TEMPORARY

CONTINUATION

OF COVERAGE

(TCC)

under the

FEDERAL

EMPLOYEES

HEALTH BENEFITS

PROGRAM

United States Office of

Personnel Management

FEHB Federal Employees

Health Benefits

Retirement and Insurance

Service

RI 79-27

Revised December 2000

Previous edition is not usable

This pamphlet describes the

conditions you must meet to be

eligible for temporary continuation

of coverage (TCC) under the Federal

Employees Health Benefits Program

when your regular coverage ends.

It also explains how to enroll for

TCC, how much it costs, and how

long it can continue.
Additional retirement and insurance information

is available on the Internet.

OPM Website — http://www.opm.gov

Retirement information:

http://www.opm.gov/retire

Insurance information:

http://www.opm.gov/insure
Table of Contents

What is TCC (temporary

continuation of coverage)? ........1

How much does TCC cost?..........1

Who is eligible for TCC? ...........1

What is a qualifying event? ..........1

Who is covered under a

TCC family enrollment? .........2

How long can coverage continue under

TCC (temporary continuation

of coverage)?...............3

How to obtain TCC if you are a

separating employee ...........3

How to obtain TCC for children

who lose FEHB coverage .........4

How to obtain TCC for

former spouses..............5

What are the spouse equity provisions?....6

Enrollment options under TCC

(temporary continuation of coverage) . . 8

Effective date of coverage ..........8

Premium payments..............9

Opportunities to change enrollment .....9

Changing from a spouse equity

enrollment to a TCC enrollment . . . . 10

Termination of enrollment or

coverage . . . . . . . . . . . . . . . . 11

Thirty-one-day temporary extension

of coverage and conversion to an

individual contract . . . . . . . . . . . 12

Additional Information . . . . . . . . . . . 13

Notes . . . . . . . . . . . . . . . . . . . . 14

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What is TCC (temporary

continuation of coverage)?

TCC is a feature of the Federal Employees

Health Benefits (FEHB) Program that allows

certain people to temporarily continue their

FEHB coverage after regular coverage ends.

Important: You must exhaust TCC eligibility as

one condition for guaranteed access to individual health coverage under the Health Insurance

Portability and Accountability Act of 1996.

How much does TCC cost?

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.

Who is eligible for TCC?

Federal employees and family members who

lose their FEHB coverage because of a qualifying

event may be eligible for TCC.

What is a qualifying event?

For employees, the only qualifying event is

separation from Federal service. However, you

are not entitled to TCC if you are involuntarily

separated due to gross misconduct.

Your human resources office decides whether

conduct that leads to an involuntary separation

is “gross misconduct.” If your human resources

office decides that you were separated because

of gross misconduct, it must notify you of that

fact and explain what you can do to appeal the

decision.

For children, the qualifying events are:

 marriage,

 reaching age 22,

 loss of status as stepchild, foster child, or

recognized natural child,

1
 in the case of children whose coverage

has continued beyond age 22 because of

their inability to support themselves due

to a disability occurring before they reached

age 22, recovering from the disability or

becoming self-supporting,

 death of the employee or annuitant if the

child does not qualify for a survivor annuity,

and

 survivor annuity stops for any reason,

including because he or she is no longer a

full-time student.

Spouses are not eligible for TCC (temporary continuation of coverage) in their own right, even if

you separate and decide not to elect TCC or you

die. However, if your marriage ends other than

by death, your former spouse is eligible for

TCC. The qualifying events are:

 divorce, and

 annulment of the marriage.

Who is covered under a TCC family

enrollment?

For a former employee, a TCC family enrollment

covers the same family members as were

covered under the regular family enrollment.

Family members must continue to meet the

same eligibility requirements as under a regular

family enrollment. A new family member, such

as a new spouse or a newborn child, who is

added during the TCC enrollment period is also

covered as a family member.

For a child with a TCC family enrollment, his or

her spouse and children are covered family

members.

2
For former spouses, family members are limited

to children of both the Federal employee and

the former spouse. The new husband or wife of

a remarried former spouse is not covered as a

family member.

