Termination, Conversion and Temporary Continuation of Coverage
Cancellation
Electing to Cancel
If you participate in premium conversion, you may cancel your enrollment:
- During the annual Open Season; or
- Within 60 days after you have a qualifying life event. Your cancellation must be consistent with and correspond to your qualifying life event.
Example:
LaTonya gets married, and since her husband's company provides health insurance for a spouse, she wants to cancel her FEHB enrollment. She can make this enrollment change outside of Open Season since it is consistent with and corresponds to her qualifying life event (marriage).
You may cancel or change your enrollment at anytime if you do not participate in premium conversion. You do not need to wait for the next Open Season or for you to experience a qualifying life event.
Your cancellation is effective on the last day of the pay period in which your employing office receives your Health Benefits Election Form (SF 2809) or other enrollment request. When you cancel your enrollment, you are not eligible for the 31-day extension of coverage and you can't convert your coverage to an individual policy.
If your temporary continuation of coverage (TCC) or Spouse Equity enrollment ends because you didn't pay the premiums, it is considered to be a voluntary cancellation.
When you cancel your enrollment, your family members' coverage terminates at midnight of the day that your cancellation is effective, with no 31-day extension of coverage.
Your Responsibility
When you cancel your enrollment, your signature certifies that you are aware:
Your employing office will process your termination by following the applicable instructions in "Employing Office Review of SF 2809." It will use the old carrier copy to notify your carrier of your cancellation and discard the new carrier copy.
Annuitants
When you cancel your enrollment as an annuitant, you may never reenroll unless:
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Termination
Enrollees
Your enrollment will terminate, subject to a 31-day extension of coverage, on the earliest of the following dates:
- the last day of the pay period in which you separate from service (unless you transfer, retire, or begin receiving Workers' Compensation benefits);
- the last day of the pay period in which you separate after you meet the requirements for an immediate annuity under the FERS MRA+10 provision and you postpone receipt of your annuity (see chapter 42A of the CSRS/FERS Handbook for Personnel and Payroll Offices);
- the last day of the pay period in which you change to a position that is excluded from coverage;
- the last day of the pay period in which you die, unless you have a family member eligible to continue enrollment as a survivor annuitant;
- the last day of the pay period that includes the 365th day of continuous leave without pay status or the last day of leave under the Family and Medical Leave Act, whichever is later;
- the last day of the last pay period in pay status, if you haven't had 4 consecutive months of pay status after you exhausted the 365 days continuation of coverage in leave without pay status;
- the day you are separated, furloughed, or placed on leave of absence to serve in the uniformed services for duty over 30 days, if you elect in writing to have your enrollment terminated;
- the date that is 24 months after the date of your separation, furlough, or leave of absence to serve in the uniformed services for duty over 30 days, or the date your entitlement to continued coverage ends, whichever is earlier;
- the day on which your temporary continuation of coverage (TCC) expires;
- the last day of the pay period for which withholding was made when you are a temporary employee enrolled under 5 U.S.C. 8906a whose pay is insufficient to pay the withholdings and you didn't or couldn't choose a plan for which your pay would cover the premiums.
Your enrollment may also terminate when you enter leave without pay status.
Family Members
Your family member's coverage terminates, subject to a 31-day extension of coverage, at midnight on the earlier of the following dates:
You cannot continue coverage for your spouse under your Self and Family enrollment upon your divorce. He/she may be eligible for his/her own enrollment under either the Spouse Equity or temporary continuation of coverage provisions.
When you cancel your enrollment, your family members' coverage terminates at midnight of the day that your cancellation is effective, with no 31-day extension of coverage.
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Processing Terminations
Employing Office Responsibilities
When your enrollment terminates, your employing office must prepare a Notice of Change in Health Benefits Enrollment form (SF 2810), showing the reason for your termination in the remarks section. Your employing office must prepare, process and distribute the SF 2810 as quickly as possible so your carrier knows that you are no longer covered under the health benefits plan.
By Termination of Membership in Employee Organization
When the employee organization plan you are enrolled in instructs your employing office to terminate your enrollment because you are no longer a member, your employing office will do so on the Notice of Change in Health Benefits Enrollment (SF 2810). It will note in the Remarks section: "Your enrollment was terminated by the plan because you are no longer a member of the sponsoring employee organization. You may enroll in another plan from 31 days before to 60 days after the date in Part A, item 8, above." (This date is the last day of the pay period in which your employing office received the plan's notice of termination.) Your new enrollment will be processed as an enrollment change.
For Other Reasons
When your enrollment terminates for any reason other than cancellation or termination of your membership in an employee organization, your employing office must:
- complete parts A, B, and H of the Notice of Change in Health Benefits Enrollment (SF 2810);
- state the reason for the termination in the Remarks section (e.g., "Employee resigned"); and
- send the carrier and payroll office copies to the payroll office for transmission to the carrier and for posting to the payroll records, respectively.
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31-Day Extension of Coverage and Conversion
Extension of Coverage
You and your eligible family members' coverage continues at no cost for 31 days after your enrollment terminates for any reason except when you voluntarily cancel your enrollment or your plan is discontinued.
