Enrollment
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Opportunities to Enroll or Change Enrollment(Continued)
Former Spouse
If you are a former spouse who has coverage under the spouse
equity or temporary continuation of coverage
(TCC) provisions of FEHB law, you may change from Self Only to Self and Family or from one
plan or option to another, or both, within 60 days after the birth or acquisition of an
eligible child. To be eligible, the child must be that of both you and the employee or
annuitant on whose service your coverage is based.
Change in Employment Status
Generally, you may enroll or change enrollment from Self Only to Self and Family, from
one plan or option to another, or make any combination of these changes within 60 days
after a change in your employment status. You can also change your premium conversion status if the enrollment change is on account of and consistent with a qualifying life event. Various changes in employment status and the
allowable enrollment changes that you may make are described below.
Return
to Pay Status after 365 Days in Leave Without Pay Status or Termination During Leave
Without Pay Status
If your enrollment terminated:
- after you had been in leave without pay status for 365 days; or
- when you entered leave without pay status; or
- at any time during the first 365 days in leave without pay status,
you may enroll for Self Only or Self and Family in any available plan or option when
you return to pay status. If you were not enrolled at the time leave without pay status
began, you may enroll upon return to pay status only if a qualifying event
occurred while you were on leave without pay.
Reemployment
after More than 3-Day Break in Service
If you move from one employing office to another (other than by retirement) with a
break in service of more than 3 days, you may enroll the same as a new employee. If you
are a Nonappropriated Fund (NAF) employee who returns to Federal employment, you are
eligible for coverage, even when you have continued coverage under the NAF retirement
system.
Return from Military Service
If you are restored to a civilian position after serving in the uniformed services
under conditions that entitle you to benefits under 5 CFR part 353, or similar authority,
you may enroll in any option of any available plan after returning to civilian duty. If
your enrollment was terminated
on entry into military service, you will have the same enrollment reinstated effective
on the day of restoration to duty in a civilian position. In addition, you may change your
enrollment based on your return to civilian duty.
Change
from Temporary Appointment to Another Type of Covered Appointment
When you are eligible to enroll as a temporary employee
under 5 U.S.C. 8906a and you change to an appointment that makes you eligible for FEHB
coverage with a Government contribution, you may change plans, options, and types of
enrollment.
Your change in health benefits status is effective either:
- on the same date as your change in employment status, if the change is on the first day
of a pay period, or
- at the beginning of the pay period following your change in employment status, if the
change is after the first day of the pay period.
If there is a break in service of more than 3 days, your old enrollment terminates at
the end of the pay period in which your temporary appointment ends. You have a new
opportunity to enroll based on the new appointment.
Separating from Service
If you are separating from service and you or your spouse are pregnant, you may enroll
or change your enrollment during your final pay period. You must provide medical
documentation of the pregnancy to your employing office.
The effective date of the change is the first day of the pay period in which your
employing office receives your appropriate request.
Although you can usually enroll for family coverage under temporary continuation of coverage
(TCC) provisions, it does not become effective until the day after the 31-day extension of
coverage. An enrollment election prior to separation will ensure that the baby's health
care costs will be covered if he/she is born during the 31-day extension of coverage.
If you are not eligible for TCC, a change to a Self and Family enrollment during your
final pay period will allow you to convert to
an individual policy for the whole family.
Transfer
To or From Overseas Employment
You may enroll or change enrollment when you transfer from a duty post within the
United States to a duty post outside the United States or the reverse. You have 31 days
before the date you are expected to leave your former duty post and 60 days after your
arrival at the new duty post to enroll or change enrollment.
If you are at an overseas duty post at the time of your retirement, you may change your
enrollment within 60 days after your retirement.
Change
To or From Part-Time Career Employment
When you change to part-time career employment (16 to 32 hours a week under 5 U.S.C.
3401(2)) with a break in service of 3 days or less, you may enroll or change your
enrollment within 60 days from the change in your employment status. Similarly, when you
change from part-time employment under 5 U.S.C. 3401(2) to full-time employment, you may
enroll or change enrollment. This does not apply to part-time appointments of other than
16 to 32 hours per week (or 32 to 64 hours biweekly in the case of a flexible or
compressed work schedule) nor to any noncareer appointment.
