Information for 

Retirees and 

Survivor 

Annuitants

Federal Employees 

Health Benefits (FEHB)

This pamphlet contains information 

about the Federal Employees 

Health Benefits Program. Refer to 

it when you or your family have 

questions about the program.
We provide re

the Internet. Y

forms, and oth

www.opm

You will find 

www.opm

You may also 

at: 

retire@op

We will respo
Health Benef

If You Are a R

Disabled Chil

Foster Childre

New Family M

If You Are a W

Are Rece

Death Be

If You Are a F

Survivor 

Deferred Ann

Federal Emp

(FERS) P

When a Fam

for Cove

Changing Yo

Factors to Con

Plan ......

Plans (called 

Approved 

and Medi

If You Want t

If You Want t

Coverage 

Medicaid and 

Health B

If You Want t

Families Whe

Under the 

Own Rig

Direct Payme

How to Chang

Effective Date

Events Whic

Federal Emp

Continuation 

After En

Widows, Wid

Continuation 

After the 

Was Cov
Coverag

If You Are a R

If You Are a R

If You Are a W

Survivor 

If You Are a 

Survivor 

If You Are a C

Widow(er)’s 

If Remar

If FEHB Cov

31-Day Exten

Conversion to 

Temporary Co

Employe

Coverage 

How Medica

Benefits 

Medicare Prem

How to File C

If Your Claim 

Is Denied

How to Obta

Identific

Special Infor

Related Infor

Publicati
enrollment. O

1-888-767-67

allows you to 

regular busine

Customer Ser

7:30 a.m. and 

hearing impai

should call 1-

us for assistan

We will make 

benefits enrol

� Change fr

� Change p

service ar

� Change fr

you are el

� Cancel or 

you the fo

writing. 

If you prefer, 

U.S. O

Retirem

P.O. B

Boyers

Anytime you 

retirement cla

annuity numb

all correspond

of birth and b

corresponden

you are a wid

premiums dire

former Federa

annuity is bas
1.	 Self Only 

only for y

2.	 Self and 

benefits f

members

If You Are 

A Self and Fa

spouse, and y

for informatio

legally adopte

children. You

you certify th

parent-child r

requirements 

include a fost

certification f

Other relative

(unless the gr

not eligible fo

they live with 

Your monthly 

enrollment is 

number of fam

enrollment. If 

coverage, you

you become t

you should co

enrollment to 

Note: A fami

immediately i
g g

child’s eligibi

former emplo

this document

action unless 

If you have a 

established th

form which y

complete. 

Foster Chil

A foster child 

under age 26 

� is financia

� lives with 

There must be 

raise the child 

as discussed o

these criteria m

child tempora

neither is one 

social service 

child and pay

New Famil

If you have a 

eligible family 

you are a retir

covered by yo

health insuran

member so th

carrier may as

as proof of ma

member’s nam

Number. If yo

acquire a new 
Basic Emp

A Self and Fa

for you and al

deceased emp

If you remarry 

See page 22 f

However, if y

you were mar

more, your co

cover your ne

If you remarry 

continue, but 

his or her dep

If you also rec

your own Fed

transfer the en

cover your ne

children. If yo

provide your r

numbers. We 

transfer your 

request. 

If You Are 

Annuitant 

If you have he

spouse (i.e., y

employee’s or 

enrollment co

adopted child 

employee or r

may also be c

child or grand

and his or her 

enrollment. If 

enrollment wi
D

If you separat

could retire an

that started wh

enroll in the F

Program. You 

as a family m

enrollment, bu

Federa

Syst

If you are cov

immediate ret

service, you m

avoid the age 

for health ben

you begin to r

were eligible 

When 

Eli

� You will n

insurance 

eligibility 

� Your spou

Self and F

divorce or 
If your family 

for any of the 

information a

coverage; this 

the family me

days after the 

period, the fam

contract offer

the family me

Changi

Factors to 

Plan 

Because healt

person, we ca

plan or option 

to choose, you 

needs, the typ

prefer, and the 

compare the b

you. Your elig

your decision

We prepare a 

and Their Sur

general inform

plan participa

has a brochur

You can obtai

1-888-767-67

writing to: 

U.S. Offic

Retiremen

P.O. Box 

Boyers, P
how to reques

you need from 

Center. 

