Termination, Conversion and Temporary Continuation of Coverage
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Employing Office Responsibilities
The employing office that is responsible for your TCC enrollment on the date of the
qualifying event remains responsible for your enrollment for the length of your TCC
enrollment. (Many employing offices contract with the National Finance Center to
administer TCC enrollments and to act as the employing office.) Your employing office's
responsibilities in administering temporary continuation of coverage (TCC) include:
Providing Information for Employees
The employing office is responsible for providing all employees who are enrolled or
eligible to enroll in FEHB with information about their right to TCC. This information is
included in plan brochures and the booklet Temporary Continuation of Coverage under
the Federal Employees Health Benefits Program (RI 79-27).
However, your employing office is not obligated to notify you or your family member
when he/she is no longer eligible for coverage under your enrollment or provide
notification of his/her eligibility for TCC.
Administering the Enrollment Process
Each employing office must establish procedures for notifying former employees about
their eligibility to enroll, including what documents are needed to determine eligibility,
and accepting enrollment elections from former employees, children and former spouses.
Verifying Eligibility to Enroll
The employing office must verify the eligibility of a
child or former spouse to enroll. If there is conflicting information on a child's
date of birth or marriage or the date of your divorce, the employing office must determine
the correct date.
Collecting Premiums
The employing office of the employee or annuitant at the time of the qualifying event
is responsible for collecting premiums. The employing office sends the premiums it
collects to OPM.
Maintaining the Health Benefits File
The employing office must maintain a
health benefits file for each TCC enrollee separate from his or her personnel records
as an employee or former employee.
Denying
TCC Due to Involuntary Separation for Gross Misconduct
The employing office must make determinations of gross
misconduct and follow the required administrative procedures.
Maintaining Enrollment
The employing office must provide services to TCC enrollees similar to those provided
to enrolled employees. For example, it must provide Open Season information and process
enrollment changes and cancellations.
Notification
Requirements for Separating Employees
When you separate from service and are eligible for
temporary continuation of coverage (TCC), your employing office must notify you no later
than 61 days after your separation of your opportunity to elect TCC.
This notice should include your right to convert
to an individual contract offered by your plan. This notice must explain your right to
enroll in TCC and how you can get the registration form and additional information. Your
employing office should attach the pamphlet, Temporary Continuation of Coverage under
the Federal Employees Health Benefits Program (RI 79-27) to the notice. If you want
to elect TCC, you must respond within the specified time limit.
Sample
Notice for Separating Employees
Your employing office may use the following sample notice to notify you of your TCC
rights upon your separation:
Dear (name):
Your coverage in the Federal Employees Health Benefits (FEHB) Program ends on the
last day of the pay period in which you separate from Federal service, subject to a 31-day
extension of coverage (at no cost to you) with opportunity for conversion to an individual
contract with your insurance carrier.
You also have the right to temporarily continue your FEHB coverage for up to 18
months after your separation instead of converting to an individual contract at this time.
You may select any plan in the FEHB Program in which to continue your coverage if you are
eligible to enroll in the plan. To continue your coverage, you must pay the full amount of
the premium (both the employee and Government shares) plus a 2 percent administrative
charge. If you choose to continue your coverage, you have the free coverage described
above for the first 31 days. Your Temporary Continuation of Coverage (TCC) enrollment and
premium charges begin on the day after the 31-day period of free coverage ends. If you
continue TCC to the end of the 18-month period, you will have another 31-day extension of
coverage with opportunity for conversion to an individual contract.
If you are interested in continuing your FEHB coverage, you can get additional
information and an election form by calling (Name of person to contact) at
(telephone number) or you can pick up the material at the following
address: (enter address).
If you want to continue your coverage, your election form must be received at the
address shown below within 60 days after the date of separation or 65 days after the date
of this notice, whichever is later. Bring or mail your election form to:(enter address)
Sincerely,
(Name of appropriate official)
If your employing office gives this notice directly to you, it should add the following
note and make two copies of the notice:
I acknowledge receipt of this notice.
Employee's signature
Date
Notification
Requirements for Children
If your child becomes eligible for temporary
continuation of coverage (TCC), it is your responsibility as the enrolled employee to
notify your employing office of the change in your child's status. You must provide your
child's name, address, and date of the event that caused his/her loss of FEHB coverage within 60 days
from the loss of coverage. Your employing office then has 14 days to notify your child of
his/her TCC rights.
Your child or another person may notify your employing office of the child's loss of
coverage; but the time limit for electing TCC will be shorter
than if you provided the notification.
The notice from your employing office to your child must include:
- an explanation of your child's right to TCC;
- FEHB Guide (RI 70-5);
- Health Benefits Election Form (SF 2809);
- Temporary Continuation of Coverage Under the Federal Employees Health Benefits Program (RI 79-27);
- how the child can get additional information; and
- if there is doubt about the date of the qualifying event, a request for the appropriate information or documentation.
Sample Notice for
Child
Employing offices may use the following sample notice of TCC rights when you timely
notified your employing office of your child's loss of coverage:
Dear (child's name):
Your coverage in the Federal Employees Health Benefits (FEHB) Program as a family
member of (enrollee's name) ended when you (enter reason), subject to a 31-day extension
of coverage (at no cost) with opportunity for conversion to an individual contract with
your insurance carrier.
You also have the right to temporarily continue your FEHB coverage for up to 36
months after the date of (enter reason) instead of converting to an individual contract at
this time. You may select any plan in the FEHB Program in which to continue your coverage
if you are eligible to enroll in the plan. If you choose family coverage, your spouse and
your children will also be covered. To continue your coverage under the temporary
continuation of coverage (TCC) provision, you must pay the full amount of the premium
(both the employee and Government shares) plus a 2 percent administrative charge. If you
choose to continue your coverage, during the first 31 days you have the free coverage
described above. Your TCC enrollment and premium charges begin on the day after the 31-day
period of free coverage ends. If you continue the coverage to the end of the 36-month
period, you will have another 31-day extension of coverage with opportunity for conversion
to an individual contract.
