Basic FEHB Eligibility

As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions. This chapter in the FEHB Handbook explains these provisions.

Retirees and Survivor Annuitants

Federal retirees and their surviving spouses retain their eligibility for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement) and must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.

Temporary Continuation of Coverage (TCC)

Temporary Continuation of Coverage is a feature of the FEHB Program that allows certain people to temporarily continue their FEHB coverage after regular coverage ends. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative charge.

FEHB for Family Members

Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, recognized natural (born out of wedlock) children and stepchildren. A child is eligible for coverage under your Self and Family enrollment, if a state-issued birth certificate lists you as a parent of that child.

Children of Same-Sex Domestic Partners

Beginning in January 2014, OPM extended coverage under FEHB and FEDVIP enrollments to children of same-sex domestic partners of Federal employees and annuitants who would marry their partners but lived in states that did not allow same-sex couples to marry (“stepchildren.”) Since the Supreme Court’s decision in Obergefell v. Hodges (June 26, 2015) all states are now required to allow same-sex couples to marry.

As a result, no employees or annuitants live in states where they are not allowed to marry. Children of same-sex domestic partners generally are no longer eligible as family members for FEHB coverage. For more information see BAL 15-207.

Former Spouses

Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.

CHAMPUS, TRICARE and Tricare-for-Life

OPM has issued a final rule to allow TRICARE and CHAMPVA eligible FEHB Program annuitants, survivors, and former spouses to suspend their FEHB enrollments, and then return to the FEHB Program during the Open Season, or return to FEHB coverage immediately if they involuntarily lose this non-FEHB coverage.

Civilian Employees on Active Military Duty

Federal employee reservists who are placed in a leave without pay status when called to active duty for more than 30 days can keep their FEHB coverage for up to 24 months. The reservist is responsible for paying the enrollee share of the premium during the first 12 months, and the agency pays the agency's share.

Full-time Temporary, Seasonal & Intermittent Employees

• Employees on temporary appointments who are expected to work 130 hours per month or more for at least 90 days;
• Employees on seasonal schedules who will be working a schedule of less than six months per year who are expected to work 130 hours per month or more for at least 90 days;
• Intermittent employees who are expected to work 130 hours per month or more for at least 90 days

Are now eligible to enroll in an FEHB plan. These newly eligible employees receive the same government contribution as full-time permanent employees.

FEHB for Employees

As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses employee eligibility and explains the special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions.

Federal retirees and their surviving spouses retain their eligibility for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement); and you must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.

Information for Retirees and Survivor Annuitants

The web version of our print pamphlet Information for Retirees and Survivor Annuitants, RI 79-2, summarizes the principal FEHB requirements and benefits from the retiree's viewpoint.

Frequently Asked Questions

The questions that we are most asked by annuitants and their families.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses the special FEHB considerations for annuitants and compensationers.

Family members eligible for coverage under your Self +1 or Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. Your employing office will look at the child's relationship to you as the enrollee to determine whether the child is a covered family member.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses family members' eligibility for coverage.

Frequently Asked Questions

The questions we are most asked about family coverage.

Family members eligible for coverage under your Self Plus One or Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. Your employing office will look at the child's relationship to you as the enrollee to determine whether the child is a covered family member.

FEHB Handbook Chapter

This chapter in the FEHB Handbook discusses family members' eligibility for coverage.

Frequently Asked Questions

The questions we are most asked about family coverage.

If you are enrolled in the Federal Employee's Health Benefits (FEHB) Program and are called to military duty, you may continue your coverage for up to 24 months or elect to have it terminate. The authority for your agency to pay your premiums is available for employees who meet certain requirements, including serving in support of a contingency operation.

Employees who serve in support of a contingency operation

FEHB law gives your agency authority to continue your coverage and pay your premiums if you are called or ordered to active duty on or after September 14, 2001, and are:

1. enrolled in an FEHB plan;
2. a member of a reserve component of the armed forces;
3. called or ordered to active duty in support of a contingency operation (as defined in section 101(a)(13) of title 10);
4. placed on leave without pay or separated from service to perform active duty; and
5. serving on active duty for a period of more than 30 consecutive days.

Employees who do not serve in support of a contingency operation

If you do not meet all of the above requirements of FEHB law, the authority for continuation of your FEHB coverage comes from the Uniformed Services Employment and Reemployment Rights Act (USERRA), now codified at section 4317 of title 38, United States Code.

Your agency has no authority to pay your premiums while you are on military duty. You are responsible for the enrollee share of the premium during the first 12 months, and your agency will pay its share. For the continued FEHB coverage of up to 12 months, you are responsible for paying both the employee and agency shares of the premium, plus an additional 2% administrative fee.

Note: If you were called to military duty and you elected to continue your FEHB coverage before the USERRA law was amended on December 10, 2004, you can continue your enrollment for 18 months.

The Office of Personnel Management has issued a final rule to allow TRICARE and CHAMPVA eligible FEHB Program annuitants, survivors, and former spouses to suspend their FEHB enrollments, and then return to the FEHB Program during the Open Season, or return to FEHB coverage immediately if they involuntarily lose this non-FEHB coverage. The intent of this rule is to allow eligible beneficiaries to avoid the expense of continuing to pay FEHB Program premiums while they are using the non-FEHB coverage, without endangering their ability to return to the FEHB Program in the future.

The rule also clarifies a similar situation involving FEHB-covered annuitants, survivors, and former spouses. The rule allows an individual who drops FEHB coverage when he or she enrolls in a Medicare-sponsored plan, or in Medicaid or a similar State-sponsored program of medical assistance for the needy, to return to FEHB coverage during the annual Open Season or immediately upon being involuntarily disenrolled from the non-FEHB coverage.

Firefighters Health Insurance

OPM has issued new regulations to extend coverage under the Federal Employees Health Benefits (FEHB) program to temporary firefighters and fire protection personnel working on wildland fires across the country. Coverage became available beginning on July 17, 2012. Please find copies of the regulations and additional material explaining the new regulations below.

• News Release: OPM Announces Rule Change to Allow Federal Firefighters Access to Health Insurance
• Regulation (Interim Final Rule)
• Federal Employees Health Benefits (FEHB) Program Fact Sheet for Firefighters
• For HR Practitioners - Benefits Administrative Letter (BAL) 12-203
• Statement by the President on extending health coverage to Federal Firefighters

Full-time Temporary, Seasonal & Intermittent Employees

More full-time employees are now eligible for FEHB coverage:

• Employees on temporary appointments who are expected to work 130 hours per month or more for at least 90 days;
• Employees on seasonal schedules who will be working a schedule of less than six months per year who are expected to work 130 hours per month or more for at least 90 days;
• Intermittent employees who are expected to work 130 hours per month or more for at least 90 days

Are now eligible to enroll in an FEHB plan. These newly eligible employees receive the same government contribution as full-time permanent employees.

More Information

Federal Employees Health Benefits (FEHB) Program Modification of Eligibility to Certain Employees on Temporary Appointments and Certain Employees on Seasonal and Intermittent Schedules

• Federal Register (5 CFR Part 890)
• Benefits Administration Letter (BAL 14-210)