A Self Only enrollment provides benefits only for the enrolled employee. An eligible employee may enroll for Self Only even though the employee has a family.
A Self and Family enrollment provides benefits for the enrolled employee and eligible family members. It automatically covers all eligible family members even if they are not listed on the PostalEASE FEHB Worksheet and even if the enrolled employee may wish to exclude some of them. An employee’s failure to list an eligible family member does not deprive the member of the right to benefits under a family enrollment.
Notes:
- Eligible employees may enroll for Self and Family even though it appears they have no family members.
- The listing on the FEHB Worksheet of a person who is not a family member does not entitle that person to benefits.
- On the FEHB Worksheet, if an employee lists a person who is not an eligible family member, the Human Resources Shared Service Center explains to the employee that the person is not eligible for coverage. The ineligible person’s name is deleted from the FEHB Worksheet.
No person may be covered by two enrollments. Thus, if both husband and wife are federal or Postal Service employees and are eligible to enroll, one or the other may enroll for Self and Family, or each may enroll for Self Only in the same or different plans.
The law prohibits an individual from being enrolled under his or her own name while covered as a family member of another person enrolled as an employee or as a retiree under the Federal Employees Health Benefits Program.
If there is a dual enrollment, arrangements are made to terminate one of the enrollments as soon as possible. If the employees involved cannot agree on which enrollment will continue, the Human Resources Shared Service Center (HRSSC) makes the decision in accordance with the following principles:
- Coverage of any children who are eligible family members is protected.
- A family enrollment takes precedence over a Self Only enrollment.
If the person whose enrollment must be terminated in order to avoid or eliminate dual coverage refuses to cancel, the HRSSC cancels the enrollment, identifying the action on the PostalEASE FEHB Worksheet as an agency action, and explains the reason for the cancellation.
When an enrollment is voided or cancelled in order to eliminate illegal dual coverage, the health benefits premiums deducted from the employee’s pay during the illegal enrollment are refunded.
Dual enrollment must be authorized by the HRSSC and will only be allowed when the employee or an eligible family member would otherwise lose coverage. Some examples of allowable dual enrollment include when:
- The employee and the employee’s spouse legally separate and their children would lose full health benefits coverage. See the following examples:
- The employee moves outside of the HMO’s service area and the employee’s spouse refuses to change health plans;
- The spouse refuses to pass along reimbursements for health benefits claims filed;
- The employee divorces;
- The employee is under age 26, is covered by a parent’s FEHB enrollment, and has a family of his or her own (spouse/children) and chose to cover them;
- The employee is under age 26, is covered by his/her parent’s enrollment, and lives outside the coverage area of his/her parent’s HMO plan;
- The employee and his/her spouse each have Self Only enrollments and one of them changes to a family enrollment and the other cancels an enrollment. A brief overlap of coverage is allowed to avoid a gap in coverage.
No employee or family member may receive benefits under more than one FEHB enrollment. The employee must inform the carriers involved of which family members will be covered and receive benefits under which enrollment. If an employee and family member will receive benefits under more than one plan, it is considered fraud and the employee is subject to disciplinary action.
The enrollment of a person who is excluded from participation in the health benefits program because of the nature of employment, but who was permitted to enroll through error, is terminated or voided (as appropriate) by the HRSSC as soon as the error is discovered. The HRSSC makes sure that all employees, whose erroneous enrollments are so terminated or voided, understand what action has been taken regarding their enrollments, the reasons for, and effect of, such action, as the following:
- Terminated Enrollments. Enrollments are terminated if withholdings and contributions were made during the period of erroneous enrollment. Termination is effective at the end of the pay period in which the action to terminate is taken. No adjustments are made for contributions and withholdings that have already been made and the employee, and covered family members are entitled to the full benefits of the plan during the time the employee was erroneously enrolled. The employee is entitled to convert to a nongroup contract, the same as any other employee whose enrollment is terminated.
