Federal Employees

Health Benefits

(FEHB) Facts

U.S. Office of Personnel Management

RI 75-13

Revised July 2008

Previous editions are usable.

Information for Federal Civilian

Employees on the

Federal Employees Health

Benefits Program.
Table of Contents

Page

What Is the Federal Employees Health Benefits (FEHB) Program? ........... 1

When Can I Change From a Self and Family Enrollment To a Self Only

Can My Former Spouse Continue Federal Employees Health Benefits


Can Someone Be Covered Under More Than One Federal Employees Health


Can I Enroll? .................................... 1

Do I Have to Join? ................................. 1

What Does the Federal Employees Health Benefits (FEHB) Program Offer?. . . 2


How Do I Stay Informed About FEHB and Participating Health Plans? ..... 2

Do I Pay for Federal Employees Health Benefits (FEHB) Coverage?....... 3

What Is Premium Conversion? ........................... 3

What Types of Plans Are Available?........................ 5

Fee-for-Service Plans ............................. 5

Health Maintenance Organizations (HMOs) ................. 6

Point of Service ................................ 7

What Types of Enrollment Are Available? .................... 7

Self Only ................................... 7

Self and Family ................................ 7

Which Family Members Are Covered Under My Enrollment? .......... 8

When Does My Family Member Lose Coverage? ................. 9

Enrollment?..................................... 9

(FEHB) Coverage? ....................... ......... 10

Benefits (FEHB) Enrollment? .......................... 11 


i 
When Can I Enroll in Federal Employees Health Benefits (FEHB) or


Change My FEHB Enrollment?.......................... 12

What Are the Major Events That Permit Enrollment or Change in


Can I Change My Enrollment if My Physician Stops Participating


What Happens When I Have Federal Employees Health Benefits (FEHB)


Can I Continue My Federal Employees Health Benefits (FEHB) Coverage


Can My Family Members Continue Federal Employees Health Benefits


Enrollment? .................................... 13

When Does My Enrollment Become Effective? ................. 14

What Is an Enrollment Request? ......................... 14

With My Plan? .................................. 15

When Will I Get an Identification Card? ..................... 15

Coverage and Medicare? ............................. 15

After I Retire? ................................... 16

When Does My Enrollment Continue Automatically? .............. 17

Transfer ................................... 17

Leave Without Pay.............................. 17

Military Service ............................... 17

Workers’ Compensation ........................... 18

What Happens to My Family’s Coverage When I Die? ............. 18

Can I Cancel My Enrollment? .......................... 18

When Will My Enrollment End? ......................... 19

Do I Get an Extension of Coverage After My Enrollment Ends? ........ 20

Can I Continue FEHB Coverage After I Separate From Service? ........ 20

How Do I Elect Temporary Continuation of Coverage? ............. 21

(FEHB) Coverage? ................................ 21

ii 
How Do My Family Members Elect Temporary Continuation of Coverage? . . 21


I’m Leaving Federal Employment. Can I Get a Certificate of My


Will the Office of Personnel Management (OPM) Process or Pay


What Are My Rights and Responsibilities as a Federal Employees


What About Premiums for Temporary Continuation of Coverage? ....... 22

When Does My Temporary Continuation of Coverage Become Effective? . . . 22


Can I Convert to an Individual Policy? ...................... 23

How Do I Apply for an Individual Policy? .................... 23

What Happens if I Miss the Deadline? ...................... 23

Can My Family Members Convert to an Individual Policy? ........... 24

When Does the Individual Policy Become Effective? .............. 24

FEHB Coverage? ................................. 24

Where Can I Get Information on How My Plan Processes Claims? ....... 24

My Claim? .................................... 25

What Can I Do if My Plan Won’t Pay a Claim? ................. 25

Health Benefits (FEHB) Enrollee? ........................ 25

What Are the Five Steps to Safer Health Care?.................. 27

Table of Permissible Changes in Enrollment ................... 29

Employees..................................... 29

Annuitants ..................................... 31

Former Spouse Under Spouse Equity Provisions ................. 33

Temporary Continuation of Coverage Enrollees ................. 35

iii 
What is the Federal Employees Health Benefits (FEHB) Program? 

The FEHB Program is the largest employer-sponsored group health insurance program in the world, 

covering almost 9 million people including employees, annuitants, and their family members, as well 

as some former spouses and former employees. The FEHB Program offers fee-for-service plans, Health 

Maintenance Organizations (HMOs), and plans offering a Point of Service (POS) product. 

Can I Enroll? 

Do I Have to Join? 

You can enroll in FEHB if you are: 

•	 a permanent Federal employee with a regularly scheduled 

tour of duty; 

•	 a temporary employee with an appointment for longer 

than one year; or 

•	 a temporary employee with an appointment limited to one 

year or less, and you have completed one year of current 

continuous employment (excluding any break in service 

of 5 days or less). 

You are not eligible to enroll if you are an intermittent 

employee (you don’t have a prearranged regular tour of 

duty) or if your position is excluded from coverage by law 

or regulation. 

No, you decide whether you want to participate in the FEHB 

Program. When you first become eligible, your human 

resources office will ask you to choose either to enroll or not 

to enroll. If you don’t enroll when you first become eligible, 

you won’t be able to enroll until open season or until 

another event permitting enrollment occurs. 

1
What Does the Federal 

Employees Health Benefits 

(FEHB) Program Offer? 

How Do I Stay Informed About 

FEHB and Participating 

Health Plans? 

•	 Group-rated premiums and benefits; 

•	 A Government contribution toward the cost of your plan; 

•	 Your choice of plans and options; 

•	 Annual enrollment opportunities (called open season); 

•	 Guaranteed coverage that your plan can’t cancel; 

•	 No waiting periods, medical examinations or restrictions 

because of age or physical condition; 

•	 Catastrophic protection against unusually large medical 

bills; 

•	 Salary deduction for premiums; 

•	 Temporary continuation of FEHB coverage or conversion 

to an individual contract after your enrollment or a family 

member’s coverage ends; 

•	 Continued group coverage into retirement or while you 

are receiving Workers’ Compensation; 

•	 Continued group coverage for your family after you die. 

Before you enroll, your human resources office will give 

you a copy of the most current Guide to Federal Employees 

Health Benefits Plans. Use that to decide which health plans 

you are interested in, and request those plans’ brochures 

from your human resources office. Read the brochures 

carefully to find out what each plan covers, its rules, its 

exclusions, and its limitations. Once you enroll, your health 

plan will send you an updated brochure every year that 

specifies how it changes for the upcoming year. If you want 

to continue your current enrollment, you don’t have to do 

anything during open season. 

