Attachment A(3) 

AGENCY LETTERHEAD 

 

 [Date] 

Model TCC Continuation Coverage Additional Election Notice 

(For use by agencies for individuals who experienced an involuntary termination in which 

the individual did not elect TCC coverage or elected, but subsequently dropped, coverage 

and for which the involuntary termination occurred during the period from September 1, 

2008, through February 16, 2009.)

Dear XXXXXX: 

The American Recovery and Reinvestment Act of 2009 (ARRA), enacted February 17, 2009, 

provides a new health insurance opportunity for former employees who were or are eligible for 

temporary continuation of coverage (TCC) under the Federal Employees Health Benefits 

(FEHB) Program because they were involuntarily terminated between September 1, 2008, and 

December 31, 2009. Under this new law, former Federal employees may request premium 

assistance for their TCC under the FEHB Program. Premium assistance means your former 

agency will make a Government contribution of 65 percent of the TCC premiums for your FEHB 

plan enrollment. 

Your Federal employment terminated on [Date]. In accordance with 5 CFR 890.1103(a)(1), you 

were eligible to enroll in TCC to continue your FEHB health benefits coverage for 18 months 

following the date of your separation from Federal employment. This is to notify you that you 

have an additional opportunity to elect TCC. In addition, you may request premium assistance, 

which will be extended for up to 9 months or until you become eligible for other group health 

coverage or Medicare or the date your TCC period, measured from the date you initially became 

eligible for TCC, ends. Note that “group health coverage” in this instance does not include 

limited coverage such as that consisting of only dental, vision, counseling, or referral services; 

coverage under a health-care flexible spending arrangement; coverage of treatment that is 

furnished in an on-site medical facility maintained by the employer and that consists primarily of 

first-aid services, prevention and wellness care, or similar care; or a combination of any of the 

above. Also note that eligibility for other group health coverage will disqualify you from 

receiving premium assistance; it does not matter whether you elect to enroll in the other group 

health coverage. 

If you are not eligible for other group health insurance coverage or Medicare and you now wish 

to enroll in TCC and receive premium assistance, you must complete the attached request form 

and send it to [Benefits Officer] at the following address: 

 [Agency Address] 

Under TCC rules, you may enroll in any FEHB Program plan as your TCC coverage. However, 

please note that to be eligible for premium assistance, you must enroll in TCC under the FEHB 
plan you were enrolled in when you were separated from Federal service, or another FEHB plan 

with an equal or lower premium. If you receive premium assistance, your premium will be 35 

percent of your FEHB TCC premium for the period in which you are eligible and enrolled. Your 

share of the premium for the health plan you were enrolled in on the day prior to your separation,

[name of plan], is [Premium amount from Attachment C]. Please note that receipt of premium 

assistance does not lengthen the 18-month period for which you are eligible for TCC. 

If you become eligible for any group health plan or other coverage described above that makes 

you ineligible for premium assistance, you must notify your FEHB Program health plan and your 

former agency at the address provided in this letter. You no longer may receive premium 

assistance for any remaining TCC period or you may be subject to a penalty of 110 percent of the 

premium assistance you received. 

You also should be aware there may be tax consequences associated with receipt of premium 

assistance for certain high-income individuals. The Internal Revenue Service website has 

information for former employees at: 

www.irs.gov/newsroom/article/0,,id=204505,00.html. 

The Guide to FEHB Plans for TCC Enrollees, the SF-2809 Health Benefits Election Form, and a 

request for premium assistance are attached. ARRA-TCC premiums for FEHB plans are on the 

FEHB website at www.opm.gov/insure/health/. 

The SF-2809 FEHB Election Form and your premium assistance request must be received at the 

address shown above within 60 days from the date of this notice for you to be eligible for TCC 

and premium assistance. 

If you have questions, please contact me at [phone number]. 

 

 Sincerely, 

 [Name] 

 Benefits Officer 

Attachments