Before you m

plans, you sho

brochures for 

When compar

your health ca

premiums and 

the following

� deductible

must incu

� coinsuran

must pay f

� co-payme

for a servi

� charges fo

services, l

not covere

The FEHB Pr

so you will ha

your health-ca

site includes a 

plans to help y

Plans (call

Approved b

and Medica

CMS-approve

age 65 or olde

B. If you join 

your FEHB en

the FEHB Pro

office for the 
compare them 

For additional 

You handbook 

If You Wan

You may susp

you are chang

using TRICA

or CHAMPVA 

not eligible fo

changing to, y

enrollment in 

for your spou

� If you are 

we need a 

enrollmen

� If you are 

Life, we n

identificat

need a cop

enrollmen

� If you are 

need a cop

coverage. 

� If you are 

of your CH

Send us a cop

enrollment da

your FEHB en
If you involun

TRICARE, T

CHAMPVA, 

or a similar st

the FEHB Pro

coverage ends

received at th

(OPM) within 

and ending 60 

Otherwise, yo

reenroll. 

Medicaid a

Health Ben

You may susp

furnish proof 

Medicaid prog

program of m

involuntarily 

state-sponsore

available FEH

before and en

coverage. The 

date following 

state-sponsore

If you suspen

furnished proo

Medicaid prog

program of m

wish to reenro

than an involu

state-sponsore

next open sea

effective on J
contract or en

coverage. In a

coverage does 

Generally, vo

permanently 

Program. If yo

will give you 

a cancellation 

If you cancel 

member unde

you are eligib

the other pers

contact us wit

and ending 60 

coverage. 

Families W

Eligible Un

Their Own 

If you are elig

retirement and 

eligible for FE

have two Self 

Family enroll

You may chan

time during th

Annuitants en

enrollment at 

(OPM) in ord

and Family FE

participating i

agency notifie

enrolled in FE

enrollment as 

deducting pre
of an annuitan

annuitant wan

enrollment, O

benefits and s

after the fami

spouse retires 

(and elects) to 

or her own an

enrollment an

from that annu

If both spouse

enrollment as 

Self Only enr

enrollment. T

and Family to 

OPM Retirem

1-888-767-67

numbers. The 

month after O

or one of the e

change from S

enrollment. 

Direct Pay

Annuitants 

Sometimes th

amount of the 

prevent the lo

you the choic

making premi

choose direct 

be deducted 

the annuity i

than the prem

The cost of yo

if we could w

annuity. You 

will receive a 
described on p

How to Cha

To change yo

give your retir

your survivor 

When you con

you wish to m

change, and th

Before we can 

enrollment, w

signed and ret

includes the f

1.	 A statem

entitled to 

2.	 A statem

reenroll i

Health B

unless yo

covered 

Note: If 

discussed 

enrollmen

Self and F

to reenro

Effective D

Open season c

effective date 

on the date ou

Generally, the 

pages 14 and 

after the mon

a change. (Fo

change to Sel

date for the ch
When you loo

remember tha

the first busin

and insurance 

example, if yo

Only coverag

premium will 

payment. 
y

Open season

Your family 

divorce, leg

family mem

child). 

You are enr

Maintenanc

you move o

moves from 

Your plan st

Federal Emp

Program (FE

You become 

(You may m

your lifetime

You or an e

coverage un

insurance pl

� Loss of 

Federa

program

� Loss of 

of mem

organiz

plan; 

� Loss of 

a simil

� Loss of 

non-Fe

*We can ma

telephone 

These are some 

you to make an 

enrollment cha
Yes 

Yes 

Yes 

Yes 

Yes 

Yes 
may receive a

may wish to h

withheld from 

annuities so th

conversion pr

If you are app

coverage, you

you whether y

in premium co

notify OPM o

premium conv

and the annuit

the agency mu

procedure is s

Service Benef

01-105 dated 

Conti

Survivo

Widows, W

After your de

continue to be 

Self and Fami

survivor annu

annuity. 

