| Events That Permit
Enrollment or Change
|
Change Permitted
|
| When You Must File Health Benefits Election Form With Your Employing Office
|
| 1
|
| 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; for example: marriage, birth
or death of family member, adoption, legal
separation, or divorce.
|
Yes
|
Yes
|
Yes
|
From 31 days before through
60 days after event.
|
| 1D
|
Change in employment status; for example:
- Reemployment after a break in service of more
than three days;
- Return to pay status following loss of coverage
due to expiration of 365 days of LWOP status or
termination of coverage during LWOP;
- Return to pay sufficient to make withholdings
after termination of coverage during a period of
insufficient pay;
- Restoration to civilian position after serving in
uniformed services;
- Change from temporary appointment to
appointment that entitles employee receipt of
Government contribution;
- Change to or from part-time career
employment.
|
Yes
|
Yes
|
Yes
|
Within 60 days of
employment status change.
|
| 1E
|
Separation from Federal employment when the
employee or employee's spouse is pregnant.
|
Yes
|
Yes
|
Yes
|
Enrollment or change must
occur during final pay period
of employment.
|
| 1F
|
Transfer from a post of duty within the United States
to a post of duty outside the United States, or
reverse.
|
Yes
|
Yes
|
Yes
|
From 31 days before leaving
old post through 60 days after
arriving at new post.
|
| 1G
|
Employee or eligible family member loses coverage
under FEHB or another group insurance plan; for
example:
- Loss of coverage under another FEHB
enrollment due to termination, cancellation, or change to self
only of the covering enrollment;
- Loss of coverage under another
federally-sponsored health benefits program;
- Loss of coverage due to termination of
membership in the employee organization sponsoring the FEHB
plan;
- Loss of coverage under Medicaid or
similar State-sponsored program;
- Loss of coverage under a non-Federal health
plan.
|
Yes
|
Yes
|
Yes
|
From 31 days before through
60 days after loss of
coverage.
|
| 1H
|
Employee or eligible family member loses coverage
due to the discontinuance, in whole or part, of an
FEHB plan.
|
N/A
|
Yes
|
Yes
|
During open season, unless
OPM sets a different time.
|
| 1I
|
Loss of coverage under a non-Federal group health
plan because an employee moves out of the
commuting area to accept another position and the
employee's non-federally employed spouse
terminates employment to accompany the employee.
|
Yes
|
Yes
|
Yes
|
From 31 days before the
employee leaves the com-muting area through 180 days
after arriving in the new
commuting area.
|
| 1J
|
Employee or covered family member in a Health
Maintenance Organization (HMO) moves or becomes
employed outside the geographic area from which
the carrier accepts enrollments, or if already outside
the area, moves or becomes employed further from
this area.
|
N/A
|
Yes
|
Yes
|
Upon notifying the employing
office of the move or change
of place of employment.
|
| 1K
|
On becoming eligible for Medicare
(This change may
be made only once in a lifetime.)
|
N/A
|
No
|
Yes
|
At any time beginning on the
30th day before becoming
eligible for Medicare.
|
| 1L
|
Temporary employee completes one year of
continuous service in accordance with 5 U.S.C.
Section 8906a.
|
Yes
|
N/A
|
N/A
|
Within 60 days after
becoming eligible.
|
| 1M
|
Salary of temporary employee insufficient
to make withholdings for plan in which enrolled.
|
N/A
|
No
|
Yes
|
Within 60 days after receiving
notice from employing office.
|
| 3
|
| 3A
|
Initial opportunity to enroll, Former spouse must be
eligible to enroll under the authority of the Civil
Service Retirement Spouse Equity Act of 1984 (P.L.
98-615), as amended, the Intelligence Authorization
Act of 1986 (P.L. 99-569), or the Foreign Relations
Authorization Act, Fiscal Years 1988 and 1989 (P.L.
100-204).
|
Yes
|
N/A
|
N/A
|
Generally, must apply within
60 days after dissolution of
marriage. However, if a
retiring employee elects to
provide a former spouse
annuity or insurable interest
annuity for the former spouse,
the former spouse must apply
within 60 days after OPM's
notice of eligibility for FEHB.