You Lose
Coverage under FEHB or Another Group Insurance Plan
If you are an employee eligible for FEHB coverage, you may enroll or change your
enrollment from Self Only to Self and Family, from one plan or option to another, or make
any combination of these changes when you or an eligible family member
lose coverage under FEHB or any other group health benefits plan (including
coverage under another Federally-sponsored health benefits program or under Medicaid).
Except as otherwise provided below, you must enroll or change your enrollment within the
period beginning 31 days before and ending 60 days after the date you lost coverage. You can also change your premium conversion status if the enrollment change is on account of and consistent with a qualifying life event.
If you are eligible for FEHB coverage in your own right and you become a survivor annuitant, you have the option to continue the current enrollment
with withholdings made from your survivor annuity. If you elect to enroll as an employee,
and you later separate or your employment status changes so that your enrollment
terminates, you may continue the enrollment as a survivor annuitant.
If you are an eligible employee under age 22 and covered under your parent's self and
family enrollment, you are eligible to enroll if you are no longer dependent on your
parent. Your employing office will permit you to enroll when it receives a statement from
your parent that you are no longer a dependent. Your parent must also submit this
statement to his/her employing office, which will notify the carrier that you are no
longer an eligible family member. Your employing office will note in your appropriate
request that you are no longer a dependent and not eligible for benefits under your
parent's enrollment.
Former Spouse Loses Regular FEHB
Coverage
If you are entitled to health benefits coverage as a former spouse, but you are instead
enrolled as an employee or family member, you may enroll or resume enrollment under spouse
equity when your coverage as an
employee or family member ends (as long as you still meet the spouse
equity requirements).
Former
TCC Enrollee Loses Regular FEHB Coverage
If you were enrolled under temporary
continuation of coverage (TCC) provisions and you acquired regular FEHB coverage
(either as an employee or family member), you may reenroll in TCC if the regular coverage
ends before the original TCC enrollment would have expired. You may reenroll in
the same plan and option as your original TCC enrollment. If you are not eligible to
enroll in the plan you had when your TCC enrollment ended, you may enroll in the same
option of any available plan. The second TCC enrollment cannot extend beyond the date the
original TCC enrollment would otherwise have stopped.
Termination
of Membership in Employee Organization
If you are enrolled in a plan sponsored by a union or employee organization and you
stop being a member of that organization, your plan can ask your employing office to
terminate your enrollment, subject to a 31-day extension of coverage.
Your plan will send a notice to your employing office and a copy to you. Your employing
office will terminate your enrollment on a Notice of Change in Health Benefits Enrollment
(SF 2810), effective at the end of the pay period in which it receives the notice. You may
then enroll for Self Only or Self and Family in any available plan or option. If you
reenroll within 60 days after termination, you are considered to have been continuously
enrolled (for purposes of continuing enrollment after
retirement) even though there actually may have been a break between the effective
date of termination of your enrollment in the employee organization plan and the effective
date of your new enrollment.
You are
Enrolled in a Plan that is Discontinued
You may change to another plan when you are enrolled in a plan that is discontinued in
whole or in part. You may enroll in the new plan for either Self Only or Self and Family
coverage. If your plan is discontinued at the end of a contract year, you must change your
enrollment during Open Season unless OPM establishes a different time. If the whole plan
is discontinued and you do not change to another plan, you are considered to have canceled your enrollment. If one option of a two-option
plan is discontinued and you do not change to another plan, you are considered to have
enrolled in the remaining option of the plan.
Normally, a plan that terminates its participation in the FEHB Program will terminate
as of December 31 of a given year. The plan will continue to provide benefits until the
new coverage takes effect. When a plan is
discontinued at any time other than at the end of a contract year, OPM will announce a
special enrollment period and give instructions about the proration of premiums and the
effective date of enrollment changes.
Change
to Position out of Commuting Area
When your or your spouse's loss of non-Federal coverage is due to a move outside of the
commuting area, you must enroll or change enrollment within the period beginning 31 days
before the date you leave employment in the old commuting area and ending 180 days after
you enter on duty at the place of employment in the new commuting area.
Loss
of Coverage under Spouse's Non-Federal Plan
Your spouse may elect to temporarily continue the employer-provided group insurance
under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). You may choose
to enroll either at the time your spouse or child loses coverage through the non-Federal
employer or whenever the COBRA coverage terminates for any reason.
