page: 1 2 3 4 |
ELIGIBILITY FOR HEALTH BENEFITS
As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility.
You are eligible for FEHB coverage if you are:
Withholdings and contributions for your coverage must be made from Federally-controlled funds and must be timely paid, or the cooperating non-Federal agency must agree in writing with your agency to make and timely remit the required withholdings and contributions from non-Federal funds. The withholdings and contributions arrangement must be approved by OPM.
Agricultural Stabilization and Conservation County Committee Employees
If you are employed by a county committee established under section 8(b) of the Soil Conservation and Domestic Allotment Act, you are eligible for FEHB coverage (unless your position is excluded from coverage).
Employees Transferred to Public International Organizations
If you transfer to a public international organization under the Federal Employees International Organization Service Act, you may elect to retain your FEHB coverage. To keep your coverage, all necessary withholdings and contributions during your service with the international organization must be currently paid.
If you are a United States Commissioner subject to the Civil Service Retirement law or the Federal Employees Retirement law, you are eligible for FEHB coverage.
Personal Services Contractors of the U.S. Department of the Treasury
Effective September 30, 1996, if you are a personal services contractor of the U.S. Department of the Treasury, you are eligible for FEHB coverage.
You are eligible for FEHB coverage if you are a Presidential appointee appointed to fill an unexpired term.
You are eligible for FEHB coverage if you are a temporary employee who receives a provisional appointment as defined in 5 CFR 316.401 and 316.403.
You are eligible for FEHB coverage if you are an acting postmaster.
Eligibility to Enroll at Own Cost
If your position is excluded from coverage because your appointment is limited to one year or less, you will be eligible to enroll under 5 U.S.C. 8906a when you have completed one year of current continuous employment, excluding any break in service of 5 days or less. You must pay both the employee and the Government shares of the premium.
The one-year requirement may be met at the end of a one-year appointment in a single agency or it may be based on a series of shorter appointments served in one or more agencies, as long as you have not had a break in service of more than 5 days.
In many cases, a temporary appointment lasts one year. If your appointment is renewed at the end of that year, you are eligible to enroll.
If you are a student employee (for example, a student aide or Stay-in-School Program participant), you generally serve on temporary appointments limited to 1 year or less. You typically work part-time during the school year and full-time during summers and vacations and become eligible to participate after completing one year on the employment rolls, provided you pay the full premium cost.
If you are an intermittent employee (you do not have a prearranged regular tour of duty), you are not eligible for coverage. Seasonal or occasional employment for one calendar year that amounted to less than 6 months of work does not meet the one year of current continuous employment requirement.
Exception
You are eligible for FEHB coverage if your appointment follows, with a break in service of no more than 3 days, a position in which you were insured.
If you work, under an appointment limited to one year or less, a mixed tour of duty (combining periods of full-time, part-time, and intermittent tours of duty during the year), you may be eligible to enroll as a temporary employee. You must be on a full-time or prearranged part-time work schedule at the beginning of the one-year period of current continuous employment and at the time you enroll under this provision. When counting the one year of current continuous employment, include any periods of intermittent service. If you change to an intermittent tour of duty after your enrollment begins, your enrollment will continue as long as you didn't have a break in service of more than three calendar days.
EMPLOYEES EXCLUDED FROM COVERAGE
District of Columbia Employees
You are excluded from FEHB coverage if you were first employed by the District of Columbia government on or after October 1, 1987.
You are eligible for FEHB coverage if you are:
You are excluded from FEHB coverage if you are not a citizen or national of the United States and your permanent duty station is located outside the United States and its territories and possessions.
Exception
You are eligible for FEHB coverage if you met the definition of employee on September 30, 1979, by service in an Executive agency (as defined in 5 U.S.C. 105), the United States Postal Service, or the Smithsonian Institution in the area which was then known as the Canal Zone.
You are excluded from FEHB coverage if you are an employee of the Tennessee Valley Authority.
Employees of Farm Credit Administration-Supervised Corporations
You are excluded from FEHB coverage if you are an employee of a corporation supervised by the Farm Credit Administration, if private interests elect or appoint a member of the board of directors. The corporations are Regional Banks for Cooperatives, Federal Intermediate Credit Banks, Federal Land Banks, Production Credit Corporations, and the Central Bank for Cooperatives.
Temporary Employees
You are excluded from FEHB coverage if you are:
Exceptions
You are eligible for FEHB coverage if:
You are excluded from FEHB coverage if you are a beneficiary or patient employee in a Government hospital or home.
Employees Paid on a Contract or Fee Basis
You are excluded from FEHB coverage if you are paid on a contract or fee basis.
Exception
You are eligible for FEHB coverage when you are a:
Employees Paid on a Piecework Basis
You are excluded from FEHB coverage if you are paid on a piecework basis.
Exception
You are eligible for FEHB coverage when your work schedule provides for full-time or part-time service with a regularly scheduled tour of duty.
OPM makes the final determination about whether the above categories apply to a specific employee or group of employees.
Part-time career employment or certain interim appointments are not excluded from FEHB coverage.