U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce
Insurance Services Programs
FEHB Handbook
Enrollment Page 3 of 3
- Dates for Open Season
- Notification to Agencies
- Employee Express
- Other Enrollment Actions during Open Season
- Timely Election
- Deductibles
- If You Don't Want to Make an Open Season Change
- Processing Open Season Changes
Each year OPM provides an open season from the Monday of the second full workweek in November through the Monday of the second full workweek in December.
The Director of OPM may modify the dates of open season or announce additional open seasons.
Your open season election generally will take effect the following January.
OPM notifies agencies of each regular open season by a Benefits Administration Letter (BAL). We give specific instructions on the coordination of open season, and let the agencies know of any changes in materials to be issued or procedures to be followed during that period.
If your employing office's health benefits official needs additional open season information or assistance, he/she may contact the headquarters benefits officer. The headquarters benefits officer may contact OPM with questions.
Your agency may allow or require you to make open season changes through "Employee Express," or another electronic method, instead of using a Health Benefits Election form (SF 2809). Check with your employing office to see if this method is available for your use.
Other Enrollment Actions During Open Season
While new enrollments and other permissible enrollment changes can be made as usual during the open season, these should not be identified as open season changes on the appropriate request because open season changes do not take effect until January. You should make sure that you specify the reason for your enrollment change on your enrollment request.
Your employing office must receive your open season election no later than the last day of open season to be considered timely filed.
Your employing office may accept and process a late election if it determines that you were unable to submit it timely for reasons beyond your control (e.g., your employing office did not distribute open season literature until after open season). Your failure to read the available material is not considered a reason beyond your control.
If your employing office decides to accept a late election, it enters "belated open season enrollment/change" in the Remarks section of your enrollment request. You or your employing office must explain why you could not make a timely election and attach the statement to the file copy of your enrollment request.
If your employing office decides that your late election was not beyond your control, it must explain to you in writing why it did not accept your late request and give you notice of your reconsideration rights.
If you change plans, any covered expenses you incur between January 1 and the effective date of coverage under your new plan count towards the prior year's deductible of your old plan.
If You Don't Want to Make an Open Season Change
You do not need to do anything if you want to continue your current enrollment (unless your plan is dropping out of the FEHB Program). If you do not change your enrollment, any benefit or rate changes apply beginning January 1.
Processing Open Season Changes
OPM provides employing offices with instructions for processing open season enrollments and enrollment changes each year via a Benefits Administration Letter (BAL).
- Upon Transfer
- Effective Date
- Transfers to or from the District of Columbia Government
- Transfers to or from the U.S. Senate and House of Representatives
- Continuation upon Retirement
- Continuation for Family Members upon Your Death
- Leave Without Pay Status
When you move from one employing office to another, your enrollment continues without interruption (see Employees Excluded from Coverage for the only exceptions to this) as long as you do not have a break in service of more than three calendar days. This is regardless of whether or not your move is designated as a transfer. You do not need to do anything to ensure your continued enrollment, but the gaining employing office must transfer your enrollment.
If you are enrolled in an HMO and transfer to a location outside of the HMO's service area, your enrollment continues. However, you will be covered only for emergency care, Point of Service (POS) benefits (if applicable), or care that you travel back to an HMO participating provider to receive. You may change to another plan before or after the move.
If you are enrolled in a plan sponsored by a union or employee organization and you transfer to another agency, you do not have the right to enroll in another plan because of your transfer. Your current enrollment will continue until:
- you change plans when you have an opportunity (such as an open season), or
- the plan terminates your enrollment because you are no longer a member of the organization.
Example
Vincent is employed by the FBI and is enrolled in the Special Agents Mutual Benefits Association (SAMBA) plan. He transfers to another agency where its employees are not eligible to join SAMBA. His enrollment in SAMBA will continue, and the gaining agency must make withholdings and contributions for SAMBA, until he changes his enrollment or SAMBA takes steps to terminate his enrollment.
The effective date of the enrollment transfer for the gaining employing office is the first day you enter on its rolls.
Transfers to or from the District of Columbia Government
If you are a Federal employee with D.C. Government service prior to October 1, 1987, and you move back to D.C. Government without a break in service, your enrollment must be transferred in by the D.C. Government on the Notice of Change in Health Benefits Enrollment form (SF 2810). Since your personnel files are not transferred, the D.C. Government must request copies of your health benefits forms when it requests other employment information from the losing Federal employing office.
If you move from the D.C. Government to a Federal agency, the gaining office must transfer your enrollment in on SF 2810 and ask the D.C. Government for the personnel folder copies of health benefits forms at the same time it asks for a transcript of personnel records.