Move from an
HMO's
Service Area
If you are enrolled in an HMO and you move or become employed outside the
HMO's service
area (or, if you are already living or working outside this area, you move or become
employed further away), you may change your enrollment. Also, you may change your
enrollment if an enrolled family member moves outside the service area (or moves further
away). You must notify your employing office of the move.
The effective date of the change is the first day of the pay period that begins after
your employing office receives your appropriate request.
You become
Eligible for Medicare
You may change your enrollment to any option of any available plan at any time
beginning on the 30th day before you become eligible for Medicare. You may make an
enrollment change under this event only once.
Salary of
Temporary Employee Insufficient to Pay Withholdings
If you are temporary employee eligible under 5 U.S.C.
8906a and your salary is not sufficient to pay your plan's premiums, your employing office
must notify you of the plans available at a cost that does not exceed your available
salary. You may enroll in another plan where the cost is no greater than your available
salary within 60 days after receiving notification from your employing office.
Coverage under your new plan is effective immediately upon termination of your old
plan's coverage.
Continuation
of Old Plan during Confinement
If you changed your enrollment from one plan or option to another and you or a covered
family member are an inpatient in a hospital or other institution on the last day of your
enrollment under the prior plan or option, the benefits of the prior plan or option will
continue for the confined person for the length of the inpatient stay, up to 91 days from
the last day of enrollment in the prior plan or option. This provision does not apply when
a plan is discontinued or when OPM orders an enrollment change.
Your new plan or option does not pay benefits for you while you are receiving continued
inpatient benefits from your old plan or option. The new plan or option will begin
coverage on the earlier of:
- the day of your discharge;
- the day after maximum inpatient benefits available under the old plan or option have
been paid or provided; or
- the 92nd day after the last day of enrollment in the old plan or option.
Coverage for other family members (who are not confined in a hospital or other
institution) under the new plan begins on the normal effective date of coverage.
Dual Enrollment
Dual Enrollment Prohibited
Dual enrollment is when you or an eligible family member under your Self and Family
enrollment are covered under more than one FEHB enrollment. Generally, dual enrollment is
prohibited except when you or a family member would otherwise lose coverage.
Your stepchildren that live with you in a regular parent-child relationship are
eligible for coverage under your Self and Family enrollment. When all of either your
children or your spouse's children live with you, only one Self and Family enrollment is
needed. If both you and your spouse are enrolled for Self and Family, you must eliminate
the dual enrollment.
Employing Office Actions
Your carrier must contact the employing offices involved when it discovers an
unauthorized dual enrollment case. One of the enrollments must be voided or canceled from the date
that dual enrollment began. The health benefits premiums you paid during the unallowable
enrollment will be refunded, and your employing office must make a corresponding
adjustment in the Government's contribution. The carrier of the enrollment that is voided
or canceled may require that you refund any benefits it paid under the unallowable
enrollment, although these benefits may be payable under the allowable enrollment.
If you and your spouse are unable to agree on which enrollment to continue, the
enrollment of the spouse with a court order to provide coverage for the children will be
continued. Otherwise, the second (later) enrollment must be voided or canceled.
When Dual
Enrollment is Allowed
Dual enrollment must be authorized by your employing office(s) and will only be allowed
when you or an eligible family member would otherwise lose coverage. Some examples of
allowable dual enrollment include when:
- you and your spouse legally separate and both of you retain custody of your children by
prior marriages;
- you and your spouse have children from prior marriages who don't live with you;
- you and your spouse legally separate and you or your children would lose full health
benefits coverage (e.g., you move outside your HMO's service area and your spouse refuses
to change health plans; your spouse refuses to pass along reimbursements for health
benefits claims filed);
- you and your spouse divorce;
- you are under age 22, covered by your parent's enrollment, and become a parent.
- you and your spouse each have Self Only enrollments and one of you changes to a family enrollment and the other cancels their enrollment. A brief overlap of coverage is allowed to avoid a gap in coverage.
No enrollee or family member may receive benefits under more than one FEHB enrollment.
If your employing office authorizes a dual enrollment, you may be covered and receive
benefits only under your own enrollment. You must inform the carriers involved which
family members will be covered and receive benefits under which enrollment. If you or a
family member receive benefits under more than one plan, it is considered fraud and you
are subject to disciplinary action.