- Voided Enrollments. If no withholding or contributions were made before the erroneous enrollment was discovered, the enrollment is voided. The employee is responsible for any benefits provided, and the carrier is responsible for recoupment of any claims expense incurred during this period.
An employee is given the opportunity to enroll or to make changes in enrollment only as specified herein. The determination of an employee’s eligibility to enroll or change enrollment under the FEHB Program is made by the Human Resources Shared Service Center (HRSSC). Therefore, employees are required to provide the HRSSC with sufficient evidence to justify a request to enroll or change enrollment under the Program.
The complete list of Qualifying Life Events can be found in each Guide to Benefits for U.S. Postal Service Employees in the Table of Permissible Changes in FEHB Enrollment and Pre-Tax/After-Tax Premium Payment at https://liteblue.usps.gov/humanresources/benefits/insurance/benefits_insurance_fehb.shtml.
A new employee eligible for coverage may enroll within 60 days after date of appointment in any available plan, option, and type of enrollment.
Employees who have been employed under conditions excluding them from coverage but whose employment later changes so that they are no longer excluded, may enroll in a plan of their choice within 60 days after the change.
During FEHB Open Season, eligible employees who are not enrolled may be enrolled, and enrolled employees may change enrollment from one plan or option to another, or from Self Only to Self and Family, or both.
An eligible employee who is reemployed after a break in service of more than 3 days may enroll or not to enroll within 60 days after date of new appointment as though a new employee.
An employee whose enrollment is terminated because the employee has been in a nonpay status for 365 days may enroll within 60 days after return to pay status. The employee may enroll in any plan, option, and type of enrollment as though a new employee. An eligible employee who was not enrolled when nonpay status began is not permitted to enroll upon return to pay status. However, if an event occurred that would have permitted enrollment while in nonpay status (e.g., marriage or FEHB Open Season), the employee’s enrollment is accepted as a late enrollment due to cause beyond the employee’s control (see 523.3).
The following provisions apply:
- A nonenrolled employee who entered the military for service not limited to 30 days or less may enroll in either option of any plan available within 60 days after return to civilian duty.
- An enrolled employee whose enrollment ended on entry into military service has the same enrollment reinstated, effective the day of restoration to duty in a civilian position, in the exercise of reemployment rights.
- The restored employee whose enrollment is reinstated may change enrollment from Self Only to Self and Family or the reverse, or from one option or plan to another, or a combination of these changes, within 60 days after restoration to duty in a civilian position.
An employee who loses coverage under any federally–sponsored health benefits program or under the Retired Federal Employees Health Benefits Program may enroll under the FEHB within 60 days after termination of coverage for any reason.
An employee may change enrollment from one option to another of any available plan at any time beginning on the 30th day before the employee becomes eligible for Medicare.
The option to change from Self and Family to Self Only at any time during the year is available only to those employees whose health premiums are being paid on an after-tax basis. For those employees with health benefit premiums being paid on a pre-tax basis, a change to Self Only may only be processed during FEHB Open Season or following a qualifying life event. Requests due to qualifying life events must be received by the Human Resources Shared Service Center (HRSSC) from the employee within 60 days of the qualifying event. See 524.52 for more information on qualifying life events. For more information on effective dates, see 524.6.
The following provisions apply for a new spouse:
- Options. As a result of a change in marital status, an employee may enroll or, if already enrolled, may change the enrollment from Self Only to Self and Family, or from one plan or option to another, or both, during the period beginning 31 days before a change in marital status and ending 60 days after the change. If an enrollment or change of enrollment becomes effective before the anticipated date of change in marital status and the change in marital status does not occur, the action taken is voided.
- Coverage for New Spouse. An employee may provide immediate coverage for the new spouse by filing a PostalEASE FEHB Worksheet during the pay period before the anticipated date of the marriage. If the effective date of the change is before the marriage, the new spouse is not eligible for coverage until the actual day of the marriage.