The two personnel offices must verify your health insurance status so that withholdings can begin with the initial pay period even if documentation has not yet arrived from the losing office.
If you do not have D.C. Government service prior to October 1, 1987, and you transfer to the D.C. Government, your enrollment is terminated because you are no longer an eligible employee. If you were first employed by the D.C. Government on or after October 1, 1987, and you transfer to a Federal agency, you may enroll in the FEHB Program if you are otherwise eligible.
Transfers to or from the U.S. Senate and House of Representatives
If you leave a Federal agency and become employed by the U.S. Senate or House of Representatives without a break in service of more than three calendar days, your health benefits enrollment is transferred.
If you leave employment with the U.S. Senate or House of Representatives and become employed by a Federal agency without a break in service of more than three calendar days, your enrollment will terminate effective at the end of the month that you separate. Withholdings and contributions will be made for that entire month. The gaining employing office will ask you for a copy of the termination Notice of Change in Health Benefits Enrollment (SF 2810), verify your eligibility for continued enrollment, and ask the losing office for the employing office copies of your health benefits forms. The gaining office will reinstate your enrollment on the SF 2810 effective the first day of the following month, so you will not have to pay double premiums.
When you retire and are eligible to continue FEHB coverage into retirement, your enrollment is transferred in by the retirement system and automatically continued.
Continuation for Family Members upon Your Death
If you die in service while enrolled for self and family, enrollment for your family members automatically continues when they meet the requirements for continuation.
Generally, your enrollment may continue for up to 365 days of leave without pay. You must pay the employee share of premiums for every pay period that your enrollment continues.
RESTORATION TO DUTY AFTER ERRONEOUS REMOVAL OR SUSPENSION
If you are suspended without pay, your enrollment may continue for up to 365 days in leave without pay status. If you are removed from service, your enrollment terminates at the end of the pay period in which you are removed. If your enrollment terminated and you are ordered restored to duty because the suspension or removal was unwarranted or unjustified, you may elect either to:
- have your prior enrollment reinstated retroactive to the date it was terminated, or
- enroll the same as a new employee.
Your employing office must notify you of the health benefits coverage choices available.
If you elect to have your prior enrollment reinstated retroactively, premium withholdings and contributions must also be made retroactively as if the erroneous suspension or removal had not taken place. The amount of the retroactive withholdings due may be withheld from your backpay award. Your health benefits coverage is considered to have been continuously in effect and you and your covered family members are retroactively entitled to full plan benefits. If you had converted to an individual contract, you may get a refund of the premiums you paid for that coverage.
If you elect to enroll the same as a new employee instead of having your prior enrollment reinstated, your enrollment is effective the first day of the first pay period that begins after your employing office receives your appropriate request. You are not retroactively entitled to plan benefits and no retroactive premium withholdings and contributions will be made.
The period of suspension or removal (during which the enrollment was not in effect) is not considered when determining your eligibility to continue coverage into retirement, as long as you enroll within 60 days after the date you are ordered restored to duty.
If you lose health benefits coverage because you separate from Federal service, whether voluntary or involuntary (except for removal due to gross misconduct), you may elect temporary continuation of coverage (TCC).
If you have an interim appointment under the Whistleblower Protection Act of 1989 [5 U.S.C. 7701(b)(2)(A)], you are entitled to the same coverage provisions as other employees with appointments that entitle them to coverage under the FEHB Program.
If your interim appointment is terminated and your prior separation still stands, you have the same rights under the FEHB Program as any other employee whose appointment terminates. These rights are based on the termination from the interim appointment - the prior separation has no bearing. If you were ineligible for temporary continuation of coverage (TCC) based on your prior separation, this has no effect on your eligibility for TCC based on the separation from your interim appointment.
If you are eligible for retirement and you receive an interim appointment, your annuity will be suspended. Your employing office must notify the retirement system to transfer your enrollment back to your employing office. If your interim appointment ends and your prior separation still stands, your enrollment will be transferred back to the retirement system.
If you are restored to duty and your interim appointment terminates, you may choose retroactive reinstatement of your health benefits coverage. If you continued health benefits coverage under TCC between your prior separation and your interim appointment, a retroactive reinstatement terminates your TCC enrollment retroactively. You are due a refund for the premiums you paid for the TCC enrollment. This amount may be applied to the premiums you owe for the retroactive reinstatement. If your backpay award and TCC enrollment refund will not cover the amount you owe for the retroactive reinstatement, you must pay the balance due directly to your employing office.
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
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