How long can coverage continue

under TCC (temporary continuation

of coverage)?

Separating employees can continue TCC for up

to 18 months after the date of separation.

Children and former spouses can continue

TCC for up to 36 months after:

 the date of the qualifying event when the

child or former spouse is covered as a family

member of an employee or annuitant under a

regular FEHB enrollment, or

 the date of the employee's separation if the

qualifying event occurs when the child or

former spouse is covered under the TCC

enrollment of a former employee.

If your child's or former spouse's qualifying

event occurs while you are enrolled for family

coverage under TCC, the child or former spouse

may elect TCC in his or her own right; however,

the TCC coverage may not continue beyond 36

months after the date of your separation.

How to obtain TCC if you are a

separating employee

If you lose your FEHB coverage because you

leave your Federal job, you are eligible for TCC

unless your separation is involuntary due to gross

misconduct. Otherwise, the reasons for your

separation don't matter.

3
Your human resources office must notify you

within 61 days after your regular FEHB enrollment terminates of your opportunity to enroll

under TCC (temporary continuation of coverage). Generally, you have 60 days after getting

the notice or 60 days after separation, whichever

is later, to enroll under TCC.

It's a good idea to ask your agency to give you

your TCC information on the day you separate.

TCC enrollments — and premiums — always

begin on the 32nd day after your regular

coverage ends (which happens on the last day

of the pay period in which you separate). The

earlier you submit your enrollment form, the

earlier your agency can process it, and the less

likely it will be for you to receive a large bill for

retroactive TCC coverage.

However, if you retire and you are eligible to

continue your regular FEHB coverage as a

retiree, you aren't eligible for TCC because your

regular FEHB coverage doesn't stop. If you are

retiring and you aren’t sure whether you are

eligible to continue regular FEHB coverage as

a retiree, ask your employing office.

How to obtain TCC for children who

lose FEHB coverage

If your child wants TCC, you must notify your

employing office within 60 days after the

qualifying event and supply the child's mailing

address. (Since the enrollment will be in the

child’s name, the child must complete the

election form and the child will be billed for

the coverage.)

Within 14 days after it receives the information

about the child, the employing office must notify

the child of his or her TCC rights. The child

must make his or her election within 60 days

after the later of:

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 the date of the qualifying event, or

 the date the child receives the notice about

TCC (temporary continuation of coverage)

rights from your employing office, if you notified the employing office within 60 days after

the qualifying event.

If you don't notify your employing office within

the 60-day time limit, the opportunity to elect

TCC ends 60 days after the qualifying event.

If someone other than you (the employee)

notifies the employing office about your child's

eligibility, your employing office will notify your

child of his or her TCC rights, but your child's

60-day time limit to elect TCC begins with the

qualifying event, not the date of the employing

office's notice of TCC rights.

How to obtain TCC for former

spouses

If your former spouse doesn't meet all the

requirements for enrollment under the spouse

equity provisions of law (see page 6), he or she

may be eligible for TCC. To be eligible for TCC,

your former spouse must have been covered

under your FEHB family enrollment at some

time during the 18 months before your marriage

ended. (The term “former spouse” does not

include widows or widowers.)

If your former spouse wants TCC, you and

your former spouse share the responsibility

for notifying your employing office within 60

days after the qualifying event (divorce or

annulment) and supplying the former spouse's

mailing address. Within 14 days after your

employing office receives the notice from you or

your former spouse, it must notify your former

spouse of his or her TCC rights. Your former

spouse must elect TCC within 60 days after the

later of:

5
 the date of the divorce or annulment; or

 the date he or she receives the notice of TCC

(temporary continuation of coverage) rights

from your employing office, if you or the former spouse notified the agency within the

60-day time limit given above.

If you or your former spouse do not notify your

employing office within the 60-day time limit,

the opportunity to elect TCC ends 60 days after

the divorce or annulment.

If someone other than you or your former

spouse notifies your employing office about

your former spouse's eligibility, the employing

office will notify your former spouse of his or

her TCC rights, but your former spouse must

elect TCC within 60 days after the divorce or

annulment, not 60 days after the employing

office's notice.