The following provisions apply for a divorce or separation:
- If an employee is legally separated, the spouse is still considered a family member and eligible for coverage under the employee’s Self and Family enrollment.
- To continue to provide health benefits coverage for their children, employees must continue their Self and Family enrollments.
- Once a final divorce decree is issued, an employee’s spouse is no longer an eligible family member and is not covered under the employee’s enrollment.
The following provisions apply:
- Criteria. Generally, a change in family status is an event that adds or decreases the number of family members. However, a change in family status is not limited to these two events. The following events are considered a change in family status for health benefits purposes:
- Marriage, including a valid common law marriage (in accordance with applicable state law).
- Birth of a child (but not a stillborn child).
- Legal adoption by the enrollee of a child under age 26 or the acquisition of a foster child under age 26.
- Submission of a Declaration of Domestic Partnership to the HRSSC or retirement system.
- Entry into, or discharge from, military service of a spouse or of a child under age 26.
- Issuance or termination of a court order granting to the enrollee or spouse final divorce, interlocutory divorce, limited divorce, legal separation, or separate maintenance.
- Issuance of a court decree of annulment, or in the case of a marriage void from its beginning (ab initio), also a declaratory judgment, or conviction of the spouse of bigamy.
- Issuance of a court order specifically requiring an employee to enroll for his or her children or to provide health benefits protections for them.
- The death of an employee’s spouse, including a declaration by a court that the employee’s missing spouse is presumed dead.
- Options. An enrolled employee who has a change in family status, including a change in marital status, may enroll, change enrollment from Self Only to Self and Family, or from one plan or option to another, or both, during the period beginning 31 days before a change in family status and ending 60 days after the change. If husband and wife are each enrolled for Self Only and wish to have a Self and Family enrollment because of a change in family status, one may change to a Self and Family enrollment if the other cancels the Self Only enrollment.
The following provisions apply:
- General Rule. When both wife and husband are covered under the FEHB in Self Only enrollment and a change in enrollment status results in one of them losing eligibility for health benefits, the eligible employee may change enrollment from Self Only to Self and Family, or from one plan or option to another, or both, during the period beginning 31 days and ending 60 days after the date of loss of coverage.
- Spouse Involuntarily Separated. An employee who loses coverage under a spouse’s nonfederal enrollment for any reason may enroll under the FEHB or change an enrollment from Self Only to Self and Family, or from one plan or option to another, or both, during the period beginning 31 days before and ending 60 days after the date of loss of coverage.
- Spouse Ends Job to Accompany Reassigned Employee. An employee whose reassignment is directed out of the commuting area and who loses coverage under a spouse’s nonfederal enrollment because the spouse terminates employment to accompany the employee may enroll under the FEHB or change an enrollment from Self Only to Self and Family, or from one plan or option to another, or both, during the period beginning 31 days before the date the employment terminates in the old commuting area and ending 180 days after entry on duty at the place of employment in the new commuting area.
The following provisions apply:
- Change to Self Only or Voluntary Cancellation. An employee enrolled for Self and Family may change enrollment to Self Only or cancel coverage as outlined in 524.529 and 524.71. This action may cause an employee listed as a family member of another employee to lose coverage. If this occurs, the losing employee may enroll for Self Only or Self and Family in either option of any plan, during the period beginning 31 days before and ending 60 days after the change to Self Only or cancellation has been filed.
- Other Than Change to Self Only or Cancellation. If an employee loses coverage as a family member for any reason other than cancellation or change in the covering enrollment to Self Only, the employee may enroll for Self Only, or for Self and Family, in either option of any plan available beginning 31 days before and ending 60 days after termination of the covering enrollment. This may occur when (1) enrolled spouse or parents enter military service or separate from federal or Postal Service rolls, or (2) employee covered by parent’s enrollment reaches age 26.
