Tables of Permissible Changes in FEHB Enrollment for Individuals Who Are Not Participating in Premium Conversion
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- Employee
- Annuitant (includes Compensationer)
- Former Spouse Under the Spouse Equity Provisions
- Temporary Continuation of Coverage (TCC) for Eligible Former Employees, Former Spouses, and Children
- Employees Who Are Not Participating In Premium Conversion
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| QLEs That Permit Enrollment or Change |
Change Permitted |
Time Limits |
| Code |
Event |
From Not Enrolled to Enrolled |
From Self Only to Self and Family |
From One Plan or Option to Another |
When You Must File Health Benefits Election Form With Your Employing Office |
| 3 |
Former Spouse Under The Spouse Equity Provisions
Note: Former spouse may change to Self and Family only if family members are also eligible family members of the employee or annuitant.
|
| 3A |
Initial opportunity to enroll. Former spouse must be eligible to enroll under the authority of the Civil Service Retirement Spouse Equity Act of 1984 (P.L. 98-615), as amended, the Intelligence Authorization Act of 1986 (P.L. 99-569), or the Foreign Relations Authorization Act, Fiscal Years 1988 and 1989 (P.L. 100-204). |
Yes |
N/A |
N/A |
Generally, must apply within 60 days after dissolution of 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. May enroll any time after employing office establishes eligibility. |
| 3B |
Open Season. |
No |
Yes |
Yes |
As announced by OPM. |
| 3C |
Change in family status based on addition of family members who are also eligible family members of the employee or annuitant. |
No |
Yes |
Yes |
From 31 days before through 60 days after change in family status. |
| 3D |
Reenrollment of former spouse who cancelled FEHB enrollment to enroll in a Medicare-sponsored plan, Medicaid, or similar State-sponsored program and who later was involuntarily disenrolled from the Medicare-sponsored plan, Medicaid, or similar State-sponsored program. |
May Reenroll |
N/A |
N/A |
From 31 days before through 60 days after disenrollment. |
| 3E |
Reenrollment of former spouse who cancelled FEHB enrollment to enroll in a Medicare-sponsored plan, Medicaid, or similar State-sponsored program and who later voluntarily disenrolls from the Medicare-sponsored plan, Medicaid, or similar State-sponsored program. |
May Reenroll |
N/A |
N/A |
During Open Season. |
| 3F |
Former spouse or eligible child loses FEHB coverage due to termination, cancellation, or change to Self Only of the covering enrollment. |
Yes |
Yes |
Yes |
From 31 days before through 60 days after date of loss of coverage. |
| 3G |
Enrolled former spouse or eligible child loses coverage under another group insurance plan; for example:
- Loss of coverage under another federally-sponsored health benefits program;
- Loss of coverage due to termination of membership in the employee organization sponsoring the FEHB plan;
- Loss of coverage under Medicaid or similar State-sponsored program (but see events 3D and 3E);
- Loss of coverage under a non-Federal health plan.
|
N/A |
Yes |
Yes |
From 31 days before through 60 days after loss of coverage. |
| 3H |
Former spouse or eligible family member loses coverage due to the discontinuance, in whole or part, of an FEHB plan. |
N/A |
Yes |
Yes |
During Open Season, unless OPM sets a different time. |
| 3I |
Former spouse or covered family member in a Health Maintenance Organization (HMO) moves or becomes employed outside the geographic area from which the carrier accepts enrollments, or if already outside this area, moves or becomes employed further from this area. |
N/A |
Yes |
Yes |
Upon notifying the employing office of the move or change of place of employment. |
| 3J |
On becoming eligible for Medicare
(This change may be made only once in a lifetime.) |
N/A |
No |
Yes |
At any time beginning the 30th day before becoming eligible for Medicare. |
| 3K |
Former spouse's annuity is insufficient to make FEHB withholdings for plan in which enrolled. |
No |
No |
Yes |
Retirement system will advise former spouse of options. |
U.S. Office of Personnel Management 1900 E Street NW, Washington, DC 20415 | (202) 606-1800 | TTY (202) 606-2532