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Insurance Services Programs

FEHB Handbook

Annuitants and Compensationers
Page 3 of 6

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BENEFITS AND COST

If you decide to pay your share of premiums directly to your retirement system, your retirement system will establish a payment schedule for you. You must continue to make premium payments directly for the length of your enrollment even if your annuity increases enough to cover your premiums.

Nonpayment of Premiums

If you are making direct payments and your retirement system doesn't 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, your retirement system will terminate your enrollment 60 days (90 days if you live overseas) after the date of the notice. Your coverage will be terminated retroactive to the end of the last pay period in which you made the payment. You may not reenroll, unless nonpayment was for reasons beyond your control.

If you weren't able to make timely payment for reasons beyond your control, you may write to your retirement system to ask that your coverage be reinstated. You must file the request within 30 days from the date your enrollment was terminated and provide proof that the nonpayment was beyond your control. Your retirement system will determine if you are eligible for reinstatement of coverage. If it decides to allow reinstatement, it will be restored retroactive to the termination date. If your request is denied, you may request that your retirement system reconsider its initial decision.

PROCEDURES FOR RETIRING EMPLOYEES

If You Want to Continue Your Health Benefits Coverage

If you meet all the requirements, you don't need to do anything to have your same health benefits enrollment continue after your retirement.

If You Want to Cancel or Change Your Health Benefits Coverage

If you don't want to continue your health benefits enrollment upon your retirement, you must cancel it on the Health Benefits Election form (SF 2809) or other appropriate request. This must be your action; your employing office must not initiate the termination of your enrollment unless you aren't eligible to continue it after your retirement.

When you cancel your FEHB enrollment as an annuitant, you will never be able to reenroll unless you had canceled it to enroll in a Medicare managed care plan or you had furnished proof of eligibility for Medicaid.

If you are a retiring employee and you submit a request to cancel or change your enrollment, but the cancellation or change can't become effective until after the starting date of your annuity, your employing office will note on part H of your request the date it received the form, and will send all copies of your request to your retirement system with your other health benefits and retirement records.

Your retirement system will make the cancellation effective on the last day of the pay period in which your employing office received your request. If you requested an enrollment change, it will be made effective as indicated in "Opportunities to Enroll or Change Enrollment." Even though you have requested a cancellation or change, your retirement system needs information on the enrollment in effect on the day of your retirement, since this enrollment may remain in effect during a part of your retirement.

EMPLOYING OFFICE PROCEDURES

General

At your retirement, your employing office will tentatively determine whether you are eligible to continue your health benefits enrollment. Your retirement system will make the final determination after it reviews all of your retirement and health benefits documents. Your employing office must take the appropriate action described below.

If You Appear Eligible to Continue Your Enrollment

Nondisability Retirement

Your employing office will document your health benefits status on your retirement application (Section A, item 6 of the Agency Checklist). It will attach a separate memorandum to note any circumstances that would be helpful for the retirement system to know when it determines your eligibility for continued coverage (such as information that you were covered as a family member before your own enrollment).

It will note your plan's enrollment code in the Remarks space on the Individual Retirement Record (SF 2806 for the Civil Service Retirement System and SF 3100 for the Federal Employees Retirement System). For other retirement systems, it should follow the same procedures.

It will send the following to the retirement system along with the Individual Retirement Record, the retirement application and any other retirement papers:

all Notice of Change in Health Benefits Enrollment forms (SF 2810), and
All Health Benefits Election forms (SF 2809) or other enrollment requests, with any attached medical certificates or other documentation, filed in your Official Personnel Folder (including any on which you elected not to enroll or to cancel, or that are marked VOID).

Disability Retirement

Your employing office will note your current plan's enrollment code in the Remarks section of the preliminary Individual Retirement Record. It will not send any health benefits forms from your Official Personnel Folder to the retirement system with the preliminary Individual Retirement Record, even if you are enrolled and eligible to continue the enrollment.

If your disability retirement application is denied, your employing office doesn't need to take any further action unless you are separated.

If your disability retirement application is approved, your employing office will then follow the same procedures as for a nondisability retirement.

If You Appear Ineligible to Continue Your Enrollment

If you don't meet all the requirements for continuing your enrollment into retirement, your employing office will document your retirement application (Section A, item 6 of the Agency Checklist) and note in the Remarks column of the Individual Retirement Record (both the preliminary and final Record in disability retirement cases): "Not eligible to continue health benefits" and state the reason (e.g., "not enrolled since first opportunity" or "not enrolled 5 years"). Your employing office will terminate your enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810) and transmit all of your health benefits documents to the retirement system, where a final decision on your eligibility to continue your FEHB enrollment will be made.

If you are unable to continue your regular FEHB enrollment into retirement, you may be eligible to temporarily continue your health benefits coverage through the Temporary Continuation of Coverage (TCC) provision of the FEHB law. Contact your employing office for information on TCC.

If You Aren't Enrolled

If you aren't enrolled in the FEHB Program, your employing office will document your retirement application (Section A, item 6 of the Agency Checklist) and note in the Remarks column of the Individual Retirement Record (both the preliminary and final Record in disability retirement cases): "Not enrolled for health benefits." It will retain your health benefits forms in your Official Personnel Folder. It doesn't need to take any other action on your health benefits, unless your enrollment terminated after 365 days in leave without pay status.

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