If you or a family member are an inpatient in a hospital on the 31st day of your extension of coverage, FEHB benefits for the hospitalized person will continue for the length of the hospitalization, up to a maximum of 60 more days, unless you convert to an individual contract.
Conversion Rights
When your enrollment terminates, you are entitled to convert to an individual policy offered by the carrier of your plan. You are not required to provide evidence of insurability.
Exception: you are not entitled to convert to an individual policy if you voluntarily canceled your enrollment or your plan was discontinued.
Benefits under a Conversion Contract
Many conversion contracts provide fewer benefits at a higher cost than what is offered under the FEHB Program. Also, there is no Government contribution to the cost of the individual conversion contract. If you anticipate that a family member will lose coverage in the near future, the benefits and cost of a plan's conversion contract may be an important consideration in your choice of a health plan. If you or a family member is considering converting to an individual policy, you should contact the carrier of your plan for information about the benefits and cost of its conversion contract.
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, follow the instructions on the back of your copy of the SF 2810 and write 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, Healthcare and Insurance, 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.
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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.
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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:
- Loses coverage because he/she reaches age 26;
- No longer meets coverage requirements as a foster child;
- Was covered as a disabled child age 26 and older, and 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 child).
- you are involuntarily separated for gross misconduct.
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Employing Office Responsibilities
The employing office that is responsible for your TCC enrollment on the date of the qualifying event remains responsible for your enrollment for the length of your TCC enrollment. (Many employing offices contract with the National Finance Center to administer TCC enrollments and to act as the employing office.) Your employing office's responsibilities in administering temporary continuation of coverage (TCC) include:
Providing Information for Employees
The employing office is responsible for providing all employees who are enrolled or eligible to enroll in FEHB with information about their right to TCC. This information is included in plan brochures and the booklet Temporary Continuation of Coverage under the Federal Employees Health Benefits Program (RI 79-27).
However, your employing office is not obligated to notify you or your family member when he/she is no longer eligible for coverage under your enrollment or provide notification of his/her eligibility for TCC.
Administering the Enrollment Process
Each employing office must establish procedures for notifying former employees about their eligibility to enroll, including what documents are needed to determine eligibility, and accepting enrollment elections from former employees, children and former spouses.
Verifying Eligibility to Enroll
The employing office must verify the eligibility of a child or former spouse to enroll. If there is conflicting information on a child's date of birth or the date of your divorce, the employing office must determine the correct date.
Collecting Premiums
The employing office of the employee or annuitant at the time of the qualifying event is responsible for collecting premiums. The employing office sends the premiums it collects to OPM.
Maintaining the Health Benefits File
The employing office must maintain a health benefits file for each TCC enrollee separate from the personnel records of the employee or former employee.
Denying TCC Due to Involuntary Separation for Gross Misconduct
The employing office must make determinations of gross misconduct and follow the required administrative procedures.
Maintaining Enrollment
The employing office must provide services to TCC enrollees similar to those provided to enrolled employees. For example, it must provide Open Season information and process enrollment changes and cancellations.
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Notification Requirements for Separating Employees
When you separate from service and are eligible for temporary continuation of coverage (TCC), your employing office must notify you no later than 61 days after your separation of your opportunity to elect TCC.
This notice should include your right to convert to an individual contract offered by your plan. This notice must explain your right to enroll in TCC and how you can get the registration form and additional information. Your employing office should attach the pamphlet, Temporary Continuation of Coverage under the Federal Employees Health Benefits Program (RI 79-27) to the notice. If you want to elect TCC, you must respond within the specified time limit.
Sample Notice for Separating Employees
Your employing office may use the following sample notice to notify you of your TCC rights upon your separation:
Dear (name):
Your coverage in the Federal Employees Health Benefits (FEHB) Program ends on the last day of the pay period in which you separate from Federal service, subject to a 31-day extension of coverage (at no cost to you) with opportunity for conversion to an individual contract with your insurance carrier.
You also have the right to temporarily continue your FEHB coverage for up to 18 months after your separation instead of converting to an individual contract at this time. You may select any plan in the FEHB Program in which to continue your coverage if you are eligible to enroll in the plan. To continue your coverage, you must pay the full amount of the premium (both the employee and Government shares) plus a 2 percent administrative charge. If you choose to continue your coverage, you have the free coverage described above for the first 31 days. Your Temporary Continuation of Coverage (TCC) enrollment and premium charges begin on the day after the 31-day period of free coverage ends. If you continue TCC to the end of the 18-month period, you will have another 31-day extension of coverage with opportunity for conversion to an individual contract.
If you are interested in continuing your FEHB coverage, you can get additional information and an election form by calling (Name of person to contact) at (telephone number) or you can pick up the material at the following address: (enter address).
If you want to continue your coverage, your election form must be received at the address shown below within 60 days after the date of separation or 65 days after the date of this notice, whichever is later. Bring or mail your election form to:(enter address)
Sincerely,
(Name of appropriate official)
If your employing office gives this notice directly to you, it should add the following note and make two copies of the notice:
I acknowledge receipt of this notice.