The survivor’

same amount 

from the surv

one survivor a

eligible for co

enrollment to 
Death Benefit 

survivor annu

of any Social 

their FEHB en

to us, if they a

coverage. 

If you elected 

a former spou

survivor annu

as long as you

OPM will set 

can pay the pr

your spouse w

because a form

survivor annu

to set up an ac

your spouse w

for coverage w

survivor annu

spouse loses e

coverage ends 

survivor annu

are not made. 

Contin

Childre

Parent W

If you are a su

and the enroll

eligible to rec

benefit, you c

annuitant’s Se

You can conti

incapable of s
benefit and th

enrollment wi

in your name. 

premiums eith

survivor annu

continue this 

annuity ends a

full-time stud

you can contin

eligible for a 

incapable of s

physical disab

Your coverag

eligibility end

During that tim

Continuation 

individual pol

Widow

Who Are 

If you are a w

employee and 

employee, im

survivor annu

enrolled in tw

Premium C

If you are a F

your Federal E

enrollment tra

to your emplo

premiums wit

We call this “

conversion all

by the amoun
participate in 

information o

of Personnel M

www.opm.gov

click on the li

(FAQ) and Pr

Reinstatem

If your enrollm

any reason, yo

as a survivor a

receiving a su

a survivor ann

suspended or 

agency.

If your enrollm

employing ag

enrollment ba

information.

What E

B

If You Are 

If your annuit

disability retir

capacity), you

of the month f

However, cov

without cost t

If you are a di

terminated as 

health benefit

for an immed

your disability 
earning capac

which you ret

to have FEHB 

enrolled at the 

terminated. 

If you are enti

disability ann

FEHB covera

If You Are 

If you are reem

position that c

Program and y

enrollment wi

allow you to t

(a pre-tax ded

want to contin

deductions fro

participation i

employing ag

If you are reem

annuity termin

will be transfe

Generally, the 

reemploymen

position unde

System or the 

System and if 

because of a d

If you are reem

immediately. 

claim number 

copy of the pe

appointment, 

of your emplo
yy

children cann

survivor annu

widow(er) sur

an annuity ba

may be eligib

retirement ann

your new spou

If you remarry 

and FEHB en

month preced

(subject to the 

page 23). How

who was marr

deceased emp

annuity and y

you are enroll

your annuity e

any eligible ch

entitled to rec

not be covere

must notify us 

with a copy o

your survivor 

If you are a w

annuity paym

receiving the 

FEHB covera

coverage term

by the paymen

spouse’s surv

payable a surv

enroll for hea

If you are a w

FEHB covera

age 55, see pa

coverage and 

marriage ends
under the 

provided 

2.	 you do no

the paym

withheld 

If you are a fo

benefits cover

before age 55

benefits cover

marriage ends

If You Are 

If you have FE

covered under 

ends when yo

Coverage End

If you are rece

coverage beca

the coverage c

enrollment to 

opportunity to 

Widow(e

I

If you remarry 

ends at the en

you remarry. 

married to th

discussed on 

death, divorce

will be reinsta

remarriage en

date your ann
number) and t

or annuitant o

If F

31-Day Ext

In order to giv

nongroup hea

continue for 3

any reason ex

confined to a 

extension, you

confined, up t

These extensi

apply to any f

under your en

you voluntaril

Conversion 

If you are: 

� a retiree,

� a widow o

� a child of 

who has c

Health Be

� a former s

and your enro

by voluntary c

to a nongroup 

carrier of the 

Nongroup con

evidence of in

premium for a 
interested in c

nearest office 

nongroup con

termination no

If you do not 

60 days of the 

unable for rea

timely reques

belated reque

within 6 mont

must provide 

ended. (For ex

your marriage 

former spouse 

remarriage be

that you were 

enrollment an

otherwise awa

convert for re

If you make a 

described in th

benefits carrie

convert to a n

convert, you m

receiving the 

If the carrier d

convert, you m

writing: 

U.S. Offic

Healthcar

P.O. Box 

Washingt

If a member o

coverage unde

example, whe

divorced from 

entitled to con

plan during th
wants to conv

days after elig

office of the p

information a

family membe

your enrollme

nongroup con

The effective 

day after the 3

expires. The p

must pay the p

under the con

Note: Many 

under the con

provide under 

premium rate

generally high

contribution t

may be an im

of changing p

will lose cove

you need to k

converted non

plan. 

