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If a family member loses coverage under your enrollment (including as a result of your change to self only), he/she is also entitled to convert to an individual policy offered by the carrier of your plan. Your family member is not required to provide evidence of insurability.
Exception: your family member is not entitled to convert to an individual policy if you voluntarily canceled your enrollment or your plan was discontinued.
It is the responsibility of you or your family member to know when he/she is no longer eligible for coverage and to apply for a conversion contract in a timely manner. Your employing office is not obligated to inform you of your family member's conversion rights when he/she is no longer eligible for coverage. Your employing office may, from time to time, publish reminders of family members' right to convert in internal publications.
To apply for conversion, you or your family member must make a written request to the carrier of your plan. You or your family member must apply for conversion within 31 days after his/her coverage as a family member terminated.
When your enrollment terminates, your employing office must give you a notice of your right to convert to an individual policy on the Notice of Change in Health Benefits Enrollment form (SF 2810). Your employing office should provide you with this notice immediately upon your enrollment termination, but no later than 60 days from the termination date.
To apply for conversion, complete the back of your copy of the SF 2810 and take or mail it to the carrier of your plan within 31 days from the date of your employing office's notice to you (part H of SF 2810), but no later than 91 days from the date your enrollment terminates (Part A, item 8 of SF 2810).
When your employing office doesn't give you the required conversion notice within 60 days, or you aren't able to request conversion on time for reasons beyond your control, you can request a late conversion by writing directly to the carrier of your plan.
You must send your request within six months after the date your enrollment terminated. Your request must:
If six months or more have passed since the date you became eligible to convert, the carrier of your plan is not required to accept a request for conversion.
If the carrier accepts your request for a late conversion, you must enroll and pay your first premium within 31 days of the carrier's notice. If you don't convert within this time period, you are considered to have waived your conversion rights, unless the carrier determines that you did not convert for reasons beyond your control. If the carrier determines that your failure to convert was within your control, you may request that OPM review its decision. To request an OPM review, write to U.S. Office of Personnel Management, Retirement and Insurance Service, Office of Insurance Programs, P.O. Box 436, Washington, D.C. 20044.
Effective Date of Conversion Contract
Your or your family member's conversion contract becomes effective at the end of the 31-day extension of coverage, even when you or your family member are an inpatient in a hospital on the 31st day of extended coverage.
Reinstatement of Enrollment after Conversion
If you converted to an individual contract after your enrollment terminated, and your enrollment is later reinstated retroactive to the effective date of your termination (e.g., you were removed and later ordered restored to duty with full restitution of back pay; or you retire with an annuity starting date made prior to your enrollment termination because of 365 days in leave without pay status), you may get a refund of all the premiums you paid on the conversion contract. You must apply in writing to the carrier of your plan for the refund. If you received benefits when your conversion contract was in effect, you are entitled to an adjustment of the difference between the benefits paid by the carrier under the conversion contract and the benefits payable under your FEHB enrollment.
If your position is
excluded from FEHB coverage but you were erroneously allowed to enroll,
your employing office must terminate or void your coverage as soon as the
error is discovered. Your employing office must explain to you why you are
not eligible for coverage and the effect of the termination. If you were erroneously enrolled and premium withholdings and contributions were made,
your employing office must terminate your
coverage and discontinue withholdings and contributions at the end of that pay period. No
adjustments are made for contributions and withholdings that already have been made. You
and your covered family members are entitled to full plan benefits during the time you
were erroneously enrolled. You are entitled to convert
to an individual contract the same as any other employee whose enrollment is terminated. If no premium withholdings and contributions were made before your erroneous enrollment
is discovered, your employing office must void your enrollment. In addition,
your employing office will note in the Remarks section of the payroll office copy of the
Health Benefits Election Form (SF 2809) (which is sent to the carrier): "Erroneous
enrollment--enrollee responsible for any benefits provided." You will be responsible
for any claims paid during your erroneous enrollment. Your carrier will contact you to
recover any payment it made. If you lose your FEHB coverage because you separate from Federal service,
you may enroll under the Temporary Continuation of Coverage (TCC) provision
of the FEHB law to continue your coverage for up to 18 months. Exception:
you are not eligible for TCC if your separation is due to gross
misconduct. Your family members who lose coverage because they are no longer eligible family members
may enroll under TCC to continue FEHB coverage for up to 36 months. Title II of Public Law 100-654, effective January 1, 1990, established
the temporary continuation of coverage provision for the FEHB Program. An employee, a child, and a former spouse are eligible for temporary continuation of
coverage based on specific qualifying events. You are eligible for temporary continuation of coverage when you: You are eligible for temporary continuation of coverage when you separate
for retirement and are not eligible to
continue FEHB coverage as an annuitant. Your child is eligible for temporary continuation of coverage when he/she: This includes a child who: Your former spouse is eligible for temporary continuation of coverage
when he/she has been covered as a family member at some time during the 18
months before your marriage ended, but does not meet the remaining
requirements for coverage under the spouse equity provisions of the FEHB law
because he/she:
You are not eligible for temporary continuation of coverage (TCC) when: In some cases, a child who would ordinarily be covered as a family member
may want TCC coverage instead. This may happen when your unmarried child has
a child and wants to provide health benefits coverage for this child.
Usually, your grandchild is not eligible for coverage as a family
member under your enrollment, unless he/she qualifies as a foster child. For your child to enroll
through TCC and cover his/her child, you must prove that he/she is no longer
a dependent.
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