You can download Guides and plan brochures from our web 

site at www.opm.gov/insure. You can also compare health 

plans, link to plan web sites, and get information on plan 

quality. You can access the FEHB Handbook, which 

contains policies, procedures, and guidance for enrollees and 

employing offices on the FEHB Program. If your agency 

participates in Employee Express, you can make enrollment 

changes online during open season. Our web site has the 

most current information available to you. 

2
Do I Pay for Federal Employees 

Health Benefits (FEHB) 

Coverage? 

What Is Premium Conversion? 

You share the cost of your health benefits coverage with the 

Government. Most full-time employees pay only 25% of the 

total premium. 

Premiums and the Government contribution change yearly. 

You can find each plan’s current premiums in the most 

recent Guide to Federal Employees Health Benefits Plans 

(available from your human resources office and at 

www.opm.gov/insure). 

If you are a part-time employee, your share of the premiums 

will be greater than for a full-time employee. Ask your 

human resources office for information about the cost of 

your enrollment. 

If you are a temporary employee, former spouse, or person 

enrolled under temporary continuation of coverage, the 

Government does not contribute toward the cost of your 

enrollment. You must pay both the Government and 

employee shares of the cost. 

Premium conversion is a method of reducing your taxable 

income by the amount of your FEHB insurance premium. 

Section 125 of the Internal Revenue Code allows your 

employer to provide a portion of your salary in pre-tax 

benefits rather than in cash. The effect is your taxable 

income is reduced. You save on: 

•	 Federal income tax, 

•	 Social Security tax, 

•	 Medicare tax, and 

•	 State and local income tax (in most states and localities). 

Premium conversion has no effect on: 

•	 statutory pay provisions, 

•	 the General Schedule, 

•	 the amount of your health insurance premium, 

•	 the Government contribution towards your FEHB 

premium, or 

•	 your base pay for retirement, life insurance, or the Thrift 

Savings Plan. 

3
What Is Premium Conversion? 

(continued) 

You are automatically enrolled in premium conversion 

effective the first pay period on or after October 1, 2000, if 

you are an active employee of the Executive Branch of the 

Federal Government and you participate in the Federal 

Employees Health Benefits (FEHB) Program. If the 

Executive Branch does not employ you, or an Executive 

Branch agency does not issue your pay, you may participate 

in premium conversion if your employer offers it. The 

Federal Judiciary, the U.S. Postal Service, and some 

Executive Branch agencies with independent 

compensation-setting authority already offer their own 

premium conversion plans. 

You may only waive participation in premium 

conversion: 

•	 At the initial premium conversion effective date; 

•	 During an open season; 

•	 When you are first hired or hired as a reemployed 

annuitant; 

•	 When you leave Federal service and are rehired in a 

different calendar year; or 

•	 When you have a qualifying life event (whether or not 

you change your FEHB enrollment). 

You can cancel your waiver and participate in premium 

conversion: 

•	 When you have a qualifying life event; or 

•	 During an open season. 

Retirees and persons paying FEHB premiums directly (not 

by payroll deduction) are not eligible for premium 

conversion. 

A qualifying life event includes: 

•	 Addition of a dependent; 

•	 Birth or adoption of a child; 

•	 Changes in entitlement to Medicare or Medicaid for you, 

your spouse, or dependent; 

•	 Change in work site; 

4
•	 Change in your employment status or that of your spouse 

or dependent from either full-time to part-time, or the 

reverse; 

•	 Death of your spouse or dependent; 

•	 Divorce or annulment; 

•	 Loss of a dependent; 

•	 Marriage; 

•	 Significant change in the health coverage of you or your 

spouse related to your spouse’s employment; 

•	 Start or end of an unpaid leave of absence by you or your 

spouse; or 

•	 Start or end of your spouse’s employment. 

What Types of Plans Are The types of plans that participate in the Federal Employees 

Available? Health Benefits (FEHB) Program are: 

Fee-for-Service Plans 

This is a traditional type of insurance in which the health 

plan will either reimburse you or pay the medical provider 

directly for each covered medical expense after you receive 

the service. When you need medical attention, you visit the 

doctor or hospital of your choice. After receiving medical 

treatment, your provider or you file a claim to your health 

plan and it pays a benefit, but you usually must first pay a 

deductible and coinsurance or a copayment. These plans use 

some managed care features such as precertification and 

utilization review to control costs. Most also provide access 

to preferred provider organizations (PPOs), as described 

below. When you use a PPO, you do not have to file a 

claim. Using a PPO will save you money. 

Fee-for-service plans include: 

• Plans open to everyone eligible to enroll under the FEHB 

Program. Some of these plans are sponsored by unions or 

employee organizations that require you to hold full or 

associate membership in the sponsoring organization.

5
What Types of Plans Are • Plans sponsored by unions and employee organizations 

and restricted to employees in certain occupational groups 

and/or agencies. 

Available? (continued) 

Generally, a sponsoring organization will require you to pay 

a membership fee or dues, in addition to the premium. The 

employee organization sets and collects this fee, which is 

not negotiated with the Office of Personnel Management 

(OPM). 

•	 Preferred Provider Organizations (PPO). A PPO is a 

fee-for-service option that allows you to see certain 

medical providers who reduce their charges to the plan, 

which means you pay less money out-of-pocket than 

when you use a non-PPO provider. When you visit a PPO 

you usually won’t have to file claims or paperwork. 

However, going to a PPO hospital does not guarantee 

PPO benefits for all services received within that hospital. 

For instance, the PPO agreement may not cover lab work 

and radiology services from independent practitioners 

within the hospital, but it would cover room and board 

charges. 

Health Maintenance Organizations (HMOs) 

An HMO is a health plan that provides care through a 

network of physicians, hospitals, and other providers in 

particular geographic areas. HMOs coordinate the health 

care services you receive. Your eligibility to enroll in an 

HMO is determined by where you live or, for some plans, 

where you work. Some HMOs have agreements with 

providers in other service areas for non-emergency care if 

you travel or are away from home for extended periods, 

called “reciprocity”. Plans that offer such reciprocity discuss 

it in their benefit brochure under Special Features. 

• The HMO provides a comprehensive set of services – as 

long as you use the doctors and providers in the HMO 

network. HMOs charge a copayment for primary 

physician and specialist visits and generally no deductible 

or coinsurance for in-hospital care. 

• Most HMOs ask you to choose a doctor or medical group 

to be your primary care physician (PCP). Your PCP 

6
What Types of Plans Are 

Available? (continued) 

What Types of Enrollment Are 

Available? 

provides your general medical care. In many HMOs, you 

must get authorization or a “referral” from your PCP for 

you to be evaluated and/or treated by a different physician 

or medical professional. The referral ensures you see 

the right provider for the care most appropriate to your 

condition. 

• Care you receive from a provider not in the HMO’s 

network is not covered unless it’s emergency care, you 

have obtained a proper referral for the care, or the plan 

has a reciprocity arrangement. 

