Termination, Conversion and Temporary Continuation of Coverage
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31-Day Extension of Coverage and Conversion (Continued)
Conversion for Family Members
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.
Conversion for Enrollees
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).
Late Conversion
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:
- include some documentation that your enrollment has terminated (for example, an SF 50
showing separation from service);
- include proof that you were not notified of the enrollment termination and the right to
convert (for example, a letter from your employing office confirming that it did not
provide timely notice of the conversion option), and were not otherwise aware of it, or
- include proof that you weren't able to convert because of reasons beyond your control.
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.
Termination of Erroneous 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 Withholdings were
Made
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 Withholdings were
not Made
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.
Temporary Continuation of Coverage
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.
Law
Title II of Public Law 100-654, effective January 1, 1990, established
the temporary continuation of coverage provision for the FEHB Program.
Eligibility
An employee, a child, and a former spouse are eligible for temporary continuation of
coverage based on specific qualifying events.
Employee
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.
Child
Your child is eligible for temporary continuation of coverage when he/she:
This includes a child who:
- Marries before reaching age 22;
- Loses coverage
because he/she reaches age 22;
- No longer meets coverage requirements as a stepchild, foster child, or a recognized
natural child;
- Was covered as a disabled
child age 22 and older, and marries, recovers from his/her disability, or becomes
self-supporting;
- Loses FEHB coverage upon the death of an employee or annuitant because he/she does not qualify for a survivor annuity;
- Loses FEHB coverage because his/her survivor annuity as a dependent of the deceased stops (for any reason, including because he/she is no longer a full-time student).
Former Spouse
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:
- remarried before reaching age 55; or
- is not entitled to a portion of your annuity benefits or a survivor benefit based on
your service.
Persons not Eligible
You are not eligible for temporary continuation of coverage (TCC) when:
- you transfer to a position that is excluded
from FEHB coverage by law;
- you lose coverage after 12 months in a leave without
pay status;
- you are a compensationer and you lose coverage because your
compensation terminates;
- you are a family member who loses coverage when the enrollee changes
to a Self Only enrollment, cancels
coverage, or separates from service and does not elect TCC;
- you are a spouse who loses coverage because of the death of an
employee or annuitant (most surviving spouses can continue
regular coverage as survivor annuitants, and so don't
need TCC);
- you are a surviving spouse whose annuity terminates;
- you are a child who enters military service (you are still considered an eligible
dependent child).
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.