- Death. If the covering enrollment terminates because of the death of the enrolled spouse or parent, the surviving employee has 60 days in which to enroll. If the employee also becomes a survivor annuitant, the enrollment may continue as that of a survivor annuitant, or the employee may enroll in any plan for which eligible as an employee whose marital status has changed. If the employee elects to enroll as an employee and later is separated, or the employee status otherwise changes so that enrollment must be terminated, the employee may continue the enrollment as a survivor annuitant. In this event, the Human Resources Shared Service Center terminates the enrollment on SF 2810 and advises the survivor annuitant to apply to the Office of Personnel Management for continuation of enrollment as an annuitant.
An employee who loses coverage under a parent’s nonfederal health plan may enroll under the FEHB Program within 31 days before and ending 60 days after losing coverage under the parent’s nonfederal plan for any reason.
An employee whose children lose coverage under the other parent’s nonfederal health plan may enroll or change enrollment from Self Only to Self and Family, or from one plan or option to another, or both during the period beginning 31 days before and ending 60 days after the children’s loss of coverage.
If a change in the employee’s family does not affect enrollment, it is not necessary to report such change to the Human Resources Shared Service Center (HRSSC) for health benefits purposes. However, the employee’s plan may request this information including evidence of family relationship. Examples of changes that will not affect enrollment are:
- Birth of a child when the parent already has a family enrollment.
- Death of the employee’s spouse when there are surviving children and the employee has a family enrollment.
- Attainment of age 26 of a child of an employee when there are other children or a spouse still covered under the family enrollment.
If an employee’s name changes for any reason, the HRSSC reports the change to the health benefits plan.
An employee legally changes names or an employee enrolled for Self Only marries but retains a Self Only enrollment. If no other changes are involved, the HRSSC reports the name change on SF 2810.
If an employee with a Self Only enrollment reports a name change due to marriage, the HRSSC reminds the employee of the opportunity to change his or her enrollment. If the employee decides to change the enrollment, no SF 2810 is required, but a PostalEASE Worksheet is submitted in accordance with 524.531b.
A new enrollment during FEHB Open Season becomes effective the first day of the first pay period that begins in the following year and that follows a pay period during any part of which the employee is in a pay status.
A change of enrollment during FEHB Open Season becomes effective the first day of the first pay period that begins after January 1 of the following year.
If a request is submitted to change from Self and Family enrollment to Self Only, and the request meets the requirements as identified in 524.51, the effective date is determined as follows:
- If health premiums are paid on an after-tax basis, a change to Self Only may be made at any time. The effective date of the change is the first day of the pay period that begins after the completed PostalEASE FEHB Worksheet is received in the Human Resources Shared Service Center (HRSSC). However, a retroactive change may be approved to the first day of the pay period following the one in which there were no family members eligible for coverage if the employee is able to satisfy the agency of that fact.
- If health premiums are paid on a pre-tax basis, the employee must provide the HRSSC with documentation showing that he or she had a qualifying life event occur within the past 60 days. The effective date of the change is the first day of the pay period that begins after the completed FEHB Worksheet is received at the HRSSC.
The effective date of a change in enrollment made in conjunction with the birth of a child, or the addition of a child as a new family member in some other manner, is the first day of the pay period in which the child is born or becomes an eligible family member. There is no requirement that the enrollee return to pay status before the enrollment change can become effective.
All other enrollments or changes in enrollment become effective the first day of the first pay period that begins after the PostalEASE FEHB Worksheet is received by the HRSSC and that follows a pay period during any part of which the employee is in pay status.
The option to cancel enrollment at any time during the year is available only to those employees whose health benefit premiums are paid on an after-tax basis. For those employees with health premiums paid on a pre-tax basis, a cancellation of coverage may only be processed during FEHB Open Season or following a qualifying life event as identified in 524.529. Requests due to qualifying life events must be received by the Human Resources Shared Service Center (HRSSC) within 60 days of the qualifying life event. The PostalEASE FEHB Worksheet used to cancel enrollment due to a qualifying life event becomes effective the last day of the pay period in which the FEHB Worksheet is received. For information on effective dates, see 524.6.