Point of Service 

Some fee-for-service plans and health maintenance 

organizations (HMOs) offer a point of service product. You 

have the choice of using a designated network of providers 

or going outside of the network for care. If you use network 

providers, your out-of-pocket costs will be less than if you 

go out of network. If you don’t use network providers, you 

must pay higher out-of-pocket costs, including deductibles, 

coinsurance, and copayments. 

The Federal Employees Health Benefits (FEHB) Program 

offers two types of enrollment: 

Self Only 

A self only enrollment covers only you as the enrollee. If 

you have a self only enrollment and want to cover a new 

family member, you must change to a self and family 

enrollment. 

Self and Family 

A self and family enrollment covers you and all of your 

eligible family members. You can not exclude any eligible 

family member from coverage. You can not provide 

coverage for anyone who is not an eligible family member, 

even if they live with you and are dependent upon you. 

7
What Types of Enrollment Are 

Available? (continued) 

Which Family Members Are 

Covered Under My Enrollment? 

A new family member is automatically covered under your 

self and family enrollment. You do not need to report the 

addition of a new family member to your human resources 

office, but your plan may ask you for information (such as a 

marriage license or birth certificate) to verify the family 

member’s eligibility. Your plan is not entitled to a new 

enrollment form as verification of the family member’s 

eligibility. 

The family members covered under your self and family 

enrollment are: 

• Your spouse; 

• Your unmarried dependent children under age 22. In 

addition to natural children of a marriage, this includes: 

• Your legally adopted child; 

• Your recognized natural child, if you live together 

in a parent-child relationship, or the child is 

financially dependent upon you, or if there is a 

judicial determination of support; 

• Your stepchild, if you live together in a 

parent-child relationship; and 

• Your foster child, if you live together in a 

parent-child relationship and you expect to raise 

the child to adulthood (this may include a 

grandchild); 

• Your unmarried dependent child age 22 or over who is 

incapable of self-support because of a disability that 

existed before age 22. You must expect the disability to 

continue for at least one year, and the disability must be 

the reason the child isn’t capable of self-support. 

The Federal Employees Health Benefits (FEHB) Handbook 

provides more detailed guidance on coverage requirements, 

including certifications that you must complete to cover a 

foster child or a child incapable of self-support (see 

www.opm.gov/insure/handbook/FEHB28.htm). 

8
When Does My Family Member 

Lose Coverage? 

When Can I Change From a 

Self and Family Enrollment To 

a Self Only Enrollment? 

Your spouse immediately loses coverage under your self 

and family enrollment when your divorce decree or 

annulment is final (according to state law). 

Your child immediately loses coverage under your self and 

family enrollment when: 

• Your child reaches age 22, unless he/she is incapable of 

self support; 

• Your child marries; 

• Your disabled child age 22 or over marries or becomes 

capable of self-support; or 

• Your stepchild or foster child stops living with you in a 

parent-child relationship. 

Your family member will get a 31-day extension of 

coverage. He/she will be eligible to elect temporary 

continuation of Federal Employees Health Benefits (FEHB) 

coverage or may elect to convert coverage to an individual 

contract. Your former spouse may be eligible to enroll for 

FEHB coverage under Spouse Equity provisions. 

Your family members also lose coverage if you change from 

a self and family to a self only enrollment. 

Neither your human resources office nor your plan will 

notify you when your family member loses eligibility. 

You should immediately tell your plan when a family 

member loses coverage. If your plan pays for services 

received after your family member’s coverage ends, you 

must repay the plan. 

If you participate in premium conversion, you may change 

to a self only enrollment during the annual open season or 

within 60 days after you have a qualifying life event. The 

change in enrollment must be consistent with your 

qualifying life event. For example, if you get divorced, 

changing to a self only enrollment would be consistent with 

that qualifying life event. If you adopt a child, a change 

from self and family to self only coverage would not be 

consistent with that qualifying life event. 

9
When Can I Change From a 

Self and Family Enrollment To 

a Self Only Enrollment? 

(continued) 

Can My Former Spouse 

Continue Federal Employees 

Health Benefits (FEHB) 

Coverage? 

If you have waived participation in premium conversion, 

you may change to a self only enrollment or cancel your 

enrollment at any time. 

Your former spouse may be eligible to continue FEHB 

coverage under Spouse Equity if your former spouse: 

• was divorced from you during your Federal employment 

or receipt of annuity; 

• was covered as a family member under an enrollment at 

least one day during the 18 months before your marriage 

ended; 

• is entitled to a portion of your annuity or to a former 

spouse survivor annuity; and 

• does not remarry before age 55. 

You or your former spouse must apply to your human 

resources office for Spouse Equity coverage within 60 days 

from the divorce. For more information on how your former 

spouse can enroll, ask your human resources office for 

Benefits for Former Spouses under the Federal Employees 

Health Benefits Program or see the FEHB Handbook at 

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

If your former spouse is not eligible to enroll under Spouse 

Equity, he/she may be eligible to continue FEHB coverage 

under Temporary Continuation of Coverage provisions. 

10
Can Someone Be Covered 

Under More Than One Federal 

Employees Health Benefits 

(FEHB) Enrollment? 

Generally, you may not be covered under two plans at the 

same time. A human resources office may authorize a dual 

enrollment to: 

• Protect children who would otherwise lose coverage as 

family members; or 

• Allow an employee under age 22 covered under a parent’s 

self and family enrollment to cover his/her dependent 

child. 

No enrollee or family member may receive benefits under 

more than one FEHB enrollment. When your human 

resources office authorizes a dual enrollment, you must 

notify the plan(s) which family members are to be covered 

under each enrollment. 

For more information on dual enrollments, contact your 

human resources office or see the FEHB Handbook at 

www.opm.gov/insure/handbook/FEHB10.htm. 

11
When Can I Enroll in Federal 

Employees Health Benefits 

(FEHB) or Change My FEHB 

Enrollment? 

I am ... When Can I Enroll? 

A new employee. Within 60 days after your 

appointment date. 

Moving to a position that Within 60 days after your 

offers FEHB coverage. My appointment date. 

previous position was excluded 

from coverage. 

An eligible employee, but I am Open season, or when another 

not enrolled in FEHB. event permitting enrollment 

occurs (such as a change in 

family status or employment 

status). 

Enrolled in FEHB, and I want Open season, or when another 

to change my enrollment. event permitting enrollment 

occurs (such as a change in 

family status or employment 

status). 

If you are an eligible temporary employee, all of the 

enrollment and enrollment change information applies to 

you with one exception. A decision not to enroll will not 

affect your future eligibility to continue FEHB enrollment 

after retirement. 

To enroll or change your enrollment, you must file an 

enrollment request with your human resources office within 

the time limit shown in the Table of Permissible Changes in 

Enrollment (see pages 29-36). 