An election form and detailed information about your opportunity to continue
coverage is enclosed. You may get additional information by calling (name of
contact) at (telephone number).
If you want to continue your coverage, your election form must be received at the
address shown below within 60 days after the date of your (enter reason) or 65 days after
the date of this notice, whichever is later. Bring or mail your election form to: (enter
address).
Sincerely,
(Name of appropriate official)
If your employing office gives the notice directly to your child, it should add the
following note and make two copies of the notice:
I acknowledge receipt of this notice.
Child's signature
Date
If someone other than yourself (the enrollee) notified the employing office of your
child's loss of coverage, the sample notice's last paragraph should be replaced by the
following paragraph:
If you want to continue your coverage, your election form must be received at the
address shown below within 60 days after the date of your (enter reason). Bring or mail
your election form to: (enter address).
Notification
Requirements for Former Spouses
If your former spouse is eligible for temporary
continuation of coverage (TCC), either you or your former spouse must notify your
employing office within 60 days after the date of your divorce or annulment. Your
employing office then has 14 days to notify your former spouse of his/her rights. The
notice to your former spouse must include the same information as the notice to a child. In addition, the
notice must request a certified copy of the divorce decree or other document showing the
date of the divorce or annulment. If he/she wants to elect TCC, he/she must respond within
the specified time limit.
Another person may notify your employing office of your former spouse's loss of
coverage; but the time limit for electing TCC will be shorter
than if you or your former spouse provided the notification.
Sample Notice
for Former Spouse
Your employing office may use the following sample notice of TCC rights when you or
your former spouse timely notified your employing office:
Dear (former spouse's name):
Your coverage as a family member in the Federal Employees Health Benefits (FEHB)
Program ended when you were divorced or your marriage was annulled, subject to a 31-day
extension of coverage (at no cost) with opportunity for conversion to an individual
contract with your insurance carrier.
You also have the right to temporarily continue your FEHB coverage for up to 36
months after your divorce instead of converting to an individual contract at this time.
You may select any plan in the FEHB Program in which to continue your coverage if you are
eligible to enroll in the plan. If you choose a family enrollment, it will cover yourself
and the children of both you and the Federal employee under whose enrollment you have been
covered. If your former spouse still carries a family enrollment, you can enroll for self
only. To continue your coverage under the Temporary Continuation of Coverage provision
(TCC), you must pay the full amount of the premium (both the employee and Government
shares) plus a 2 percent administrative charge. If you choose to continue your coverage,
during the first 31 days you have the free coverage described above. The TCC enrollment
and premium charges begin on the day after the 31-day period of free coverage ends. If you
continue the coverage to the end of the 36-month period, you will have another 31-day
extension of coverage with opportunity for conversion to an individual contract.
Enclosed is an election form and detailed information about your opportunity to
continue your coverage. You can get additional information by calling (name of
contact) at (telephone number).
If you want to continue your coverage, your election form must be received at the
address shown below within 60 days after the date of your divorce or annulment or 65 days
after the date of this notice, whichever is later. Bring or mail your election form and a
certified copy of the divorce decree or another document showing your divorce date to:
(enter address).
Sincerely,
(Name of appropriate official)
If your employing office gives the notice directly to your former spouse, it should add
the following note and make two copies of the notice:
I acknowledge receipt of this notice
Former spouse's signature
Date
If someone other than you or your former spouse notified the employing office of
his/her loss of coverage, the sample notice's last paragraph should be replaced by the
following paragraph:
If you want to continue your coverage, your election form must be received at the
address shown below within 60 days after the date of your divorce or annulment. Bring or
mail your election form to: (enter address).
Receipt of Notice
Your employing office must either give the notice directly to the person eligible for
temporary continuation of coverage (TCC) or send it by first class mail. (A notice that is
mailed is considered to be received 5 days after the date of the notice.) If you, your
child, or former spouse are given the notice directly by your employing office, it will
require that you acknowledge receipt by signing a copy of the notice. The signed copy must
be placed on the right side of your Official Personnel Folder (OPF) or the equivalent. If
the notice is sent by mail, a dated copy of the notice must be filed in your OPF.
Time Limits for Electing Temporary
Continuation of Coverage
If you are a separating employee, you must submit your Temporary Continuation of
Coverage (TCC) election to your employing office within 60 days after the date of your
separation or 65 days after the date of your employing office's notice, whichever is
later.
Your eligible child must submit his or her TCC election to your employing office within
either:
- 60 days after the date of the qualifying event, if you (the enrollee) did not notify your employing office within the required 60-day notification period (even if someone else provided notification); or,
- 65 days after the date of your employing office's notice, if you notified your employing office within the required 60-day notification period.
Your former spouse must submit his or her TCC election to your employing office by the
later of:
- 60 days after the date of your divorce or annulment, if you or your former spouse did not notify your employing office within the required 60-day notification period (even if someone else provided notification); or
- 65 days after the date of your employing office's notice, if you or your former spouse notified your employing office within the required 60-day notification period; or
- 60 days after the date he/she lost coverage under Spouse Equity provisions (because of remarriage before age 55 or loss of the qualifying court order), if the loss of coverage is within the 36-month period of TCC eligibility.
If you or your former spouse do not notify your employing office within the 60-day
period, your former spouse's opportunity to elect TCC ends 60 days after the divorce or
annulment.