An employee whose enrollment is terminated because of the discontinuance of the plan or option because of new limitations on the service area of, or the geographic area served by, a comprehensive plan may change to either option of any other plan for which eligible and from Self Only to Self and Family. If a plan, or part of it, is terminated, OPM gives special instructions to enrollees regarding their rights and the procedures to be followed.
The health benefits enrollment of an employee who completes 365 days LWOP (26 pay periods) is terminated by the Eagan ASC. The Eagan ASC issues an SF 2810, terminating the coverage, retains Eagan ASC and carrier copies, and forwards employee and agency copies to the HRSSC. If it is determined a termination was improper, the HRSSC must promptly take corrective action.
If an employee who is enrolled in an employee organization plan ceased to be a member of the organization, the plan may instruct the HRSSC to terminate the enrollment, subject to a 31-day temporary extension of coverage. Action to terminate the enrollment for this reason can be initiated only by the plan, not by the employee. The plan sends a copy of its notice to the employee:
- On the basis of either the original or the copy of the notice, the HRSSC terminated the enrollment on SF 2810 with a note in Remarks similar to the following:
- The date in Item 8A is the last day of the pay period in which the plan’s notice of termination is received by the HRSSC.
An employee whose enrollment is so terminated may enroll for Self Only or Self and Family in either option of any available plan during the period beginning 31 days before and ending 60 days after the effective date of termination.
An employee who enrolls within this 90–day period for purposes of continuing enrollment after retirement is considered as having been continuously enrolled.
An employee’s enrollment terminates, subject to a 31–day temporary extension of coverage for conversion to a nongroup contract, on the earliest of the following dates:
- The last day of the pay period in which the employee is separated, other than for transfer or retirement, or because of a compensable disability under conditions entitling the employee to continue the enrollment.
- The last day of the pay period in which employment status changes so as to exclude the employee from coverage.
- The last day of the pay period in which the employee dies unless survived by a member of the family entitled to continue enrollment as a survivor annuitant.
- The last day of the pay period that includes day 365 of continuous nonpay status or, if the employee is not entitled to any further continuation because of having less than 4 consecutive months of pay status since exhausting the 365 days continuation of coverage in nonpay status, the last day of the employee’s last pay period in pay status.
- The day the employee is separated or placed on a leave of absence to enter military service for a period not limited to 30 days or less.
The coverage of a member of the family of an employee terminates on the earlier of the following dates:
- The date on which the enrollment covering the family member is cancelled, changed to Self Only, or terminates (unless the employee dies and there is a survivor annuitant eligible to continue the enrollment).
- The date on which the family member is no longer considered to be a member of the family for purposes of health benefit coverage.
Example: Coverage of an employee’s child terminates on the day the child reaches age 26.
Coverage for an enrolled employee continues temporarily without cost for 31 days after the enrollment terminates for any reason except voluntary cancellation.
Coverage for any family member who loses coverage other than by the employee’s voluntary cancellation, or by the employee’s enrollment change from Self and Family to Self Only, continues for 31 days. (A change to Self Only is considered a cancellation for the family members who were covered under the enrollment, and they are not entitled to temporary extension of coverage for conversion.)
An employee or family member who has been granted a 31–day extension of coverage and who is confined to a hospital or other institution for care or treatment on day 31 of the temporary extension of coverage, is entitled to continuation of benefits of the plan during continuance of the confinement up to a maximum of 60 days after the end of the temporary extension.
If an employee’s enrollment ends for any reason other than voluntary cancellation, or if the coverage of a family member ends for any reason other than the employee’s cancellation or change to a Self Only enrollment, the person whose enrollment or coverage is ended has a right to convert, without evidence of insurability, to a nongroup health benefits contract offered by the health benefits plan. A family member who loses coverage because of the employee’s cancellation or change to Self Only enrollment does not have a conversion right.
