Premium Conversion allows employees who are eligible for FEHB the opportunity to pay for their share of FEHB premiums with pre-tax dollars. Premium conversion plans are governed by Section 125 of the Internal Revenue Code, and IRS rules govern when a participant may change his or her election outside of the annual open season. All employees who enroll in the FEHB Program automatically receive premium conversion tax benefits, unless they waive participation. When an employee experiences a qualifying life event (QLE) as described below, changes to the employee's FEHB coverage (including change to self only and cancellation) and premium conversion election may be permitted, so long as they are because of and consistent with the QLEs. For more information about premium conversion, please visit www.opm.gov/insure/archive/health.
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Qualifying Life Events (QLEs) that May Permit Change in FEHB Enrollment or Premium Conversion Election |
FEHB Enrollment Change that May Be Permitted |
Premimum Conversion Election Change that May Be Permitted |
Time Limits in which Change May Be Permitted |
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---|---|---|---|---|---|---|---|---|
Code |
Event |
From Not Enrolled to Enrolled |
From Self Only to Self and Family |
From One Plan or Option to Another |
Cancel or Change to Self Only1 |
Participate |
Waive |
When You Must File Health Benefits Election Form With Your Employing Office |
1 |
Employee electing to receive or receiving premium conversion tax benefits |
|||||||
1A |
Initial opportunity to enroll, for example:
|
Yes |
N/A |
N/A |
N/A |
Automatic Unless Waived |
Yes |
Within 60 days after becoming eligible |
1B |
Open Season |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
As announced by OPM |
1C |
Change in family status that results in increase or decrease in number of eligible family members, for example:
|
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Within 60 days after change in family status |
Employees may enroll or change beginning 31 days before the event. |
||||||||
1D |
Any change in employee's employment status that could result in entitlement to coverage, for example:
|
Yes |
N/A |
N/A |
N/A |
Automatic Unless Waived |
Yes |
Within 60 days after employment status change |
1E |
Any change in employee's employment status that could affect cost of insurance, including:
|
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Within 60 days after employment status change |
1F |
Employee restored to civilian position after serving in uniformed services.2 |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Within 60 days after return to civilian position |
1G |
Employee, spouse or dependent: |
No |
No |
No |
Yes |
Yes |
Yes |
Within 60 days after employment status change |
1H |
Salary of temporary employee insufficient to make withholdings for plan in which enrolled. |
N/A |
No |
Yes |
Yes |
Yes |
Yes |
Within 60 days after receiving notice from employing office |
1I |
Employee (or covered family member) enrolled in FEHB health maintenance organization (HMO) moves or becomes employed outside the geographic area from which the FEHB carrier accepts enrollments or, if already outside the area, moves further from this area.4 |
N/A |
Yes |
Yes |
N/A |
No |
No |
Within 60 days after employment status change |
1J |
Transfer from post of duty within a State of the United States or the District of Columbia to post of duty outside a State of the United States or District of Columbia, or reverse. |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Within 60 days after arriving at new post |
Employees may enroll or change beginning 31 days before leaving the old post of duty. |
||||||||
1K |
Separation from Federal employment when the employee or employee's spouse is pregnant. |
Yes |
Yes |
Yes |
N/A |
N/A |
N/A |
During employee's final pay period |
1L |
Employee becomes entitled to Medicare and wants to change to another plan or option.5 |
No |
No |
Yes (Changes may be made only once.) |
N/A |
N/A |
N/A |
Any time beginning on the 30th day before becoming eligible for Medicare |
1M |
Employee or eligible family member loses coverage under FEHB or another group insurance plan including the following:
|
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Within 60 days after loss of coverage |
Employees may enroll or change beginning 31 days before the event. |
||||||||
1N |
Loss of coverage under a non-Federal group health plan because an employee moves out of the commuting area to accept another position and the employee's non-Federally employed spouse terminates employment to accompany the employee. |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
From 31 days before the employee leaves the commuting area to 180 days after arriving in the new commuting area |
1O |
Employee or eligible family member loses coverage due to discontinuance in whole or part of FEHB plan.7 |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
During open season, unless OPM sets a different time |
1P |
Enrolled employee or eligible family member gains coverage under FEHB or another group insurance plan, including the following:
|
No |
No |
No |
Yes |
Yes |
Yes |
Within 60 days after QLE |
1Q |
Change in spouse's or dependent's coverage options under a non-Federal health plan, for example:
|
No |
No |
No |
Yes |
Yes |
Yes |
Within 60 days after QLE |
(If you are a United States Postal Service employee, these rules may be different. Consult your employing office or information provided by your agency.)