May enroll any time after
employing office establishes
eligibility.
|
| 3B
|
Open season.
|
No
|
Yes*
|
Yes
|
As announced by OPM.
|
| * Former spouse may change to self and family only if family members are also eligible family members of the employee or annuitant.
|
| 3C
|
Change in family status 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 change in family
status.
|
| 3D
|
Reenrollment of former spouse who cancelled FEHB
enrollment to enroll in a Medicare sponsored
Coordinated Care Plan (Medicare HMO), Medicaid, or
similar State-sponsored program and who later was
involuntarily disenrolled from the Medicare HMO,
Medicaid, or similar State-sponsored program.
|
May
Reenroll
|
N/A
|
N/A
|
From 31 days before through 60 days after
disenrollment.
|
| 3E
|
Reenrollment of former spouse who cancelled FEHB
enrollment to enroll in a Medicare-sponsored
Coordinated Care Plan (Medicare HMO), Medicaid, or
similar State-sponsored program and who later
voluntarily disenrolls from the Medicare-sponsored
Coordinated Care Plan (Medicare HMO), Medicaid, or
similar State-sponsored program.
|
May
Reenroll
|
N/A
|
N/A
|
During open season.
|
| 3F
|
Former spouse or eligible child loses FEHB coverage
due to termination, cancellation, or change to self
only of the covering enrollment.
|
Yes
|
Yes
|
Yes
|
From 31 days before through
60 days after date of loss of
coverage.
|
| 3G
|
Enrolled former spouse or eligible child loses
coverage under another group insurance plan; for
example:
- Loss of coverage under another
federally-sponsored health benefits program;
- Loss of coverage due to termination of
membership in the employee organization
sponsoring the FEHB plan;
- Loss of coverage under Medicaid or similar
State-sponsored program (but see 3D and 3E);
- Loss of coverage under a non-Federal health plan.
|
N/A
|
Yes
|
Yes
|
From 31 days before through
60 days after loss of
coverage.
|
| 3H
|
Former spouse or eligible family member loses
coverage due to the discontinuance, in whole or part,
of an FEHB plan.
|
N/A
|
Yes
|
Yes
|
During open season, unless
OPM sets a different time.
|
| 3I
|
Former spouse or covered family member in a Health
Maintenance Organization (HMO) moves or becomes
employed outside the geographic area from which
the carrier accepts enrollments, or if already outside
this area, moves or becomes employed further from
this area.
|
N/A
|
Yes
|
Yes
|
Upon notifying the employing
office of the move or change
of place of employment.
|
| 3J
|
On becoming eligible for Medicare
(This change may
be made only once in a lifetime.)
|
N/A
|
No
|
Yes
|
At any time beginning the 30th day before
becoming eligible for Medicare.
|
| 3K
|
Former spouse's annuity is insufficient to make FEHB
withholdings for plan in which enrolled.
|
No
|
No
|
Yes
|
Retirement System will advise
former spouse of options.
|
| 4
|
| 4A
|
Opportunity to enroll for continued
coverage under TCC provisions:
- Former employee
- Former spouse
- Child who ceases to qualify as a family member
|
|
|
|
Within 60 days after the qualifying event,
or receiving notice of eligibility, which-ever is later.
|
| 4B
|
Open season:
- Former employee
- Former spouse
- Child who ceases to qualify as a family member
|
|
|
|
As announced by OPM.
|
| * Former spouse may change to self and family only if family members are also eligible family members of the employee or annuitant.
|
| 4C
|
Change in family status (except former spouse); for
example, marriage, birth or death of family member,
adoption, legal separation, or divorce.
|
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 eligible family
members of the employee or annuitant.
|
No
|
Yes
|
Yes
|
From 31 days before through
60 days after event.
|
| 4E
|
Reenrollment of a former employee, former spouse,
or child whose TCC enrollment was terminated
because of other FEHB coverage and who loses the
other FEHB coverage before the TCC period of
eligibility (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; for example:
- Loss of coverage under another FEHB
enrollment due to termination, cancellation, or change to self
only of the covering enrollment (but see event 4E);
- Loss of coverage under another
federally-sponsored health benefits program;
- Loss of coverage due to termination of
membership in the employee organization sponsoring the FEHB
plan;
- Loss of coverage under Medicaid or
similar State-sponsored program;
- Loss of coverage under a non-Federal health plan.
|
No
|
Yes
|
Yes
|
From 31 days before through
60 days after loss of
coverage.
|
| 4G
|
Enrollee or eligible family member loses coverage due
to the discontinuance, in whole or part, of an FEHB
plan.
|
N/A
|
Yes
|
Yes
|
During open season, unless
OPM sets a different time.
|
| 4H
|
Enrollee or covered family member in a Health
Maintenance Organization (HMO) moves or becomes
employed outside the geographic area from which
the carrier accepts enrollments, or if already outside
this area, moves or becomes employed further from
this area.
|
N/A
|
Yes
|
Yes
|
Upon notifying the employing
office of the move or change
of place of employment.
|
| 4I
|
On becoming eligible for Medicare.
(This change may be made only once a
lifetime.)
|
N/A
|
No
|
Yes
|
At any time beginning on the
30th day before becoming
eligible for Medicare.
|
