Enrollment
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Annual Open Season
Dates for Open Season
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.
Notification to Agencies
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.
Employee Express
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.
Timely Election
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.
Deductibles
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, new benefit or rate changes will apply beginning January 1 of each year.
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).
Continuation of Enrollment
Upon Transfer
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:
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.
Effective Date
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.
Continuation upon Retirement
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.
Leave Without Pay Status
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
Election
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:
Your employing office must notify you of the health benefits coverage choices
available.
Reinstatement of Enrollment
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.
New Enrollment
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 and that follows any part of a pay period of which you are in pay status. 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.
Following Separation from Service
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).
During an Interim Appointment
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.