Taxes

Table of Permissible Changes in FEHB Enrollment for Employees Participating in Premium Conversion

Qualifying Life Events (QLEs) that

FEHB Enrollment Change that May Permit Change in FEHB Enrollment or Premium Conversion Election

Time Limits in which Change May Be Permitted

Code

Event

From Not Enrolled to Enrolled

Increase From Enrollment Type*

Cancel or One Plan or Option to Another

When You Must File Decrease Enrollment Type**

Health Benefits Election Form With
Your Employing Office

1A

Initial Opportunity to Enroll, for example: • New employee • Change from excluded position • Temporary employee who completes 1 year of service and is eligible to enroll under 5 USC 8906a

Yes

N/A

N/A

N/A

Within 60 days after becoming eligible

1B

Open Season.

Yes

Yes

Yes

Yes

As announced by OPM

1C

Change in family status that results in increase or decrease in number of eligible family members, for example: •Marriage,divorce, annulment, legal separation • Birth, adoption, acquiring foster child or stepchild, issuance of court order requiring employee to provide coverage for child • Last eligible child loses coverage, for example, child reaches ages 26, disabled child becomes capable of self-support, child acquires other coverage by court order • Death of spouse or dependent

Yes

Yes

Yes

Yes

Within 60 days after change in family status

1D

Any change in employee’s employment status that could result in entitlement to coverage, for example: • Re-Employment after a break in service of more than three days; • Return to pay status from non-pay status, or return to receiving pay sufficient to cover premium withholdings, if coverage terminated (If coverage did not terminate, see 1G.)

Yes

N/A

N/A

N/A

Within 60 days after employment status change

1E

Any change in employee’s employment status that could affect cost of insurance, including:

• Change from temporary appointment with eligibility for coverage under 5 USC 8906a to appointment that permits receipt of government contribution • Change from full time to part-time career or the reverse

Yes

Yes

Yes

Yes

Within 60 days after employment status change

1F

Employee restored to civilian position after serving in uniformed services

Yes

Yes

Yes

Yes

Within 60 days after return

1G

Employee, spouse or dependent:

• begins non-pay status or insufficient pay or

• ends non-pay status or insufficient pay if coverage continued

(If employee’s coverage terminated, see 1D.)

• (If spouse’s or dependent’s coverage terminated, see 1M.)

No

No

No

Yes

Within 60 days after employment status change

1H

Salary of temporary employee insufficient to make withholdings for plan in which enrolled.

N/A

No

Yes

Yes

Within 60 days after receiving notice from employing office to civilian position

1I

Employee (or covered family member) enrolled in FEHB health maintenance organization (HMO) moves or becomes employed outside the geographic area from which the FEHB carrier accepts enrollments or, if already outside the area, moves further from this area.

N/A

Yes

Yes

N/A

Upon notifying employing office of move

1J

Transfer from post of duty within a State of the United States or the District of Columbia to post of duty outside a State of the United States or District of Columbia, or reverse.

Yes

Yes

Yes

Yes

Within 60 days after arriving at new post

1K

Separation from federal employment when

the employee or employee’s spouse is pregnant.

Yes

Yes

Yes

N/A

During employee’s final pay period

1L

Employee becomes entitled to Medicare and wants to change to another plan or option.

No

No

Yes

N/A

Any time beginning on the 30th day before becoming eligible for Medicare

1M

Employee or eligible family member loses coverage under FEHB or another group insurance plan including the following:

• Loss of coverage under another FEHB enrollment due to termination, cancellation, or change to Self-Only of the covering enrollment

• Loss of coverage due to termination of membership in employee organization sponsoring the FEHB plan

• Loss of coverage under another federally-sponsored health benefits program, including: TRICARE, Medicare, Indian Health Service

• Loss of coverage under Medicaid or similar State-sponsored program of medical assistance for the needy

• Loss of coverage under a nonfederal health plan, including foreign, state or local government, private sector

• Loss of coverage due to change in worksite or residence (Employees in an FEHB HMO, also see 1I.)

Yes

Yes

Yes

Yes

Within 60 days after loss of

coverage

1N

Loss of coverage under a nonfederal group health plan because an employee moves out of the commuting area to accept another position and the employee’s nonfederally employed spouse terminated employment to accompany the employee.

Yes

Yes

Yes

Yes

From 31 days before the employee leaves the commuting area to 180 days after arriving in the new commuting area

1O

Employee or eligible family member loses coverage due to discontinuance in whole or part of FEHB plan.

Yes

Yes

Yes

Yes

During open season, unless OPM sets a different time

1P

Enrolled employee or eligible family member gains coverage under FEHB or another group insurance plan, including the

following:

• Medicare (employees who become eligible for Medicare and want to change plans or options, see 1L.)

• TRICARE for Life, due to enrollment in Medicare.

• TRICARE due to change in employment status, including: (1) entry into active military service, (2) retirement from reserve military service under Chapter 67, title 10.

• Medicaid or similar State-sponsored program of Medical assistance for the needy

•Health insurance acquired due to change of worksite or residence that affects eligibility for coverage

• Health insurance acquired due to spouse’s or dependent’s change inemployment status (includes state, local, or foreign government or private sector employment).

No

No

No

Yes

Within 60 days after QLE

1Q

Change in spouse’s or dependent’s coverage under a nonfederal health plan, for example:

• Employer starts or stops offering a different type of coverage (If no other coverage is available, also see 1M.)

• Change in cost of coverage

• HMO adds a geographic service area that makes spouse ineligible for coverage under that HMO, but other plans or options are available (if no other coverage is available, see 1M)

No

No

No

Yes

Within 60 days after QLE

1R

Employee or eligible family member becomes

eligible or assistance under Medicaid or a State

Yes

Yes

Yes

Yes

Within 60 Days after the date the employee of family member

Children's Health Insurance Program (CHIP). becomes eligible for assistance.

* Change from self-only to self plus one or to self and family, or change from self plus one to self and family
** Change from self and family to self plus one or to self-only, or change from self plus one to self-only

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