Important: You will not be eligible for FEHB coverage 

after retirement unless you are enrolled before you retire and 

meet all the requirements for continuing enrollment after 

retirement (see page 16). 

12
What Are the Major Events 

That Permit Enrollment or 

Change in Enrollment? 

• A change in family status: 

3 marriage

3 birth or adoption of a child

3 acquisition of a foster child

3 legal separation

3 divorce

• A change in employment status: 

3 you are reemployed after a break in service of more 

than 3 days 

3 you return to pay status after your coverage terminated 

during leave without pay status or because you were in 

leave without pay status for more than 365 days 

3 your pay increases enough for premiums to be withheld 

3 you are restored to a civilian position after serving in 

the uniformed services 

3 you change from a temporary appointment to an


appointment that entitles you to a Government


contribution


3 you change to or from part-time career employment. 

• You or a family member lose Federal Employees Health 

Benefits (FEHB) or other coverage: 

3 under another FEHB enrollment because the covering 

enrollment was terminated, canceled, or changed to self 

only 

3 under another Federally-sponsored health benefits


program


3 under Medicaid or similar state-sponsored program for 

the needy 

3 because your membership terminates in the employee 

organization sponsoring the FEHB plan 

3 under a non-Federal health plan. 

• When one of these events occur, you may:

3 enroll

3 change your enrollment from self only to self and


family


3 change your enrollment to another FEHB plan or


option.


13
What Are the Major Events 

That Permit Enrollment or 

Change in Enrollment? 

(continued) 

When Does My Enrollment 

Become Effective? 

What Is an Enrollment Request? 

You also may waive or cancel your waiver of premium 

conversion at the same time (see “What Is Premium 

Conversion?”). 

You must give your enrollment change to your human 

resources office from 31 days before to 60 days after the 

event. 

See the Table of Permissible Changes in Enrollment for 

other enrollment and enrollment change opportunities. 

Generally, the effective date of your enrollment or 

enrollment change is the first day of the pay period that 

follows: 

• the day your human resources office receives your 

completed enrollment request; and 

• a pay period during any part of which you were in pay 

status. (This pay status requirement doesn’t apply to a 

change from self only to self and family.) 

However, some events, such as open season, have different 

effective dates. You can find complete information about 

effective dates in the Federal Employees Health Benefits 

(FEHB) Handbook at 

www.opm.gov/insure/handbook/FEHB10.htm. 

You may use the Health Benefits Election form (SF 2809) to 

request a new enrollment or change in enrollment. The 

SF 2809 may be in either paper or electronic format. In 

addition, your human resources office may also allow you to 

make open season changes through “Employee Express” or 

another electronic method, which doesn’t involve a 

SF 2809. 

14
Can I Change My Enrollment 

if My Physician Stops 

Participating With My Plan? 

When Will I Get an 

Identification Card? 

What Happens When I Have 

Federal Employees Health 

Benefits (FEHB) Coverage and 

Medicare? 

No, this is not a qualifying event for changing your 

enrollment. However, if you have a chronic or disabling 

condition and your health plan terminates your provider’s 

contract (unless the termination is for cause), you may be 

able to continue seeing your provider for up to 90 days after 

the notice of termination. If you are in the second or third 

trimester of pregnancy, you may continue seeing your 

obstetrician until the end of postpartum care. 

Your plan will send you an identification card once it 

processes your enrollment. If you need services before you 

get your identification card, use your copy of the Health 

Benefits Election form (SF 2809) or your Employee Express 

enrollment verification letter as proof of enrollment. 

Generally, your FEHB plan and Medicare provide protection against the same kind of medical expenses. Your FEHB 

plan also provides prescription drug coverage, routine 

physicals and a wider range of preventive services that 

Medicare does not. Some FEHB plans also provide coverage 

for dental and vision care. Medicare covers orthopedic and 

prosthetic devices, durable medical equipment, home health 

care, limited chiropractic services, and medical supplies, 

which some FEHB plans may not cover or only partially 

cover (check your plan brochure for details). 

Whether your FEHB plan or Medicare is primary depends 

on your current employment or health status. Your FEHB 

plan brochure provides specific information on how its 

benefits are coordinated with Medicare. 

You can get more information about Medicare at 

www.medicare.gov or from the publication Medicare and 

You (also available on the web site). You can get more 

information on FEHB plans and Medicare in the booklet 

entitled “The Federal Employees Health Benefits Program 

and Medicare,” at 

www.opm.gov/insure/MCare/MHB01.htm. 

15
Can I Continue My Federal 

Employees Health Benefits 

(FEHB) Coverage After I 

Retire? 

You may continue your FEHB enrollment after you retire if: 

• you are entitled to retire on an immediate annuity under a 

retirement system for Federal civilian employees; and 

• you have been continuously enrolled (or covered as a 

family member) in any FEHB plan(s) for the 5 years of 

service immediately before your annuity starts, or for the 

full period of service since your first opportunity to enroll 

(if less than 5 years). 

An immediate annuity is one that begins within 30 days of 

separation for retirement. An annuity you receive under the 

Minimum Retirement Age (MRA)+10 provision of the 

Federal Employees Retirement System (FERS) also 

qualifies as an immediate annuity, even though you 

postponed receipt of your annuity after separating from 

service. 

“Service” means time in a position in which you were eligible to be enrolled and receive a Government contribution 

towards the cost of your enrollment. You do not need to 

have been enrolled in the same FEHB plan. Coverage under 

a non-FEHB plan doesn’t count toward the five-year or 

first-opportunity requirement, except that time covered 

under TRICARE counts as long as you are covered under an 

FEHB enrollment when you retire. 

Your first opportunity to enroll is within 60 days after you 

first become eligible to enroll and receive a Government 

contribution towards the cost of your enrollment. 

The Office of Personnel Management (OPM) may waive the 

five-year requirement for continuation of enrollment after 

retirement only under exceptional circumstances. For more 

information on OPM’s waiver authority, see the FEHB 

Handbook at www.opm.gov/insure/handbook/FEHB22.htm. 

16
When Does My Enrollment 

Continue Automatically? 

Transfer 

Your Federal Employees Health Benefits (FEHB) 

enrollment will continue when you transfer from one agency 

to another, as long as you: 

• don’t have a break in service of more than three calendar 

days; and 

• are eligible for FEHB coverage in your new position. 

Leave Without Pay 

Your FEHB enrollment will continue for up to one year 

while you are in leave without pay status, unless you cancel 

it. You must pay your share of the premiums. Your human 

resources office will tell you how to make the premium 

payments. 

Military Service 

Your FEHB enrollment will continue without change if you 

enter on active duty in the military service for 30 days or 

less. 

If you enter on active duty for more than 30 days, you may 

continue your FEHB enrollment for up to 18 months. You 

may have to pay your share of the premiums for the first 12 

months, and you may have to pay an additional amount to 

continue coverage during the last 6 months of the 18-month 

period. Your human resources office will tell you whether 

you will have to pay premiums, how much the premiums 

will be, and how to make the premium payments. 