What are the spouse equity

provisions?

The spouse equity provisions of law allow

the former spouse of a Federal employee or

annuitant to enroll in FEHB if he or she:

 Was covered under FEHB as a family

member at some time during the 18 months

before the marriage ended,

 Has not remarried before reaching age 55,

and

 Has a qualifying court order (a court order

that awards the former spouse a portion of the

employee's or retiree's annuity benefit or a

survivor benefit based on the employee's or

retiree's Federal service).

6
The cost of coverage under the spouse equity

provisions is slightly less than under TCC (temporary continuation of coverage). Spouse equity

enrollees pay the full premiums (both the

employee and Government shares), but they

do not pay the extra 2 percent administrative

charge.

Coverage under a spouse equity enrollment does

not begin until after the Office of Personnel

Management has reviewed the court order to

determine if it is “qualifying” and the employing

office gets both the election form and proof that

the former spouse is eligible for coverage under

the spouse equity provisions. The former spouse

can enroll under TCC while waiting for the

spouse equity coverage to begin to avoid any

gap in health insurance coverage.

There is no specific time limit on how long

spouse equity enrollments can continue. The

enrollment can continue as long as the former

spouse meets the requirements given above and

pays the premiums when they are due. If the

former spouse loses eligibility under the spouse

equity provisions (for example, he or she

remarries before reaching age 55) before the

36-month period for TCC runs out, the former

spouse can change to a TCC enrollment, which

can continue for the remainder of the 36-month

period. (See “Changing from a spouse equity

enrollment to a TCC enrollment" on page 10.)

If you need more information about the

spouse equity provisions, ask your employing

office or see the Federal Employees Health

Benefits (FEHB) Handbook at

www.opm.gov/insure/handbook/FEHB31.htm.

7
Enrollment options under TCC

(temporary continuation of

coverage)

To enroll for TCC, you (or your child or former

spouse, as applicable) complete Standard Form

2809, Employee Health Benefits Election Form,

and submit it to your employing office within

the time limit explained here. Employing offices

can accept belated enrollments in very limited

circumstances. Contact your employing office for

further information.

You are not limited to the plan or option in

which you were covered when the regular

Federal Employees Health Benefits (FEHB)

coverage ended. You (or your child or former

spouse, as applicable) may enroll in any plan for

which you are qualified. (Some plans require

that enrollees live in a certain geographic area or

belong to the sponsoring employee organization.)

You may elect either a self only or self and

family enrollment; however, the individuals

who qualify as family members under a TCC

family enrollment vary depending on whether

the enrollee is a former employee, a child, or a

former spouse. (See “Who is covered under a

TCC family enrollment?" on page 2.)

If a person who is eligible for TCC can't make an

election on his or her own behalf because of a

mental or physical disability, a court-appointed

guardian may file an election for that person.

Effective date of coverage

If you lose FEHB coverage other than by cancellation (including cancellation by nonpayment

of premiums), you have a 31-day temporary

extension of coverage, at no cost, in the same

8
enrollment category held at separation. TCC

(temporary continuation of coverage) takes effect

on the day that the 31-day temporary extension

of coverage ends. Coverage is retroactive to that

date if the enrollment processing is completed

later.

As previously discussed, depending on the

circumstances, a timely election can be made

up to 120 days after the qualifying event. If

you wait that long to enroll, you are billed for

the entire 89-day period of retroactive coverage.

In cases where the employing office accepts

a belated election, the period of retroactive

coverage for which you are billed is even longer.

If you do not pay the bill for the retroactive

coverage, the TCC enrollment is canceled retroactively to the beginning date and you are not

eligible to reenroll.

Premium payments

The employing office (or its agent if it has made

arrangements for some other office to handle its

TCC accounts) bills you for each pay period

(generally each month) you are covered. The

initial bill may include more than one month's

coverage if more than one month has passed

since the effective date. Payments are due after

the month during which you are covered in

accordance with the schedule and procedures

established by the employing office.