Employee's signature Date
Notification Requirements for Children
If your child becomes eligible for temporary continuation of coverage (TCC), it is your responsibility as the enrolled employee to notify your employing office of the change in your child's status. You must provide your child's name, address, and date of the event that caused his/her loss of FEHB coverage within 60 days from the loss of coverage. Your employing office then has 14 days to notify your child of his/her TCC rights.
Your child or another person may notify your employing office of the child's loss of coverage; but the time limit for electing TCC will be shorter than if you provided the notification.
The notice from your employing office to your child must include:
- an explanation of your child's right to TCC;
- FEHB Guide (RI 70-5);
- Health Benefits Election Form (SF 2809);
- Temporary Continuation of Coverage Under the Federal Employees Health Benefits Program (RI 79-27);
- how the child can get additional information; and
- if there is doubt about the date of the qualifying event, a request for the appropriate information or documentation.
Sample Notice for Child
Employing offices may use the following sample notice of TCC rights when you timely notified your employing office of your child's loss of coverage:
Dear (child's name):
Your coverage in the Federal Employees Health Benefits (FEHB) Program as a family member of (enrollee's name) ended when you (enter reason), subject to a 31-day extension of coverage (at no cost) with opportunity for conversion to an individual contract with your insurance carrier.
You also have the right to temporarily continue your FEHB coverage for up to 36 months after the date of (enter reason) instead of converting to an individual contract at this time. You may select any plan in the FEHB Program in which to continue your coverage if you are eligible to enroll in the plan. If you choose family coverage, your spouse and your children will also be covered. To continue your coverage under the temporary continuation of coverage (TCC) provision, you must pay the full amount of the premium (both the employee and Government shares) plus a 2 percent administrative charge. If you choose to continue your coverage, during the first 31 days you have the free coverage described above. Your TCC enrollment and premium charges begin on the day after the 31-day period of free coverage ends. If you continue the coverage to the end of the 36-month period, you will have another 31-day extension of coverage with opportunity for conversion to an individual contract.
An election form and detailed information about your opportunity to continue coverage is enclosed. You may get additional information by calling (name of contact) at (telephone number).
If you want to continue your coverage, your election form must be received at the address shown below within 60 days after the date of your (enter reason) or 65 days after the date of this notice, whichever is later. Bring or mail your election form to: (enter address).
Sincerely,
(Name of appropriate official)
If your employing office gives the notice directly to your child, it should add the following note and make two copies of the notice:
I acknowledge receipt of this notice.
Child's signature Date
If someone other than yourself (the enrollee) notified the employing office of your child's loss of coverage, the sample notice's last paragraph should be replaced by the following paragraph:
If you want to continue your coverage, your election form must be received at the address shown below within 60 days after the date of your (enter reason). Bring or mail your election form to: (enter address).
Notification Requirements for Former Spouses
If your former spouse is eligible for temporary continuation of coverage (TCC), either you or your former spouse must notify your employing office within 60 days after the date of your divorce or annulment. Your employing office then has 14 days to notify your former spouse of his/her rights. The notice to your former spouse must include the same information as the notice to a child. In addition, the notice must request a certified copy of the divorce decree or other document showing the date of the divorce or annulment. If he/she wants to elect TCC, he/she must respond within the specified time limit.
Another person may notify your employing office of your former spouse's loss of coverage; but the time limit for electing TCC will be shorter than if you or your former spouse provided the notification.
Sample Notice for Former Spouse
Your employing office may use the following sample notice of TCC rights when you or your former spouse timely notified your employing office:
Dear (former spouse's name):
Your coverage as a family member in the Federal Employees Health Benefits (FEHB) Program ended when you were divorced or your marriage was annulled, subject to a 31-day extension of coverage (at no cost) with opportunity for conversion to an individual contract with your insurance carrier.
You also have the right to temporarily continue your FEHB coverage for up to 36 months after your divorce instead of converting to an individual contract at this time. You may select any plan in the FEHB Program in which to continue your coverage if you are eligible to enroll in the plan. If you choose a family enrollment, it will cover yourself and the children of both you and the Federal employee under whose enrollment you have been covered. If your former spouse still carries a family enrollment, you can enroll for self only. To continue your coverage under the Temporary Continuation of Coverage provision (TCC), you must pay the full amount of the premium (both the employee and Government shares) plus a 2 percent administrative charge. If you choose to continue your coverage, during the first 31 days you have the free coverage described above. The TCC enrollment and premium charges begin on the day after the 31-day period of free coverage ends. If you continue the coverage to the end of the 36-month period, you will have another 31-day extension of coverage with opportunity for conversion to an individual contract.
Enclosed is an election form and detailed information about your opportunity to continue your coverage. You can get additional information by calling (name of contact) at (telephone number).
If you want to continue your coverage, your election form must be received at the address shown below within 60 days after the date of your divorce or annulment or 65 days after the date of this notice, whichever is later. Bring or mail your election form and a certified copy of the divorce decree or another document showing your divorce date to: (enter address).