If an employee’s coverage is terminated, the Human Resources Shared Service Center (HRSSC) issues SF 2810 as promptly as possible, but no later than 60 days after the date the enrollment terminates due to the limited time allotted for conversion. The HRSSC is not expected to monitor conversion rights of family members. It is the responsibility of an employee (or the person who loses status as a family member) to apply in a timely manner for a conversion contract. However, from time to time, the HRSSC should publish reminders of a family member’s right to convert. These reminders can be in the form of bulletins, letters, memos, etc.
Application for conversion (by letter in the case of family members or on the back of the enrollee’s copy of SF 2810 in the case of employees) is made directly to the nearest office of the plan. The application must be submitted within 31 days of the termination of enrollment. If the notice to the employee on SF 2810 is delayed, the employee has 31 days from the date of the notice, but no later than 91 days from the termination date, to apply for conversion.
If notice is not given within 60 days of termination or the request for conversion cannot be made for reasons beyond the employee’s control, the employee can request a late conversion by writing directly to the carrier of the plan. This request must be made within 6 months of the enrollment termination date and must include:
- Documentation that the enrollment has terminated (for example, an SF 50 showing separation from service).
- Proof that the employee was not notified of the enrollment termination and the right to convert (for example, a letter from the HRSSC confirming that it did not provide timely notice of the conversion option), and that he or she was not otherwise aware of it.
- Proof that the employee was not able to convert because of reasons beyond his or her control.
A converted contract becomes effective at the end of the 31–day period of temporary extension of coverage even though the employee or a family member may be confined in a hospital on day 31 and, therefore, entitled to a further extension of coverage.
Many plans do not provide the same benefits under the converted nongroup contract as are provided under federal employee group plans. The premium rates are relatively higher, and there is no Postal Service or government contribution to the cost of the nongroup conversion contract. An employee interested in converting is advised to contact the local office of the plan for information about the benefits and cost of its conversion contract.
If, on termination of enrollment, an employee obtains a conversion contract and the enrollment later is reinstated retroactive to the effective date of the termination, the employee may obtain a refund of all premiums paid on the conversion contract.
Example: The case of an employee who is removed and later is ordered to duty with full restitution of back pay, or an employee whose application for disability retirement is retroactively allowed. The employee applies in writing to the plan for the refund.
If the employee receives benefits during the time the conversion contract is in effect, the employee is entitled to an adjustment of the difference between the benefits paid by the carrier under the conversion contract and benefits payable under the enrollment in this program.
Postal Service contribution for health benefits is adjusted, as required, on the first day of the first pay period of each calendar year and on dates set by the National Agreement or management decision.
The employee’s share of the cost for health benefits is the difference between the Postal Service contribution and the total health benefits premium for the plan, option, and type of enrollment selected by the employee. Employees’ shares are withheld from their pay each pay period. If the amount of salary for a pay period is not enough to cover the full withholding, no withholding (or Postal Service contribution) is made for that particular pay period. Employees who do not have health benefit premiums withheld as a result of insufficient pay or partial LWOP, however, will have their past–due premiums withheld from their next available pay. Deductions for retirement, FICA, and federal income tax have priority over health benefits withholdings.
The Postal Service has established the pre-tax payment of health insurance premium contributions as a tax-saving benefit feature for its employees. FEHB premiums paid on a pre-tax basis are not included in an employee’s gross income. This practice reduces the taxable income figure reported and reduces income taxes. However, employees may also receive slightly lower Social Security benefits, upon eligibility, because paying FEHB premiums pre-tax reduces the earning reported to the Social Security Administration.
