Annuitants and Compensationers
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Benefits and Cost
Direct Premium Payments
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.