Sincerely,
(Name of appropriate official)
If your employing office gives the notice directly to your former spouse, it should add the following note and make two copies of the notice:
I acknowledge receipt of this notice
Former spouse's signature Date
If someone other than you or your former spouse notified the employing office of his/her loss of coverage, the sample notice's last paragraph should be replaced by the following paragraph:
If you want to continue your coverage, your election form must be received at the address shown below within 60 days after the date of your divorce or annulment. Bring or mail your election form to: (enter address).
Receipt of Notice
Your employing office must either give the notice directly to the person eligible for temporary continuation of coverage (TCC) or send it by first class mail. (A notice that is mailed is considered to be received 5 days after the date of the notice.) If you, your child, or former spouse are given the notice directly by your employing office, it will require that you acknowledge receipt by signing a copy of the notice. The signed copy must be placed on the right side of your Official Personnel Folder (OPF) or the equivalent. If the notice is sent by mail, a dated copy of the notice must be filed in your OPF.
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Time Limits for Electing Temporary Continuation of Coverage
If you are a separating employee, you must submit your Temporary Continuation of Coverage (TCC) election to your employing office within 60 days after the date of your separation or 65 days after the date of your employing office's notice, whichever is later.
Your eligible child must submit his or her TCC election to your employing office within either:
- 60 days after the date of the qualifying event, if you (the enrollee) did not notify your employing office within the required 60-day notification period (even if someone else provided notification); or,
- 65 days after the date of your employing office's notice, if you notified your employing office within the required 60-day notification period.
Your former spouse must submit his or her TCC election to your employing office by the later of:
- 60 days after the date of your divorce or annulment, if you or your former spouse did not notify your employing office within the required 60-day notification period (even if someone else provided notification); or
- 65 days after the date of your employing office's notice, if you or your former spouse notified your employing office within the required 60-day notification period; or
- 60 days after the date he/she lost coverage under Spouse Equity provisions (because of remarriage before age 55 or loss of the qualifying court order), if the loss of coverage is within the 36-month period of TCC eligibility.
If you or your former spouse do not notify your employing office within the 60-day period, your former spouse's opportunity to elect TCC ends 60 days after the divorce or annulment.
Guardian may file
A court-appointed guardian may file a temporary continuation of coverage (TCC) election on behalf of an eligible person that is unable to file because of a mental or physical disability.
Late Election
Your employing office may allow a late temporary continuation of coverage (TCC) election if it determines that you or your family member were unable to elect it on a timely basis for reasons beyond your control. It must accept the TCC election within 31 days after it provides notification of its decision to allow a late enrollment. Coverage is made retroactive, and retroactive premiums are due, to the date it would have been effective if elected on a timely basis.
Your employing office cannot accept a late election when it did not receive the required notification of your family member's eligibility for TCC within the time limits set by law and regulation.
Election Options
When you elect Temporary Continuation of Coverage (TCC), you may choose Self Only or Self and Family coverage in any plan or option that you are eligible to join. You are not limited to the plan, option, or type of enrollment under which you had been covered.
Covered Family Members
If you are a former employee with a Temporary Continuation of Coverage (TCC) Self and Family enrollment, the eligibility requirements for your family members are the same as for active employees.
When your child enrolls for Self and Family, covered family members are his/her spouse and eligible children.
When your former spouse enrolls for Self and Family, covered family members are limited to the children of both you (the employee) and your former spouse. If your former spouse remarries, the new husband or wife is not covered. Stepchildren who were covered under your enrollment are not covered under your former spouse's TCC enrollment. The stepchild then becomes eligible to enroll under TCC because he/she is no longer a covered family member.
After the initial enrollment, a TCC enrollee may change enrollment during an open season or when another event occurs that would allow a change in enrollment.
Election Procedures
To make a Temporary Continuation of Coverage (TCC) election, you should submit a Health Benefits Election Form (SF 2809) to the employing office that is servicing your account. If you submit a signed election request in a format other than the SF 2809, your employing office must complete a SF 2809 on your behalf based on your written request. Your name, date of birth, and social security number must be entered in part A of the form.
If you are a separated employee, your employing office must enter the following information under Remarks: "Eligibility expires: (enter date 18 months after separation date)."
If you are a child or former spouse, your servicing employing office must enter the following information under Remarks: name, date of birth, and social security number of the employee or annuitant; the expiration date of eligibility for enrollment; and your relationship to the employee.
Example:
Employee: Archibald M. Higgenbottom, SSN 123 45 6789, DOB 12/12/55. Eligibility ends: 4/20/97. Former spouse.
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Effective Date of Coverage
The effective date of your Temporary Continuation of Coverage (TCC) enrollment is the day after the 31-day extension of coverage ends. Your coverage is retroactive to that date if you elect TCC after the 31-day extension of coverage ends.
Exception: When your former spouse loses coverage in the 18 month period before your divorce or annulment because you change to a Self Only enrollment, the 31-day extension of coverage takes place after he/she loses coverage, not after the divorce or annulment. In this case, your former spouse's TCC enrollment is effective the day after the date of your divorce or annulment. Since there is a gap in FEHB coverage between the end of the 31-day extension of coverage and the beginning of the TCC enrollment, your former spouse may want to convert his/her coverage to an individual contract until the TCC enrollment can begin.