Career employees have their portion of health benefit premiums automatically paid on a pre-tax basis unless a waiver is submitted by the employee. PS Form 8201, Pre-Tax Health Insurance Premium Waiver/Restoration Form for Career Employees, is accepted during an employee’s first opportunity to enroll in health benefits, during the annual FEHB Open Season period, or upon the occurrence of a qualifying life event (see 524.529). Once a waiver is processed and deductions are being made on an after-tax basis, a return to a pre-tax basis requires the completion of a second PS Form 8201 to cancel the waiver and restore the pre-tax status. Requests to cancel pre-tax waivers are accepted during FEHB Open Season periods or upon the occurrence of a qualifying life event (see 524.529).
Generally, noncareer employee health benefit premiums are withheld on an after-tax basis. However, noncareer employees in the Rural Carrier craft, NALC City Carrier Assistant employees, Postal Support Employees covered by the APWU contract, and other employees as specified in collective bargaining agreements may elect to have premiums paid on a pre-tax basis by completing PS Form 8202, Application to Elect or Waive Pretax FEHB Premiums (for Noncareer Employees), at their first opportunity to enroll in health benefits, during the annual FEHB Open Season periods, or upon the occurrence of a qualifying life event (see ELM 524.529).
Complete information on pre-tax and after-tax premiums is available from the Human Resources Shared Service Center (HRSSC).
Publication 12, Health Benefits Open Season Administrative and Processing Information, is published annually during FEHB Open Season and is available for employee review on the Human Resources Web site at blue.usps.gov/cpim/ftp/pubs/pub12.pdf. The publication provides plan change information for all participating health plans under the FEHB.
For detailed information concerning Spouse Equity and Temporary Continuation of Coverage (TCC) enrollment for former spouses, go to http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/former-spouses/#eligibility.
A former spouse eligible to enroll in the FEHB Program may elect coverage for Self Only or for Self and Family. A family enrollment covers the former spouse only and any child of the former spouse and the employee provided the child is not also covered by another FEHB enrollment. A child must be under age 26 or incapable of self-support because of a mental or physical disability that existed before age 26 (see 526).
The effective date of a new enrollment for a former spouse is the first day of the pay period after the Human Resources Shared Service Center received the properly completed SF 2809 and OPM’s approval of eligibility or at a future date (at the beginning of a pay period) requested by the former spouse.
If the former spouse requests immediate coverage and both the SF 2809 and proof of eligibility are received within 60 days of the date of divorce, the enrollment may be made effective the same day that Temporary Continuation of Coverage (TCC) would otherwise take effect.
The effective date of a change in enrollment is the first day of the pay period after the date the NFC receives the properly completed SF 2809.
The former spouse is responsible for the total health benefits premium (employee and employer share) for every pay period during which the enrollment continues.
The former spouse is billed in accordance with a schedule established by the NFC.
If payment is not received by the due date established by the NFC, the former spouse is notified by certified mail, return receipt requested, that continuation of coverage rests upon payment being made within 15 days after receipt of the notice. The enrollment of a former spouse who fails to remit payment within the specified time frame is terminated. (See 524.963 for effective date of termination.)
A former spouse may change an enrollment to Self Only at any time. Family members who lose coverage as a result of this change in enrollment are entitled to the temporary extension of coverage for conversion.
During FEHB Open Season, the former spouse may change to another plan, another option, or from Self Only to Self and Family, or may make any combination of these changes. (See 524.91 for eligible family members under a Self and Family enrollment.)
The former spouse may make an enrollment change upon the occurrence of any one of the following events:
- Birth or acquisition of a child. (An enrolled former spouse may change enrollment from Self Only to Self and Family, or from one plan or option to another, or both, within the period beginning 31 days before and ending 60 days after the birth or acquisition of a child who is a qualified family member under 524.91.)
- Move from an area served by a comprehensive medical plan.
- Termination by an employee organization plan.
- Termination of plan in which enrolled.
- Becoming eligible for Medicare.
- End of child’s coverage. A former spouse may change enrollment from Self Only to Self and Family within the period beginning 31 days before and ending 60 days after an eligible child loses coverage under another FEHB enrollment. (See 524.91 for definition of eligible child.)