You may also choose to terminate your enrollment. You will 

get it back when you exercise your reemployment rights and 

return to civilian service. Your decision to terminate your 

enrollment will not affect your future eligibility to continue 

FEHB enrollment after retirement as long as you enroll 

within 60 days after you return to civilian service. 

17
When Does My Enrollment 

Continue Automatically? 

(continued) 

What Happens to My Family’s 

Coverage When I Die? 

Can I Cancel My Enrollment? 

Workers’ Compensation 

Your enrollment continues while you are receiving 

compensation from the Office of Workers’ Compensation 

Programs (OWCP) if: 

• OWCP determines you are unable to return to duty; 

and 

• you meet the same requirements for continuing coverage 

as for retirement. 

Your surviving eligible family members may continue your 

health benefits enrollment after you die if: 

• you had a self and family enrollment; and

• one family member is entitled to a survivor annuity.

Your retirement system will take appropriate action with 

your survivors. 

If you participate in premium conversion, you may cancel 

your enrollment only during an open season or upon a 

qualifying life event. The cancellation of coverage must be 

consistent with and correspond to your qualifying life event. 

For example, if you get married and your spouse is 

employed by a company that provides health insurance for 

you, then canceling Federal Employees Health Benefits 

(FEHB) coverage would be consistent with that qualifying 

life event. If you are divorcing and have children to cover, 

canceling coverage would not be consistent with that 

qualifying life event. 

If you have waived participation in premium conversion, 

you may cancel your enrollment at any time. 

Your cancellation takes effect on the last day of the pay 

period in which your human resources office receives your 

request. You and your family members are not eligible for 

the 31-day extension of coverage, Temporary Continuation 

of Coverage, or conversion to an individual policy. 

18
Can I Cancel My Enrollment? 

(continued) 

When Will My Enrollment End? 

When you cancel your enrollment, you may not enroll again 

until an event occurs (such as an open season or a change in 

family status) that permits enrollment. 

You will not be eligible for health benefits coverage after 

your retirement unless you reenroll before you retire and 

meet all of the requirements for continuing enrollment into 

retirement. If you plan to reenroll in time to qualify for 

coverage as a retiree, keep in mind you may have to 

retire earlier than expected. You then might not meet the 

five-year requirement for continuing coverage into retirement. When you cancel your enrollment you are 

accepting this risk. You may want to consider changing 

your enrollment to a lower cost plan instead of cancellation. 

If you are going to be covered by someone else’s enrollment 

and do not want a gap in coverage, you can coordinate the 

effective dates of your cancellation and your new coverage. 

Your enrollment will end, subject to a 31-day extension of 

coverage, when you: 

• separate from service (unless you can retire and continue 

your enrollment); 

• separate under the Federal Employees Retirement System 

(FERS) MRA+10 provision and you postpone receiving 

your annuity (you will get Federal Employees Health 

Benefits [FEHB] coverage back when your annuity 

starts); 

• change to a position that is excluded from coverage; 

• die (your family may be eligible to continue coverage); 

• have been on leave without pay for 365 consecutive days, 

or when your leave under the Family and Medical Leave 

Act expires, whichever is later; 

• return to leave without pay status, if you haven’t been in 

pay status for 4 consecutive months after 365 days of 

continued coverage while in leave without pay status; 

• enter on active duty in the military service for more than 

30 days, if you decide to terminate your enrollment; 

• have completed 18 months of active duty in the military 

service, or your entitlement to continued coverage ends, 

whichever is earlier; or 

19
When Will My Enrollment 

End? (continued) 

Do I Get an Extension of 

Coverage After My Enrollment 

Ends? 

Can I Continue FEHB Coverage 

After I Separate From Service? 

• are a temporary employee whose pay is not enough to 

cover the premiums and you do not choose a lower-cost 

plan.

See the Federal Employees Health Benefits (FEHB) 

Handbook at www.opm.gov/insure/handbook/FEHB15.htm 

for the effective dates of termination actions. 

Your coverage will continue without cost to you for 31 days 

after your enrollment ends for any reason except when you 

cancel it. During that time you can elect Temporary 

Continuation of Coverage (TCC) or convert to an individual 

health benefits contract with your FEHB plan. 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. 

Your family members are eligible for the extension of 

coverage when they lose coverage for any reason except 

when you cancel your enrollment. 

If you are hospitalized on the 31st day of extended coverage, 

your FEHB plan will continue to provide benefits for up to 

60 more days of continuous hospitalization unless you 

converted to an individual contract. 

You are eligible to temporarily continue your FEHB 

coverage for up to 18 months when you: 

• separate from service, voluntarily or involuntarily, unless 

your separation is for gross misconduct; and 

• are not otherwise eligible for continued coverage under 

the Program (not counting the 31-day extension of 

coverage). 

You can get more details on Temporary Continuation of 

Coverage (TCC) from the FEHB Handbook at 

www.opm.gov/insure/handbook/FEHB15.htm or from the 

booklet Temporary Continuation of Coverage under the 

Federal Employees Health Benefits Program (RI 79-27). 

20
How Do I Elect Temporary 

Continuation of Coverage? 

Can My Family Members 

Continue Federal Employees 

Health Benefits (FEHB) 

Coverage? 

How Do My Family Members 

Elect Temporary Continuation 

of Coverage? 

Your human resources office will give you notice of your 

Temporary Continuation of Coverage (TCC) rights within 

61 days after you separate from service. If you want TCC, 

you must elect it within 60 days from the later of: 

• your separation; or 

• the date of your human resources office’s notice. 

You may choose self only or self and family coverage in any 

plan or option you are eligible to join. You are not 

limited to the plan, option, or type of enrollment under 

which you had been covered. 

Your family members are eligible to continue FEHB 

coverage for up to 36 months under their own Temporary 

Continuation of Coverage (TCC) enrollments when they: 

• lose their eligibility under your coverage; and 

• are not otherwise eligible for FEHB coverage. 

This includes when your child reaches age 22 or marries, or 

when you divorce and your former spouse does not qualify 

under Spouse Equity provisions. Neither your human 

resources office nor your plan will notify you or your 

family member when he/she loses coverage. 

Your family members are not eligible for TCC when you 

cancel your enrollment or change to a self only enrollment. 

You must notify your human resources office or retirement 

system within 60 days from the date your family 

member loses eligibility under your enrollment. (If you are 

divorcing, your former spouse may notify your human 

resources office on his/her own behalf.) Within 14 days, 

your human resources office will send your family member 

notice of his/her own Temporary Continuation of Coverage 

(TCC) rights. 