If you elect a different plan or option when you enroll under TCC, and you or a covered family member are an inpatient in a hospital on the 31st day of the extension of coverage, coverage under your old plan or option will continue for the hospitalized person for the length of the confinement, up to 60 days. The other family members' coverage will switch to the new plan or option after the 31-day extension of coverage ends.
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Length of Temporary Continuation of Coverage
Former Employee
If you are a former employee, your Temporary Continuation of Coverage (TCC) eligibility time period continues up to 18 months from the date you separated from service.
Example
Laura separates from service on February 3, 2011. She is no longer an employee on February 4. Her period of TCC coverage expires on August 3, 2012.
Child
Your child's TCC eligibility time period continues for up to 36 months from the date of his/her change in status as a family member. If the change in status as a family member takes place while he/she is covered as a family member under your TCC enrollment as a former employee, he/she is eligible to enroll under TCC in his/her own right, but the TCC enrollment cannot continue beyond 36 months after the date of your separation from service.
Example 1
Robert's child turns 26 on April 22, 2012. She is considered to have turned 26 at midnight on April 21 and on April 22 is no longer a family member. She enrolls under TCC; her TCC eligibility ends on April 21, 2015.
Example 2
Laura separates from service on February 3, 2012. She enrolls under TCC for a Self and Family enrollment. Her child turns 26 on April 22, 2012 and enrolls under TCC. Her child's TCC eligibility ends on February 3, 2015.
Former Spouse
Your former spouse's TCC eligibility time period continues for up to 36 months from the date of your divorce or annulment that takes place before your separation from service. If your divorce or annulment takes place while he/she is covered as a family member under your TCC enrollment as a former employee, he/she is eligible to enroll under TCC in his/her own right, but the TCC enrollment cannot continue beyond 36 months after the date of your separation from service.
Example 1
Paul (the employee) and Betsy divorce becomes final on December 10, 2012. She is considered to no longer be a family member on December 11. She enrolls under TCC; her TCC eligibility ends on December 10, 2015.
Example 2
Maria separates from service on September 1, 2012 and enrolls under TCC for a self and family enrollment. On December 10, 2013, her divorce from Eugene becomes final. Eugene enrolls under TCC; his TCC eligibility ends on September 1, 2015.
Length of Coverage Based on Qualifying Event
Your Temporary Continuation of Coverage (TCC) eligibility time period is based on the qualifying event that made you eligible for TCC.
Separating Employee
If you are a separating employee, you lose regular FEHB coverage at the end of the pay period in which you separate. Then you have a 31-day extension of coverage, at no cost to you, before your TCC coverage begins. Your 18-month eligibility time period begins immediately after your separation, although the first 31 days fall under the 31-day extension of coverage provision. Your TCC coverage is effective on the day after the 31-day extension of coverage ends.
If you change plans or options upon election of TCC, your enrollment in your previous plan or option will continue through the 31-day extension of coverage. Your enrollment in the new plan or option will become effective the day after the 31-day extension of coverage and will continue for up to 17 months.
After your TCC coverage ends (except if you canceled your enrollment or your plan was discontinued), you are eligible for another 31-day extension of coverage at no cost to you, and you are eligible to convert to an individual contract offered by your health benefits plan.
Example
Tyra separates from service on January 15, 2012. She enrolls under TCC and changes her enrollment to a different health benefits plan. Her enrollment with her previous plan continues for the first 31 days after separation. Her TCC coverage with the new plan begins on February 16, 2012. Her TCC eligibility time period ends on July 15, 2013. Her 31-day extension of coverage ends on August 16, 2013.
Child or Former Spouse
If you are a child or former spouse of a Federal employee or annuitant, you also have a 31-day extension of regular FEHB coverage (at no cost to you) before your TCC coverage begins, beginning the day after the event that caused the loss of coverage. The 36-month TCC eligibility time period begins immediately after the event, although the first 31 days fall under the 31-day extension of coverage provision. TCC coverage is effective on the day after the 31-day extension of coverage ends, and continues for up to 35 more months.
If you change plans or options upon election of TCC, your enrollment in the previous plan or option will continue through the 31-day extension of coverage. Your enrollment in the new plan or option will become effective the day after the 31-day extension of coverage and will continue for up to 35 more months.
After your TCC coverage ends (except if you canceled your enrollment or your plan was discontinued), you are eligible for another 31-day extension of coverage at no cost to you, and you are eligible to convert to an individual contract offered by your health benefits plan.
Example
Caroline turns age 26 on October 1, 2012 and loses coverage under her father's self and family enrollment. She elects TCC coverage and decides to enroll in the same plan that she was enrolled in under her father's coverage. Her 31-day extension of coverage ends on October 31, 2012 and her TCC eligibility time period ends on September 30, 2015. Her second 31-day extension of coverage ends on October 31, 2015.
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Premium Payments
There is no Government contribution towards the premiums charged for a Temporary Continuation of Coverage (TCC) enrollment. If you are a TCC enrollee, you must pay the full premium charge (both employee and Government shares) plus a 2 percent administrative charge. Premium charges, and your TCC coverage, begin on the day after the free 31-day extension of coverage ends. If you elect TCC after the 31-day extension of coverage, you will be billed for premiums retroactive to the effective date of coverage.