A former spouse may cancel enrollment at any time by filing a properly completed SF 2809 with the NFC. If a former spouse cancels enrollment, the cancellation becomes effective the last day of the pay period that the health benefits form canceling the enrollment is received by the NFC. The former spouse and family members, if any, are not entitled to the temporary extension of coverage or the right to convert to an individual contract. A former spouse who cancels an enrollment may not later re-enroll unless Spouse Equity enrollment is suspended to enroll in a Medicare managed care plan or Medicaid (or a similar State-sponsored program of medical assistance for the needy).
If a former spouse submits documentation that the cancellation is for the purpose of enrolling in a Medicare managed care plan or Medicaid, the suspension becomes effective the day before the enrollment under the Medicare managed care plan takes effect. Documentation must be submitted to the Human Resources Shared Service Center during the period beginning 31 days before and ending 31 days after the enrollment takes effect.
A former spouse who cancels his or her Spouse Equity enrollment for this purpose may re-enroll, if still qualified for a Spouse Equity enrollment, in any available plan at any time during the period beginning 31 days before and ending 60 days after involuntary disenrollment from the Medicare managed care plan. A former spouse who voluntarily disenrolls from the Medicare managed care plan or Medicaid may re-enroll under the Spouse Equity provisions during the following Open Season.
A former spouse’s enrollment terminates, subject to the temporary extension of coverage for conversion, at midnight of the last day of the pay period in which the earliest of the following events occurs:
- Qualifying court order ceases to provide entitlement to former spouse survivor annuity or portion of retirement annuity under a retirement system for federal or Postal Service employees.
- Former spouse remarries before age 55.
- Former spouse dies.
- Employee on whose service benefits are based dies and no survivor annuity is payable.
- Separated employee on whose service the benefits are based dies before the requirements for deferred annuity have been met.
- Employee on whose service benefits are based leaves federal or postal service before establishing title to an immediate annuity or a deferred annuity.
- Refund of retirement money is paid to the separated employee on whose service the health benefits are based.
OPM may authorize a longer time frame for the temporary extension of coverage for conversion than the 31 days provided if in OPM’s judgment the former spouse could not have known either of the following:
- The employee on whose service benefits are based left the federal or postal service before establishing title to an immediate or deferred annuity.
- The separated employee on whose service the benefits are based died before the requirements for deferred annuity were met. In such cases, the right of conversion may be exercised up to 31 days after the HRSSC’s notice of termination (SF 2810). During that time, the former spouse may convert to individual coverage. The former spouse must pay the full premium (employee and employer share) during the extended period exclusive of the 31-day period following the notice.
Failure to pay premiums by a former spouse will result in termination of enrollment. The effective date of a termination due to failure to pay premiums is retroactive to the end of the last pay period for which payment has been timely received. A former spouse whose enrollment is terminated due to failure to pay premiums may not reenroll and will not be entitled to the temporary extension of coverage for conversion.
The coverage of a family member of a former spouse terminates, subject to the temporary extension of coverage for conversion, at midnight of the earlier of the following dates:
- The day on which the individual ceases to be an eligible family member.
- The day the former spouse ceases to be enrolled unless the family member is entitled as a survivor annuitant to continued coverage under the enrollment of another.
The former spouse is responsible for notifying the NFC, which maintains health benefits enrollment, of any event that will terminate eligibility for coverage. (See 523.62.)
The NFC acts as follows:
- As soon as the former spouse submits proper notification indicating an event that will require termination, the NFC prepares an SF 2810 terminating the enrollment and provides appropriate copies of the SF 2810 to the former spouse. This enables the former spouse to convert to individual coverage within the 31–day time limit.
- In cases where OPM is establishing a survivor benefit for the former spouse, the NFC prepares a “transfer out” to OPM of the health benefits enrollment. The effective date of the transfer is the day prior to the commencement date of the annuity.
