Annuitants and Compensationers
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Eligibility for Health Benefits After Retirement
Requirements
You are eligible to continue health benefits coverage, upon retirement, if you meet all of the following requirements:
- you are entitled to retire on an immediate
annuity under a retirement system
for civilian employees (including FERS MRA + 10 retirements); and
- you have been continuously enrolled (or covered as a family member) in any FEHB plan(s)
for the 5 years of service immediately before the date your annuity
starts, or for the full period(s) of service since your first opportunity to enroll (if less
than 5 years).
When you elect not to enroll or cancel your enrollment, you certify by your signature
on the Health Benefits Election form (SF 2809) that you understand the effect this has on
your eligibility to carry coverage into retirement.
MRA + 10
If you are a separating employee covered under FERS and you qualify for an immediate
annuity under the Minimum Retirement Age (MRA)
+ 10 provision, you can continue your enrollment when your annuity starts, as long as
you meet the requirements for continuing coverage.
If you postpone receipt of your annuity, your enrollment will terminate when you
separate from your employment. You will be eligible for temporary continuation of coverage
(TCC) or to convert to an individual
contract. You may choose to resume FEHB coverage on the date you select for your annuity
to begin.
Service
For purposes of continuing FEHB coverage into retirement, "service" means
time in a position in which you were eligible
to be enrolled. You are not required to have been an enrollee
continuously, but you must have been continuously covered by an FEHB enrollment.
This includes:
- time you are covered as a family member under another person's FEHB enrollment;
- time you are covered under the Uniformed Services Health Benefits Program (also known as
TRICARE or CHAMPUS) as long as you were covered under an FEHB enrollment at the time of
your retirement. (You must enroll in FEHB within 60 days after you lose coverage under the
Uniformed Services Health Benefits Program for that time to be considered as part of
continuous FEHB coverage.)
Coverage under Medicare does not count in determining continuous coverage.
Service as a Non-appropriated Fund employee does not count in determining continuous
coverage since it is not Federal service and not subject to FEHB coverage.
Break in Service
Breaks in service are not counted as interruptions when the 5
years of service requirement is determined, as long as you reenroll within 60 days
after your return to Federal service.
Example 1
Joan elected FEHB coverage on February 11, 1990, and had a break in service from
January 1, 1994 through January 1, 1996. Upon her return to service, she again elected to
enroll. She retires on December 31, 1997. She is eligible to continue her health benefits
coverage into retirement, since she has been continuously enrolled for the 5 years of
service prior to retirement.
Example 2
Eduardo elected not to enroll in the FEHB Program upon his employment. He left
Federal service in 1993. He was rehired in 1993, and elected to enroll. When he retired in
1996, he was not eligible to continue health benefits into retirement since he was not
covered for the five years of service before his retirement. His 1993 rehire date does not
count as his first opportunity to be insured because of his prior employment in which he
elected not to enroll.
Late Election
You are considered to have been continuously enrolled when you are allowed to make a
late election because your employing office determined that you weren't able to timely
enroll for reasons beyond your control.
Example
Anne's employing office notified her on March 20, 1993 that she could make a late
election to enroll in the FEHB Program. She promptly enrolled, and on January 1, 1998, she
retired. She is able to continue her health benefits coverage into retirement, since March
20, 1993, is considered to be her first opportunity to enroll.
Service
with an International Organization
If you transfer to an International Organization and elect to continue FEHB coverage,
the service with the International Organization is included in determining whether the 5 years of service requirement is met. If you don't elect to
continue your FEHB coverage or drop your enrollment before you return to Federal service,
the time with the International Organization without FEHB coverage is not included in
determining whether the 5-year requirement was met.
Eligibility as
a Temporary Employee
Your decision not to enroll as a temporary employee eligible for coverage under 5
U.S.C. 8906a doesn't affect your future eligibility to continue coverage as a retiree.
Only service for which the Government contributes toward the cost of your health benefits
counts in determining whether you meet the 5 years of service (or
first opportunity) requirements to continue coverage as a retiree. Since the
Government doesn't share in the cost of a temporary employee's enrollment, eligibility to
enroll under 5 U.S.C. 8906a is not considered your first opportunity for purposes of
continuing health benefits coverage into retirement.
Eligibility
under Temporary Continuation of Coverage
Your enrollment or eligibility for enrollment as a former employee under the temporary
continuation of coverage (TCC) provisions is not considered in determining whether you
meet the 5 years of service requirement for continued coverage
as a retiree, since you are not a Federal employee at that time. However, time that you
were an employee eligible to enroll but were covered as a family member under the TCC
enrollment of another person does count toward the 5 years of service requirement.