Temporary 

Employees 

Coverage 

Under certain 

FEHB covera

spouses who l

annulment an

the Spouse Eq

continuation o

the qualifying 

coverage is th

enrollee and G

administrative 

premium. 
For a former s

must contact u

spouse loses c

annulment, or 

The correspon

address of the 

your name an

information, s

of Coverage U

Benefits Prog

How Med

Because many 

Employees H

Medicare cov

or no-fault au

have a coordin

provision. Th

enrollees and 

much of their 

coverage perm

charges for th

benefits (COB

plan normally 

payer and the 

secondary pay

Generally, Me

health benefit

you: 

� are age 65 

� are not em
All FEHB pla

that they supp

benefits. If M

generally pay 

FEHB plan w

secondary pay

The combined 

equal 100 per

Although 100 

expenses may 

medical expen

either Medica

You are respo

expenses. You 

handbook (av

and your hea

information a

expenses. 

If Medicare is 

expenses, you 

Medicare for 

your insuranc

after Medicar

Most FEHB c

transfer your 

its share. If yo

arrangement, 

Explanation o

to your carrier 

If you (and yo

(Part A-Hospi

Insurance) an

Fee-For-Servi

coverage for a
� pays for c

travel is in

� is required 

for Life.

Note: The m

enrollment is 

have Medicar

30th day befo

you have a on

enrollment to 

are eligible). Y

open season. 

Medicare P

OPM can with

Insurance (Pa

under certain 

local Social S

Personnel Ma

premiums wit

Security will n

(CSA number

number). If yo

Security offic

Administratio

which will no

from your ann

these premium

being withhel

notified to do 

Administratio

should always 

office if you h

matter. 
completing an

carrier for pay

claim form to 

for claim form

This informat

discusses Disp

brochure, whi

www.opm.gov

If Yo

E

If your carrier 

service, it wil

written reques

denial. This ti

you were prev

control from m

limit. In your 

your carrier sh

service. Your 

provisions in 

Within 30 day

reconsideratio

affirm the 

pay the cl

provide th

request ad

to make a 

If this informa

carrier will ba

on hand.
demonstrate 

opportunity t

Before seekin

some things y

� Submit bi

carrier alo

send bills 

within our 

disputed c

� Providers 

and with t

and are re

assigned a

regard to t

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to be sure 

instance, t

complicat

or operativ

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� a copy 

recons

� a copy 

� copies 

(such 

explan

� your d

You may ask 

respond withi

reconsideratio

additional info

a request for r

request to the 

you were noti

information. I

date of your r
You (or a per

bring a lawsu

treatment, ser

your plan unti

established at 

Federal Regul

If you decide 

claim, you mu

of the third ye

service was pr

relief that rela

recoverable u

amount of ben

must be broug

limited to the 

the basis of ou

affirming the 

Privacy Act S

review of a de

we or our con

title 5, United 

collected from 

carrier has act

payment or se

may be disclo

of OPM’s de

How 

I

If you have lo

must contact y

replacement. 

change plans, 

the change, an
your new ID c

to the doctor o

enrollment. B

Number and d

carrier. If you 

also refer to th

or annuitant o

and give his o

of birth. 

Sp

If your annuit

eligible for an

from the Offic

Programs, U. 

contact your c

change or can

maintains you

compensation 

your annuity r

your health be

premiums fro

Rel

We hope this 

other question

benefits, you 

retire@opm.g
service retirem

date of birth t

promptly. If y

booklets, liste

automated sys

You may send 

address. For m

www.opm.gov

FEHB Guides 

Questions at

www.opm.gov

Information 

(CSRS)

Information 

(CSRS)

Information 

Annuitants (

Information 

Federal Emp

Insurance Pr

Temporary C

Under the Fe

Benefits Pro

Information 

Retirement S

Information 

Annuitants

Information 

Annuitants


United State

Office f Per nnel Manage ent

1900 E Street, NW

Washington, DC 20415

www.opm.gov/retirement-services

RI 79-2

Revised June 2013

Previous edition is usable.