Exception: certain Department of Defense employees who have TCC based on a separation due to reduction in force as described in 5 U.S.C.8905a(d)(4) continue to receive a Government contribution towards premiums.
Each payment is due after the pay period in which you are covered according to the schedule established by your servicing employing office. Your servicing employing office submits the premium payments it collects along with its regular health benefits payments to OPM.
Unlike most enrollments, the beginning and ending dates of TCC enrollments are not always the same as the beginning and ending date of a pay period. In this case, your servicing employing office must prorate the premium charge. It must determine a daily premium rate by multiplying the monthly premium rate (including the administrative charge) by 12 and dividing the result by 365.
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Nonpayment of Premiums
If your servicing employing office does not receive your premium payment by the due date, it must notify you in writing that you must make payment within 15 days (45 days if you live overseas) for your coverage to continue. If you don't make payment within this time frame, you are considered to have voluntarily canceled your enrollment effective with the last day that you paid your premiums. If you don't make any payments within 60 days (90 days if you live overseas) after the date of the notice, your enrollment ends, effective with the end of the last pay period that you paid your premiums.
If your coverage is canceled because you didn't pay your premiums, you aren't entitled to the 31-day extension of coverage and you can't convert to an individual contract. You may not reenroll or be reinstated unless you were unable to make payment within the specified time frames for reasons beyond your control.
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Sample Notice for Delinquent Premiums
Your employing office may use the following sample notice for enrollees who do not make payments on time:
Dear (name):
We have not received your payment for health benefits coverage in the amount of $ that was due on (date), and represents payment for coverage for the month of (month, year). If we do not receive the payment with 15 days after the date you receive this letter, your health benefits will be terminated, effective (last day of coverage for which premiums were paid).
Termination of health insurance because of nonpayment of premiums is considered to be a voluntary cancellation by the enrollee. If your enrollment is canceled, you may not enroll again nor be reinstated (except as explained in the following paragraph). In addition, you will not be entitled to convert your coverage to an individual contract with your insurance carrier or to have the 31-day temporary extension of coverage.
If your coverage is canceled, it may be reinstated only if you were prevented by circumstances beyond your control from making the payment within the time frame specified above. You may request reinstatement by writing to the following address: (enter employing office address).
Sincerely,
(Name of appropriate agency official)
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Effective Date of Enrollment Change
Generally, an enrollment change that you make while you are covered under Temporary Continuation of Coverage (TCC) is effective on the first day of the first pay period that begins after the date your servicing employing office receives your Health Benefits Election Form (SF 2809).
When your servicing employing office determines that you were unable, for reasons beyond your control, to change your enrollment within the specified time limits, you may do so within 60 days after your employing office tells you of its determination.
At your servicing employing office's discretion, a person with your authorization to take health benefits actions may enroll or change your enrollment on your behalf.
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Opportunities to Change Your TCC Enrollment
When you make a change based on one of the following events, your servicing employing office will follow the same procedures as for employees enrolled under regular FEHB coverage.
Change to Self Only
You may change your enrollment from Self and Family to Self Only at any time. Generally, the change is effective on the first day of the first pay period that begins after the date your servicing employing office receives your request to change your enrollment. Your employing office may make a change to Self Only retroactive to the first day of the pay period after the one in which you no longer had any eligible family members. This type of retroactive change will be made only if you request it and your employing office is satisfied that the last family member lost eligibility for coverage.
Open Season
During Open Season, you may change your enrollment from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes. Exception: if you are an enrolled former spouse, you may change from one plan or option to another, but you cannot change from Self Only to Self and Family unless you are covering a child of both you and the employee or annuitant on whose service your coverage was based.
Your Open Season enrollment change is effective on the first day of the pay period that begins in January of the next year. If your servicing employing office accepts a late Open Season change from you, the effective date is the same date it would have been if submitted timely, even if that means it is effective retroactively.
Change in Family Status
If you are an enrolled former employee or child, you may 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 have a change in family status. You must make the enrollment change during the period beginning 31 days before and ending 60 days after the date of the change in family status.
If you are an enrolled former spouse, you may change your enrollment from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes within the period beginning 31 days before and ending 60 days after the birth or acquisition of a child of both you and the employee or annuitant on whose service your coverage was based.
A change that you make because of the birth or acquisition of a child is effective on the first day of the pay period in which your child is born or becomes an eligible family member.
Reenrollment Under TCC
If your TCC enrollment ended because you acquired regular FEHB coverage (as an employee or family member), you may reenroll if your regular FEHB coverage ends before your 18- to 36-month eligibility period ends (however, you may be eligible for a new TCC enrollment period). Your coverage does not extend beyond your original eligibility period. The effective date of your reenrollment is the day following the date that your regular FEHB coverage ended.
