Eligibility for Health Benefits
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Election Procedures
Election Required
If you are eligible to enroll in
the FEHB Program, you must complete an election either to enroll in a plan or not to
enroll. You must do this within 60 days after you become eligible. Your employing office
must remind you of the 60-day deadline and ensure that you make your election on a timely
basis. If you don't make an election, you are considered to have declined coverage.
Health Benefits Election Form
Generally, you will make elections--to enroll, not to enroll, to change enrollment, or
to cancel enrollment-- on the Health Benefits Election Form (SF 2809). The SF 2809 may be
in either paper or electronic format. However, your employing office may allow or require
you to make Open Season changes through "Employee Express" or another electronic
method which does not involve an SF 2809. You should check with your employing office to
see if this is available for your use.
Social Security Number
All carriers use your social security number as your identification number for
enrollment purposes. Your social security number must be shown on all enrollment or
disenrollment documents.
Change in Election
If you are a participant in premium conversion, once your election takes effect it is irrevocable, unless you have a Qualifying Life Event. If you want to change your election before the election period ends, you must waive premium conversion before your employing office accepts the change.
Temporary Employees
If you are a temporary employee, your employing office must establish a potential FEHB
eligibility date for you. Your employing office must notify you as soon as you are eligible to enroll and give you 60 days to make an election.
Free Choice of Plans
Employing Office Responsibility
You will be given a full opportunity to make a free choice among the plans available to
you. Your employing office will explain the FEHB Program to you as soon as you become
eligible; give you informational material; caution you against cancellation of any private
health insurance you may already have before coverage under this Program becomes
effective; and urge that you study the material and decide which plan is best suited to
meet your health care needs.
Materials to be Given
Your employing office will give you the following materials before, or as soon as
possible after, you become eligible for FEHB coverage:
- Guide to Federal Employees
Health Benefits Plans. This booklet, which is updated each year, contains general
enrollment information, lists all FEHB plans and gives your share of the premium rates,
and gives the major features of each fee-for-service plan.
- Health Benefits Election Form (SF
2809). You will be asked to complete and return this
form, regardless of whether you elect to enroll or not to enroll in the FEHB Program.
- Health Plan Brochures. Your employing office will allow you to review the brochures of
the plans you are eligible to enroll in. Your employing office will allow you to keep the
brochure of the plan you select.
Plan Selection
Only you can decide which plan is best suited for your individual needs. Your employing
office will not make comparisons between benefits offered by various plans and will not
show favoritism toward a plan. They should not in any other way try to influence your
final selection of a plan. However, your employing office will answer your questions about
the FEHB Program.
Plans
Sponsored by Unions and Employee Organizations
You may elect to enroll in a plan sponsored by a union or employee organization if you
are a member of the organization or if you promptly take steps to become a member. Some
employee organizations will allow your enrollment in its plan if you become an associate
member (where you are enrolled in that organization only for health benefits purposes).
Certain plans are open only to specific groups of employees.
Your employing office will not verify whether you are a member of the organization when
it accepts your Health Benefits Election Form enrolling in the organization's plan; the
organization will verify your membership when it receives your election form. However,
your employing office will make sure that you understand that membership in the
organization that sponsors the plan is necessary to be an enrollee in the plan.
Late Election
Accepting Late Elections
If, for reasons beyond your control, you were unable to make an election within the
required time limits, your employing office may allow you to make a late election. You
must make your election within 60 days after your employing office notified you of its
decision.
Your employing office will decide whether your failure to make a timely election was
beyond your control. Your error in judgment or failure to read information are not
considered causes beyond your control. Some examples of cause beyond your control are:
- You were on service elsewhere when you ordinarily would have been able to make the
election.
- You are a new employee and your employing office didn't give you information about
health benefits.
- Your employing office told you in error that you were not eligible to enroll.
- You are an employee, formerly covered under another person's enrollment, and were
belatedly informed of that coverage's termination.
Documenting Late Elections
If your employing office accepts a late election from you, it records its determination
that you were unable to make the election on a timely basis for reasons beyond your
control, giving the date you were notified of the determination, in the Remarks section of
the Health Benefits Election Form (SF 2809). If you are electing to enroll, it is
especially important that this be documented on the SF 2809 for purposes of meeting the requirements for continuing enrollment after retirement.
Your employing office must state the reason for your failure to make the election on a
timely basis on either the SF 2809 or on a memo attached to the Official Personnel Folder
copy of the SF 2809.
Effective Date
Late elections are effective prospectively, except for belated Open Season elections,
as explained in "Correction of Errors."
Election by Proxy
Your employing office may permit your representative to make an election for you with
your written authorization. This may by done when you are unable to make an election on a
timely basis; for example, when you will be on extended travel in a remote location, or
you expect to be hospitalized during the next election opportunity. Your representative
must sign his or her own name on the Health Benefits Election Form (SF 2809) and add after
it "For: (your name)." Your employing office attaches the written
authorization to the Official Personnel Folder copy of the SF 2809 and writes
"Authorization attached" in the Remarks section.
Election Not to Enroll
Your Responsibility
It is your responsibility to ensure that your Health Benefits Election Form (SF 2809)
correctly reflects your intentions. When you elect not to enroll you certify by your
signature on the SF 2809 that you are aware:
Change in Election Not to Enroll
If you want to change your election before the election period ends, your employing
office must accept the change.
Effect of Transfer on Election not to Enroll
If you transfer to another employing office without a break in service of more than 3
calendar days, your election not to enroll is also transferred and you may not enroll as a
new employee of the gaining agency. If you have a break in service of more than 3 calendar
days, you must elect either to enroll or not to enroll, the same as a new employee.
Employing Office Action when You do not Make an Election
If you don't make an election, your employing office will contact you before the
election period ends and urge you to make an election. If you still don't make an
election, you are considered to have elected not to enroll.
If you are an eligible temporary employee
who doesn't enroll, your employing office will document in your Official Personnel Folder
your date of eligibility, the date it sent notification of your eligibility, and the date
of its follow-up contact urging you to make an election.