If your family member wants TCC, he/she must elect it 

within 60 days from the later of: 

21
How Do Family Members Elect 

Temporary Continuation of 

Coverage? (continued) 

What About Premiums for 

Temporary Continuation of 

Coverage? 

When Does My Temporary 

Continuation of Coverage 

Become Effective? 

• the date he/she loses eligibility under your enrollment; or 

• the date of your human resources office’s notice. 

If your former spouse loses Spouse Equity eligibility within 

36 months after your marriage ends, he/she must notify your 

human resources office within 60 days of losing this 

eligibility to apply for the remaining months of TCC. 

Generally, you or your family member must pay both the 

Government and employee shares of the premium, plus a 

2% administrative charge. When Temporary Continuation of 

Coverage (TCC) ends, you will get another 31-day 

extension of coverage and conversion rights (unless you 

canceled your coverage or did not pay premiums). 

The first 31 days of the Temporary Continuation of 

Coverage (TCC) eligibility period overlap with the free 

31-day extension of coverage. You must begin to pay 

premiums for TCC after the 31-day extension of coverage 

ends. You must pay retroactive premiums to this date even if 

your enrollment is not finalized by then. 

If you: 

• elect a different plan or option when you enroll under 

TCC, and 

31

• you or a covered family member are in a hospital on the 

st day of the extension of coverage, 

your old plan or option will continue coverage for the 

hospitalized person as long as he/she is hospitalized, 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. 

22
Can I Convert to an Individual 

Policy? 

How Do I Apply for an 

Individual Policy? 

What Happens if I Miss the 

Deadline? 

You may convert to an individual policy with the carrier of 

your plan when your Federal Employees Health Benefits 

(FEHB) coverage ends, except when you cancel your 

enrollment. 

The plan is not allowed to: 

• ask for evidence of good health; 

• impose waiting periods; or 

• limit coverage for pre-existing conditions. 

Your benefits and rates will be different from those under 

the FEHB Program. The Government does not contribute to 

the cost of the individual conversion contract. 

Your human resources office must give you a notice of your 

right to convert to an individual policy no later than 60 days 

from the termination date. 

Complete the back of your copy of the notice and send it to 

the carrier of your plan within 31 days from the date of the 

notice, but no later than 91 days from the date your 

enrollment terminates. 

You lose your opportunity to convert to an individual policy 

unless there are reasons beyond your control (including 

when you do not get the required conversion notice within 

60 days). In those cases, you can ask the carrier of your plan 

to accept a late conversion. You must send your written 

request within 6 months after the date your enrollment 

terminated. You must include some documentation that your 

enrollment has terminated (for example, a Notification of 

Personnel Action, SF 50 showing separation from service). 

23
Can My Family Members 

Convert to an Individual Policy? 

When Does the Individual Policy 

Become Effective? 

I’m Leaving Federal 

Employment. Can I Get a 

Certificate of My FEHB 

Coverage? 

Where Can I Get Information 

on How My Plan Processes 

Claims? 

Your family members also may convert to individual 

coverage when they lose eligibility under your enrollment, 

or when their Spouse Equity or Temporary Continuation of 

Coverage (TCC) ends. Neither your human resources 

office nor your plan will notify you or your family member 

when he/she loses coverage. 

You or your family member should write to the carrier of 

your plan within 31 days after your family member’s 

Federal Employees Health Benefits (FEHB) coverage ends 

to request conversion to an individual 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 hospitalized on 

the 31st day of extended coverage. 

When your FEHB coverage ends, your plan will automatically send you a Certificate of Group Health Plan Coverage. 

You need to show this certificate to a new non-FEHB 

insurer to reduce or eliminate any pre-existing condition 

limitations that it may otherwise be able to apply to your 

coverage. If you do not get a certificate automatically, the 

plan must send you one at your request. If needed, you also 

may get certificates from other FEHB plans you have been 

enrolled in to document continued group health plan coverage. 

You can get this information by reading your plan brochure 

carefully. It will help you become familiar with your plan’s 

benefits and claims procedures. You may also ask your plan 

directly about benefits, claims payment and claims 

processing. 

24
Will the Office of Personnel 

Management (OPM) Process or 

Pay My Claim? 

What Can I Do if My Plan 

Won’t Pay a Claim? 

What Are My Rights and 

Responsibilities as a Federal 

Employees Health Benefits 

(FEHB) Enrollee? 

No, OPM does not pay or process claims. 

Your plan brochure has detailed information on how to file a 

reconsideration request with your plan and a disputed claim 

request with OPM. Before you request reconsideration from 

the plan or ask OPM for a disputed claim review, please 

read this information in your plan brochure. 

A mainstay of the FEHB Program is the Patients’ Bill of 

Rights and Responsibilities, as recommended by the 

President’s Advisory Commission of Consumer Protection 

and Quality in the Health Care Industry. The following are 

consumer protections and quality initiatives you can count 

on from your FEHB plan. 

• Transitional care:

3 If you have a chronic or disabling condition and your 

health plan terminates your provider’s contract (unless 

the termination is for cause), you may be able to 

continue seeing your current specialist for up to 90 

days after the notice of termination. If you are in the 

second or third trimester of pregnancy, you may 

continue seeing your obstetrician until the end of your 

postpartum care. 

3 If you have a chronic or disabling condition or are in 

your second or third trimester of pregnancy and your 

health plan drops out of the FEHB Program, you may 

be able to continue seeing your provider if you enroll in 

a new FEHB plan. You may continue to see your 

current specialist after your old enrollment ends, even 

if he or she is not associated with your new plan, for up 

to 90 days after you receive the termination notice or 

through the end of postpartum care, and pay no more 

than if your old enrollment had not ended. 

• You have the right to review and obtain copies of your 

medical records on request. You may ask a physician 

amend a record that is not accurate, relevant, or complete. 

If the physician does not amend your record, you may add 

a brief statement to the record. 

25
What Are My Rights and 

Responsibilities as a Federal 

Employees Health Benefits 

(FEHB) Enrollee? (continued) 

• Direct access to women’s health care providers for routine 

and preventive health care services. 

• Coverage of emergency department services for screening 

and stabilization without authorization if you have reason 

to believe serious injury or disability would otherwise 

result. 

• Direct access to a qualified specialist within your network 

of providers if you have complex or serious medical conditions that need frequent specialty care. Authorizations, 

when required by the plan, will be for an adequate number 

of direct access visits under an approved treatment plan. 

• Assurance there will be no “gag rules” in provider 

contracts that could limit communication about medically 

necessary treatment. 

• Extensive information about plan characteristics and 

performance, provider network characteristics, physician 

and health care facility characteristics, and care 

management. 

Check our web site at 

www.opm.gov/insure/health/billrights.htm for listings of the 

specific types of information your health plan must 

make available to you. You may also contact your health 

plan directly for this information. 