Loss of FEHB Coverage or Coverage under Another Group Insurance Plan
You may 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 lose other FEHB coverage or your eligible family member loses FEHB coverage or coverage under another group health plan. Except as noted, you must change your enrollment within the period beginning 31 days before and ending 60 days after the loss of coverage. Some examples of loss of coverage are:
- loss of coverage under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to Self Only
- loss of coverage under another Federally-sponsored health benefits program
- loss of coverage under the Medicaid program or a similar State-sponsored program of medical assistance for the needy
- loss of coverage under a non-Federal health plan
- loss of coverage because of termination of membership in an employee organization sponsoring or underwriting an FEHB plan
- loss of coverage because the FEHB plan is discontinued.
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 already living or working outside this area, move or become employed further away), you may change your enrollment. You must notify your employing office of the change.
You Become Eligible for Medicare
You may change your enrollment from one plan or option to another 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 in a lifetime.
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Termination of TCC Enrollment or Coverage
Your Temporary Continuation of Coverage (TCC) enrollment will end either because your eligibility period ends or you cancel your enrollment (this includes cancellation when you don't pay your premiums). If your enrollment ends because your TCC eligibility period ends, you are entitled to the 31-day extension of coverage for conversion to an individual contract.
Your family member's coverage ends when your enrollment ends or when he/she no longer is eligible for coverage as a family member. If your family member loses TCC coverage for any reason other than your cancellation (this includes cancellation when you don't pay your premiums), he/she is entitled to the 31-day extension of coverage for conversion to an individual contract. If you are a former employee, your family member that loses coverage is also eligible for TCC in his/her own right.
Your enrollment ends when your premiums remain unpaid 60 days (90 days if you live overseas) after the date of your employing office's notice of nonpayment.
If your enrollment ends because you didn't pay your premiums, it is considered to be a voluntary cancellation effective with the last day of the pay period for which you made payment. Your servicing employing office must complete a Health Benefits Election Form (SF 2809) for you. In part G, which normally would have your signature, your employing office will enter "Canceled due to nonpayment of premiums." In part H, it will enter "N/A" in item 2, and in item 3 it will enter the effective date of the cancellation. In cases where you never made payment, it enters the same effective date as on the original SF 2809 enrolling you. In the Remarks section it enters "This cancellation voids the prior SF 2809 enrolling this individual in your plan on the date in item 3." This voiding action has the same effect as a cancellation for nonpayment of premiums.
31-Day Extension of Coverage and Conversion to an Individual Contract
If you lose your Temporary Continuation of Coverage (TCC) other than by cancellation (including cancellation by nonpayment of premiums) or discontinuance of the plan, your coverage is automatically extended for 31 days, at no cost to you. You are also entitled to convert to an individual contract with your health benefits carrier, without providing evidence of insurability. You are eligible for the 31-day extension of coverage and have the right to convert even if you are eligible to elect TCC in your own right (e.g., you are a child of a former employee and you lose TCC coverage because you are no longer considered a covered family member).
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Denial of TCC because of Involuntary Separation for Gross Misconduct
Under the law, you are not eligible for Temporary Continuation of Coverage (TCC) when you are involuntarily separated from Federal service because of gross misconduct.
Your employing office must determine whether the offense for which you are being removed constitutes gross misconduct. The determination must be made on a case-by-case basis by employing office staff (employee relations, Office of General Counsel, etc.) with a knowledge of case law involving gross misconduct.
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General Guidelines for Gross Misconduct Determination
Generally, an offense punishable as a felony is considered gross misconduct. Lesser offenses may also be gross misconduct, depending on the circumstances. Other elements that must be considered are:
- There must be a connection between the offense and your job. Also, some individuals, such as judges, are held to a higher standard of conduct than others.
- You must have the ability to understand the gravity of your conduct.
- Your offense must be affirmative and willful, not simply negligent.
An adverse action procedure (5 CFR Part 752) does not result in a specific finding of gross misconduct. There are some offenses for which you can be removed under adverse action procedures that are not considered gross misconduct or are even considered disciplinary in nature (e.g., your refusal to transfer with your function).
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Removal Must Result from Gross Misconduct
In order to be denied Temporary Continuation of Coverage (TCC) eligibility for gross misconduct, your removal (or resignation in lieu of removal) must be a direct result of your gross misconduct. If you resign before your employing office initiates adverse action procedures, your separation is considered voluntary and you are entitled to TCC. If you resign after receiving notice of your employing office's proposal to remove, but before you are removed, your separation is considered to be involuntary and you are not entitled to TCC. If you commit an offense that would be considered gross misconduct, but you are removed on another basis (e.g., unsatisfactory performance), your removal is not due to the gross misconduct and you are entitled to TCC.
Example
Simon was found to have embezzled money from his employing office's imprest fund. His employing office notifies him that it will begin an adverse action procedure to have him removed from service. Simon resigns the next day. He is not entitled to TCC since this is considered an involuntary separation.
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Notification Requirements
When your employing office determines that your offense constitutes gross misconduct, it must notify you in writing that it intends to deny you TCC eligibility. The notice must:
- give the reason for the denial;
- give you at least 7 days to respond;
- be given to you no later than the date of your separation.
This notification may be combined with other notifications required for adverse action procedures or other procedures for actions based on misconduct.