Opportunities to change enrollment

After the initial enrollment, a TCC enrollee may

change enrollment during the annual FEHB

open season or, generally, when an event occurs

that would allow an employee to change enrollment.

9
A TCC (temporary continuation of coverage)

enrollee may change enrollment from self and

family to self only at any time. Family members

who lose coverage because an enrollee changes

enrollment from self and family to self only are

entitled to the 31-day temporary extension of

coverage for conversion to an individual contract, but are not eligible to enroll under TCC in

their own right.

A TCC enrollee may change coverage during the

annual Federal Employees Health Benefits

(FEHB) open season or when one of the following events occur:

 Change in family status

 Move from an HMO’s (Health Maintenance

Organization) service area

 Termination of membership in an employee

organization plan

 Termination of the plan in which enrolled

 Become eligible for Medicare coverage

 Loss of coverage under another FEHB enrollment because the covering enrollment was

terminated, cancelled, or changed to self only

 Loss of coverage under another federallysponsored health benefits program

 Loss of coverage under the Medicaid program

or similar State-sponsored program of medical

assistance for the needy

 Loss of coverage under a non-Federal health

plan

Changing from a spouse equity

enrollment to a TCC enrollment

A former spouse enrolled under the spouse

equity provisions may be able to change to a

TCC enrollment if he or she loses spouse equity

eligibility because —

10
 he or she remarries before reaching age 55,

or

 the court order is changed in such a way that

it is no longer a “qualifying” court order.

A former spouse can change from a spouse

equity to a TCC (temporary continuation of

coverage) enrollment if:

 the loss of spouse equity eligibility occurs

during the 36-month period following the

divorce or annulment (or following the

employee's separation if the marriage ended

while the former spouse was covered under a

TCC family enrollment); and

 the divorce or annulment occurred on or after

January 1, 1990.

The former spouse must notify the employing

office within 60 days after eligibility for spouse

equity coverage ends. The employing office

will give the former spouse details about how

to change to a TCC enrollment. The TCC enrollment cannot continue beyond 36 months after

the divorce or annulment (or the employee's

separation, if applicable).

Termination of enrollment or

coverage

Your TCC coverage ends either because the

period of temporary continuation expires or

you cancel the enrollment. (Coverage also stops

when you don't pay premiums. If your coverage

terminates because you don’t pay your premiums, it is considered a voluntary cancellation.)

If your enrollment ends because the TCC period

expires, you are entitled to a 31-day temporary

extension in the same enrollment category held

at the time TCC expires for conversion to an

individual contract.

11
A family member’s TCC (temporary continuation

of coverage) ends when the covering enrollment

ends or when the person ceases to meet the

requirements for being considered a family

member. A family member who loses the continued coverage for any reason other than cancellation of the covering enrollment is entitled to a

31-day extension of coverage for conversion to

an individual contract. The family member may

be eligible for TCC in his or her own name if he

or she loses family member status because of a

qualifying event that occurs while he or she is

covered under the TCC family enrollment of a

separated employee.

Thirty-one-day temporary extension

of coverage and conversion to an

individual contract

When you lose Federal Employees Health

Benefits (FEHB) coverage other than by cancellation (including cancellation by nonpayment

of premiums) you have a 31-day temporary

extension of coverage, at no cost, in the same

enrollment category so you may convert to an

individual contract with your current health

benefits plan. This is true even when you also

have the right to elect temporary continuation of

FEHB coverage. TCC takes effect on the day that

the 31-day temporary extension of coverage

ends. Coverage is retroactive to that date if the

enrollment processing is completed later.

When you elect TCC instead of the conversion

policy you have another 31-day extension of

coverage, at no cost, in the same enrollment

category held at the time TCC expires. You have

another opportunity to convert to an individual

contract when the temporary continuation ends

(other than for cancellation).

12
Additional Information

You can get more information about the

Federal Employees Health Benefits (FEHB)

Program at www.opm.gov/insure. Detailed

information on Temporary Continuation of

Coverage is in the FEHB Handbook at

www.opm.gov/insure/handbook/FEHB16.htm.

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