The health care system works best when you take the time to 

become informed. As a responsible consumer, you should: 

• Read and understand your health benefits coverage, 

limitations, and exclusions, health plan processes, and 

procedures to follow when seeking care. 

• Work with your physician in developing and carrying out 

a treatment plan. 

• Practice healthy habits. 

26
What Are the Five Steps to Safer 

Health Care? 

Medical error and patient safety aren’t well understood by 

most Americans. When we need vital or risky health care 

services, we want to believe someone else has made 

sure that we’ll get safe care. Sadly, every hour, 10 Americans die in a hospital due to avoidable errors; another 50 are 

disabled. Too many patients get the wrong medicines, the 

wrong tests and the wrong diagnosis. By asking questions, 

learning more and understanding your risks, you can 

improve the safety of your own health care, and that of your 

family members. Take these simple steps: 

1. Speak up if you have questions or concerns. Choose a 

doctor who you feel comfortable talking to about your 

health and treatment. Take a relative or friend with you if 

this will help you ask questions and understand the answers. 

It’s okay to ask questions and to expect answers you can 

understand. 

2. Keep a list of all the medicines you take. Tell your 

doctor and pharmacist about the medicines you take, 

including over-the-counter medicines such as aspirin and 

ibuprofen, and dietary supplements such as vitamins and 

herbals. Tell them about any drug allergies you have. Ask 

the pharmacist about side effects and what foods or other 

things to avoid while taking the medicine. When you get 

your medicine, read the label, including warnings. Make 

sure it is what your doctor ordered and you know how to use 

it. If the medicine looks different than you expected, ask the 

pharmacist about it. 

3. Make sure you get the results of any test or procedure. 

Ask your doctor or nurse when and how you will get the 

results of tests or procedures. If you do not get them when 

expected — in person, on the phone, or in the mail — don’t 

assume the results are fine. Call your doctor and ask for 

them. Ask what the results mean for your care. 

4. Talk with your doctor and health care team about 

your options if you need hospital care. If you have more 

than one hospital to choose from, ask your doctor which one 

has the best care and results for your condition. Hospitals do 

a good job of treating a wide range of problems. However, 

for some procedures (such as heart bypass surgery), research 

shows results often are better at hospitals doing a lot of these 

procedures. Also, before you leave the hospital, be sure to

27
What Are the Five Steps to 

Safer Health Care? (continued) 

ask about follow-up care, and be sure you understand the 

instructions. 

5. Make sure you understand what will happen if you 

need surgery. Ask your doctor and surgeon: Who will take 

charge of my care while I’m in the hospital? Exactly what 

will you be doing? How long will it take? What will happen 

after the surgery? How can I expect to feel during recovery? 

Tell the surgeon, anesthesiologist, and nurses if you have 

allergies or have ever had a bad reaction to anesthesia. 

Make sure you, your doctor, and your surgeon all agree on 

exactly what will be done during the operation. 

28
Table of Permissible Changes in Enrollment 

Employees

Event 

Code for 

SF 2809 

Events that Permit 

Enrollment Changes 

May 

Enroll 

Self Only to 

Self and 

Family 

Change 

Plans or 

Options 

Time Limits 

1A Initial opportunity to enroll Yes N/A N/A Within 60 days 

after becoming 

eligible 

1B Open Season Yes Yes Yes As announced by 

OPM 

1C Change in family status Yes Yes Yes From 31 days 

before through 60 

days after event 

1D Change in employment status Yes Yes Yes Within 60 days of 

employment status 

change 

1E Separation from Federal 

employment when you or your 

spouse are pregnant 

Yes Yes Yes During final pay 

period of 

employment 

1F Transfer from a post of duty 

within United States to one 

outside United States, or 

reverse 

Yes Yes Yes From 31 days 

before leaving old 

post through 60 

days after arriving 

at new post 

1G You or eligible family member 

lose coverage under FEHB or 

another group insurance plan 

Yes Yes Yes From 31 days 

before through 60 

days after date of 

loss of coverage 

1H You or eligible family member 

lose coverage because FEHB 

plan is discontinued, in whole 

or part 

N/A Yes Yes During open 

season, unless 

OPM sets a 

different time 

29
Event 

Code for 

SF 2809 

Events that Permit 

Enrollment Changes 

May 

Enroll 

Self Only to 

Self and 

Family 

Change 

Plans or 

Options 

Time Limits 

1I You or eligible family member 

lose coverage under a 

non-FEHB group health plan 

because you move out of the 

commuting area to accept 

another position and your 

non-Federally employed spouse 

leaves job to join you 

Yes Yes Yes From 31 days 

before you leave 

commuting area 

through 180 days 

after arriving in 

new commuting 

area 

1J You or covered family member 

in an HMO move or take job 

outside the service area, or if 

already outside this area, move 

or take job further from this 

area 

N/A Yes Yes Upon notifying the 

human resources 

office of the move 

or change of place 

of employment 

1K On becoming eligible for 

Medicare (You may make this 

change only once in a 

lifetime.) 

N/A No Yes At any time 

beginning on the 

30th day before 

becoming eligible 

for Medicare 

1L You complete one year of 

continuous service as a 

temporary employee 

Yes N/A N/A Within 60 days 

after becoming 

eligible 

1M Your salary as a temporary 

employee is not enough to pay 

for plan in which enrolled 

N/A No Yes Within 60 days 

after receiving 

notice from human 

resources office 

30
Annuitants

Event Events that permit May Self Only to Change Time Limits 

Code for enrollment changes Enroll Self and Plans or 

SF 2809 Family Options 

2A Open season No Yes Yes As announced by 

OPM 

2B Change in family status (Special No Yes Yes From 31 days 

rules apply for survivor 

annuitants; refer to the FEHB 

before through 60 

days after the event 

Handbook) 

2C Reenrollment when you 

suspended FEHB enrollment to 

enroll in a Medicare HMO or 

Medicaid and later were 

May 

Reenroll 

N/A N/A From 31 days 

before through 60 

days after 

disenrollment 

involuntarily disenrolled from 

Medicare HMO or Medicaid 

2D Reenrollment when you May N/A N/A During open season 

voluntarily disenroll from a Reenroll 

Medicare HMO or Medicaid 

2E You apply for postponed Yes N/A N/A Within 60 days 

Minimum Retirement Age 

(MRA)+10 annuity under the 

after OPM mails 

you a notice of 

Federal Employees Retirement eligibility 

System (FERS) 