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Response
Your response may be oral or in writing. You are entitled to be represented by an attorney or other representative. Your employing office must designate an official who has the authority to either make or recommend a final decision to hear your oral answer. If you respond to the notice of denial, your employing office must issue a final decision that fully describes its findings and conclusion.
The final decision is not subject to OPM reconsideration. If you want to challenge the decision, you may file suit against your employing office in a district court.
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Coordination with the Office of Workers' Compensation Programs (OWCP)
Your employing office is responsible for providing notification to eligible family members who lose family member status, for accepting their enrollments, and for collecting their premiums.
When you are a covered compensationer and you aren't entitled to continue your FEHB coverage as a compensationer upon your separation from service, your employing office must provide you with notification of your right to elect Temporary Continuation of Coverage (TCC), accept your enrollment, and collect your TCC premiums in the same way as for any other separating employee.
If your enrollment has been transferred to OWCP, your employing office must contact OWCP to determine whether you are enrolled and, if the person seeking continued coverage is a family member, whether the enrollment is for Self and Family. If your child is seeking continued coverage and his/her date of birth is not available, OWCP can supply that information.
If you are a compensationer who is no longer an employee, OWCP is responsible for providing notification to eligible family members who lose family member status, for accepting their enrollments, and for collecting their premiums.
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Coordination with Spouse Equity Provisions
If you are a former spouse of a Federal employee or annuitant and you don't qualify for FEHB coverage under Spouse Equity provisions, you may be eligible for Temporary Continuation of Coverage (TCC).
Coverage under the Spouse Equity provisions is often delayed because the retirement system must determine whether you have a qualifying court order. Coverage does not begin until the pay period after the employing office receives the determination that the court order is qualifying (although you may request retroactive enrollment). You may be eligible for TCC while you are waiting for coverage under the Spouse Equity provisions to begin (but not beyond 36 months after your divorce or annulment).
Your coverage under the Spouse Equity provisions will end if you remarry before you reach age 55. If you remarry during the 36 months following your divorce or annulment, you are eligible for TCC. Your TCC will expire 36 months after the date of your divorce or annulment from the Federal employee.
Example
Nick and Nora's divorce becomes final on June 1, 2012. Nora applies for FEHB coverage under the Spouse Equity provisions and under TCC. She is covered under TCC until her Spouse Equity application is approved. Nora remarries on October 15, 2013, and since she is under age 55, her Spouse Equity coverage ends. She reenrolls under TCC provisions, and her coverage expires on June 1, 2015.
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Health Benefits File
When you become enrolled under Temporary Continuation of Coverage (TCC), your servicing employing office will establish a health benefits file in your name. If you are a former employee, this file must be separate from your personnel records. If you are a former spouse or child, the name of the employee on whose service your TCC coverage is based must be noted on the front cover of your file.
Your servicing employing office must keep the following documents in your health benefits file:
- The Official Personnel Folder (OPF) copy of the Health Benefits Election forms (SF 2809) documenting your enrollment and any changes in enrollment;
- The OPF copy of the Notice of Change in Health Benefits Enrollment (SF 2810) terminating your enrollment; and
- Copies of any correspondence or other documents related to your enrollment (e.g., employing office notice of the premium amount and payment schedule; any notice of overdue premiums; documentation of a child's mental or physical disability before age 26; a cancellation request).
The contents of your file are subject to the provisions of the Privacy Act [5 U.S.C. 552a(b)]. Your health benefits file may be destroyed 2 years after the end of the calendar year in which your TCC eligibility period expires.
If you are a former spouse who elects TCC after you lose coverage under the spouse equity provisions, your servicing employing office must forward your Spouse Equity health benefits file to the employee's (on whose service your TCC coverage is based) retirement system. It must prepare a new health benefits file for your TCC enrollment.
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When You have TCC Coverage and you become Employed by the Federal Government
When you have Temporary Continuation of Coverage (TCC) and you become employed by the Federal Government, your TCC coverage stops when you enroll for regular FEHB coverage. Either you or your new employing office must send a copy of the Health Benefits Election Form (SF 2809) documenting your new enrollment to the employing office that maintains your TCC enrollment, with a cover letter instructing it to stop your TCC enrollment.
If your regular FEHB coverage ends before the expiration of your TCC eligibility, you may resume your previous TCC enrollment. You will likely be eligible for a new TCC enrollment period based on your separation from service. In some cases, it may be more beneficial to continue your previous TCC enrollment. This would happen when your previous TCC enrollment was for 36 months and it extends beyond the 18-month eligibility period after your separation from service.
Example
Janice is covered as a family member under her mother's FEHB enrollment. She turns age 26 on May 15, 2012, and elects TCC coverage. Her eligibility period under TCC ends on May 14, 2015 (36 months). She later becomes employed by the Federal Government and elects to carry regular FEHB coverage, so her TCC coverage is terminated. She leaves Federal service on April 20, 2016, and is eligible to elect TCC as a separated employee. Her eligibility period would end on October 20, 2017 (18 months). She chooses instead to resume her original TCC coverage since this would give her a longer eligibility period.
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