health Maintenance Organizations or Fee-for-Service plans with comprehensive coverage and higher premiums.
• There are no waiting periods and no preexisting condition limitations, even if you change plans.
• Enrollment changes can only be made during Open Season or if you experience a qualifying life event.
• All nationwide FEHB plans offer international coverage.
• There are separate and/or different provider networks for each plan.
• Utilizing an in-network provider will reduce your out-of-pocket costs.

What enrollment types are available?

• Self Only, which covers only the enrolled employee;
• Self and Family, which covers the enrolled employee and all eligible family members.
  Note: A former spouse's eligible family members are limited to children of both the employee or annuitant and the former spouse.

How much does it cost?

Under Spouse Equity coverage, you pay the total monthly premium, that is, both the enrollee and Government shares. Under TCC, you pay the total monthly premium plus a 2 percent administrative charge. The charts in Appendix E provide cost information for all plans in the FEHB Program.

Am I eligible to enroll?

Individuals eligible for TCC include:

• former employees whose FEHB coverage ended because they separated from service, unless they were separated for gross misconduct. This includes employees who are not eligible to continue FEHB into retirement;
• children who lose FEHB coverage under a self and family enrollment because they are no longer considered eligible family members; and
• former (divorced) spouses who are not eligible for FEHB coverage under the Spouse Equity provisions of FEHB law because they have remarried before age 55 or are not entitled to a portion of the Federal employee's annuity or a former spouse survivor annuity.

Former (divorced) spouses eligible to enroll under the Spouse Equity provisions of FEHB law or similar statutes. If you are the spouse of a Federal employee or annuitant and lose FEHB coverage because of divorce, you may elect FEHB coverage - under certain circumstances. Contact the employee's human resources office or the annuitant's retirement system for the requirements for electing coverage.

When can I enroll?

Individuals eligible for TCC generally must enroll within 60 days after the qualifying event permitting enrollment, or after receiving notice of eligibility, whichever is later. However, the opportunity to elect TCC ends 60 days after the qualifying event if: (1) you do not notify your human resources office or retirement system within 60 days of your child's loss of coverage, or (2) you or your former spouse do not notify your human resources office or retirement system within 60 days of your divorce.

Former spouses under the Spouse Equity provisions generally must apply within 60 days after the dissolution of the marriage. However, if a retiring employee elects to provide a former spouse annuity or insurable interest annuity for the former spouse, the former spouse must apply within 60 days after OPM's notice of eligibility for FEHB. Former spouses may enroll any time after an employee's or retiree's employing office establishes eligibility.

How do I enroll?

You must contact the employee's human resources office or the retiree's retirement system to enroll.

What should I consider in making my decision to participate in this program?

• In the case of a former employee, TCC ends on the date that is 18 months after the date of separation.
• Children who lose coverage because they are no longer dependent, and former spouses not eligible for coverage under the Spouse Equity provisions, may carry the enrollment for 36 months from the time they cease being an eligible family member for FEHB purposes
• A TCC enrollee may cancel the enrollment at any time. However, once the cancellation takes effect, the enrollee cannot reenroll - the cancellation is final.
• Former spouses enrolled under the Spouse Equity provisions may suspend their FEHB enrollment because they are enrolling in one of these programs: A Medicare Advantage health plan; Medicaid or similar State-sponsored program of medical assistance for the needy; TRICARE (including Uniformed Services Family Health Plan or TRICARE for Life); CHAMPVA; or coverage as a Peace Corps volunteer. For more information on how to suspend your FEHB enrollment, contact the human resources office or retirement system that handles your account.

How do I get more information about this Program?

Visit FEHB on-line at www.opm.gov/insure/health for more information about Temporary Continuation of Coverage and the Spouse Equity provisions.

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