2F Your annuity or OWCP 

payments are restored 

Yes N/A N/A Within 60 days 

after OPM or 

OWCP mails a 

notice of insurance 

eligibility 

2G You or eligible family member Yes Yes Yes From 31 days 

lose FEHB coverage because the through 60 days 

covering enrollment was 

terminated, canceled, or changed 

after date of loss of 

coverage 

to self only 

31
Event 

Code for 

SF 2809 

Events that permit 

enrollment changes 

May 

Enroll 

Self Only to 

Self and 

Family 

Change 

Plans or 

Options 

Time Limits 

2H You or eligible family member 

lose coverage under FEHB or 

another group insurance plan 

No Yes Yes From 31 days 

before through 60 

days after loss of 

coverage 

2I You or eligible family member 

lose coverage because FEHB 

plan is discontinued in whole or 

part 

N/A Yes Yes During open 

season, unless 

OPM sets a 

different time 

2J You or covered family member 

move or take job outside the 

HMO service area, or if already 

outside this area, move or take 

job further from this area 

N/A Yes Yes Upon notifying the 

Retirement System 

of the move or 

change of place of 

employment 

2K You are in an overseas post of 

duty and retire or die 

No Yes Yes Within 60 days 

after retirement or 

death 

2L You are enrolled and separate 

from duty after serving 31 days 

or more in a uniformed service 

N/A Yes Yes Within 60 days 

after separation 

from the uniformed 

service 

2M On becoming eligible for 

Medicare (You may make this 

change only once in a lifetime.) 

N/A No Yes At any time 

beginning on the 

30th day before 

becoming eligible 

for Medicare 

2N Your annuity is not enough to 

make withholdings for plan in 

which enrolled 

N/A No Yes Retirement system 

will advise you of 

the options 

32
Former Spouse Under Spouse Equity Provisions 

Event Events that Permit May Self Only to Change Time Limits 

Code for Enrollment Changes Enroll Self and Plans or 

SF 2809 Family Options 

3A Initial opportunity to enroll Yes N/A N/A Generally, must 

apply within 60 

days after marriage 

ends. If retiring 

employee elects a 

former spouse or 

insurable interest 

annuity, the former 

spouse must apply 

within 60 days after 

OPM’s notice of 

FEHB eligibility. 

May enroll any 

time after 

eligibility 

established 

3B Open season No Yes Yes As announced by 

OPM 

3C Change in family status based No Yes Yes From 31 days 

on addition of family members 

who are also eligible family 

before through 60 

days after change 

members of the employee or in family status 

annuitant 

3D Reenrollment of former spouse 

who cancelled FEHB enrollment 

to enroll in a 

Medicare-sponsored HMO or 

Medicaid and who later was 

May 

Reenroll 

N/A N/A From 31 days 

before through 60 

days after 

disenrollment 

involuntarily disenrolled from 

Medicare HMO or Medicaid 

33
Event Events that Permit May Self Only to Change Time Limits 

Code for Enrollment Changes Enroll Self and Plans or 

SF 2809 Family Options 

3E Reenrollment of former spouse 

who voluntarily disenrolls from 

May 

Reenroll 

N/A N/A During open season 

a Medicare-sponsored HMO or 

Medicaid 

3F Former spouse or eligible child 

loses FEHB coverage because 

Yes Yes Yes From 31 days 

before through 60 

covering enrollment is days after date of 

terminated, canceled, or 

changed to self only 

loss of coverage 

3G Enrolled former spouse or N/A Yes Yes From 31 days 

eligible child loses coverage 

under another group insurance 

before through 60 

days after date of 

plan (but see 3D and 3E) loss of coverage 

3H Former spouse or eligible 

family member loses coverage 

because FEHB plan is 

N/A Yes Yes During open 

season, unless 

OPM sets a 

discontinued in whole or part different time 

3I Former spouse or covered 

family member move or take 

N/A Yes Yes Upon notifying the 

employing office of 

job outside the HMO’s service the move or change 

area, or if already outside this 

area, move or take job further 

of place of 

employment 

from this area 

3J On becoming eligible for 

Medicare (You may make this 

N/A No Yes At any time 

beginning the 30th 

change only once in a lifetime.) day before 

becoming eligible 

for Medicare 

3K Former spouse’s annuity is not No No Yes Retirement System 

enough to make the FEHB 

withholdings for plan in which 

will advise former 

spouse of options 

enrolled 

34
Temporary Continuation of Coverage Enrollees 

Event 

Code for 

SF 2809 

Events that Permit 

Enrollment Changes 

May 

Enroll 

Self Only to 

Self and 

Family 

Change 

Plans or 

Options 

Time Limits 

4A Opportunity to enroll for 

continued coverage under 

Temporary Continuation of 

Coverage (TCC) provisions 

Yes Yes, for 

former 

employee. 

N/A for 

former spouse 

and child who 

ceases to 

qualify as a 

family 

member 

Yes, for 

former 

employee. 

N/A for 

former 

spouse and 

child who 

ceases to 

qualify as 

a family 

member 

Within 60 days 

after the qualifying 

event, or receiving 

notice of eligibility, 

whichever is later. 

4B Open season No Yes* Yes As announced by 

the Office of 

Personnel 

Management 

(OPM) 

4C Change in family status (except 

former spouse) 

No Yes Yes From 31 days 

before through 60 

days after event 

4D Change in family status of 

former spouse based on addition 

of family members who are also 

eligible family members of the 

employee or annuitant 

No Yes Yes From 31 days 

before through 60 

days after event 

4E Reenrollment after Temporary 

Continuation of Coverage 

(TCC) enrollment terminated 

because of other Federal 

Employees Health Benefits 

(FEHB) coverage; then the other 

FEHB coverage is lost before 

the TCC eligibility period (18 or 

36 months) expires 

May 

Reenroll 

N/A N/A From 31 days 

before through 60 

days after the 

event. Enrollment 

is retroactive to the 

date of the loss of 

the other FEHB 

coverage 

4F Enrollee or eligible family 

member loses coverage under 

FEHB or another group 

insurance plan (but see 4E) 

No Yes Yes From 31 days 

before through 60 

days after date of 

loss of coverage 

35
Event 

Code for 

SF 2809 

Events that Permit 

Enrollment Changes 

May 

Enroll 

Self Only to 

Self and 

Family 

Change 

Plans or 

Options 

Time Limits 

4G Enrollee or eligible family 

member loses coverage because 

FEHB plan is discontinued in 

whole or part 

N/A Yes Yes During open 

season, unless the 

Office of Personnel 

Management 

(OPM) sets a 

different time 

4H Enrollee or covered family 

member in a Health 

Maintenance Organization 

(HMO) move or take job outside 

the service area, or if already 

outside this area, move or take 

job further from this area 

N/A Yes Yes Upon notifying the 

human resources 

office of the move 

or change of place 

of employment 

4I On becoming eligible for 

Medicare (You may make this 

change only once in a lifetime.) 

N/A No Yes At any time 

beginning on the 

30th day before 

becoming eligible 

for Medicare 

* Former spouse may change to self and family only if family members are also eligible family members of 

the employee or annuitant. 

36
United States Office

of

Personnel Management

1900 E Street, NW

Washington, DC 20415

www.opm.gov/forms