Impact on Health Insurance Coverage

Chapter 7: Section 3

General Eligibility Rules

A former spouse who is awarded a portion of a CSRS or FERS annuity or a survivor annuity by a qualifying court order, even though the benefit is not yet payable, may be eligible to enroll for health benefits coverage under the FEHB program under the spouse equity provision. However, the former spouse is not eligible to retain coverage under the employee’s or retiree’s own family enrollment. FEHB coverage may also be temporarily continued under the temporary continuation of coverage authority; see Temporary Continuation of Coverage in Chapter 2, Section 1. (Note: Coverage under spouse equity or TCC qualifies for purposes of avoiding penalties under the Affordable Care Act, Public Law 111-148, for those who do not have health insurance coverage on themselves and their dependents that meets certain standards. See FEHB Eligibility and Enrollment Rules in Chapter 2, Section 1.)

A former spouse’s continued entitlement to FEHB coverage is based on the court order requirements for a former spouse annuity. Children’s eligibility for FEHB coverage is controlled by federal law and cannot be affected by a state court order.

A court order granting the former spouse a portion of the retiree’s annuity provides the former spouse with a monthly payment after the employee retires and continued FEHB coverage until the employee dies. A court order that grants a survivor annuity provides the former spouse with continued FEHB coverage until the former spouse dies, but the annuity does not begin until the employee/retiree dies. A court order providing a portion of the retirement annuity and a survivor annuity ensures an annuity payment from the date of retirement or death and continued FEHB coverage until the former spouse dies.

Individuals who qualify as a former spouse must enroll in FEHB coverage in their own right and must pay both the employee’s and the government’s share of the premium. Those who are receiving survivor annuity benefits will have the premium cost withheld from the annuity; otherwise the former spouse must pay the cost of such health coverage directly to the OPM.

For a former spouse of an active or retired employee to continue FEHB coverage after a divorce, four basic requirements must be met. The former spouse must:

• have been covered as a family member under the employee/retiree’s FEHB enrollment for at least one day during the 18 months before the end of the marriage;
• be entitled to receive a portion of the retirement annuity after the employee retires or a survivor annuity at the time the employee/retiree dies;
• within 60 days after the end of the marriage, apply to the employment office of the agency where the employee worked and provide written notice that he or she wants to continue FEHB coverage under the spouse equity provisions of the FEHB law. If the marriage ended after retirement, that notice must be sent to OPM’s retirement system; and
• not remarry before age 55.

If both parents are eligible for FEHB coverage (for example, if both are federal employees), children are entitled to receive benefits under only one enrollment. If there is a reason for both parents to enroll in self and family coverage (for example, if both parents remarry and need to cover their new spouses and any stepchildren), each enrollee must notify his or her insurance carrier of the name(s) of the child(ren) to be covered under his or her enrollment.

Court-Ordered Benefits for Children—Public Law 106-394, 114 Stat. 1629, mandates compliance with court or administrative orders requiring federal employees to provide health benefits for their children. Under 5 CFR Parts 890 and 892, a federal employee subject to such an order must enroll for self and family coverage in a health plan that provides full benefits in the area where the children live or provide documentation to the agency that he or she has obtained other health benefits for the children.

If the employee does not do so:

• if the employee has no FEHB coverage, the agency will enroll him or her for self and family coverage in the option of the Blue Cross and Blue Shield Service Benefit Plan that provides the lower level of coverage;
• if the employee has a self-only enrollment in a fee-for-service plan or in an HMO that serves the area where all the children live, the agency will change his or her enrollment to self and family in the same option of the same plan;
• if the employee is enrolled in an HMO that does not serve the area where all the children live, the agency will determine if a reciprocity agreement will cover all the children (a reciprocity agreement allows enrollees of one HMO to receive services from another HMO). If a reciprocity agreement between the employee’s HMO and another plan would cover each child, the employee may remain in his or her HMO. If there is no such agreement, the agency will change his or her enrollment to self and family in the lower option of the Blue Cross and Blue Shield Service Benefit Plan.

If you were involuntarily enrolled in Blue Cross and Blue Shield, you may change to another plan if you were prevented from enrolling or changing enrollment within the 60-day time due to circumstances beyond your control. Agencies are responsible for deciding whether your failure to make a timely election was beyond your control. Generally, an error in judgment or failure to read information is not considered beyond your control. You have 60 days from the date notified of an allowance to enroll in another FEHB plan. The change is effective on a prospective basis only.

As long as the court or administrative order is in effect, and you have at least one child identified in the order who is still eligible under the FEHB program, you cannot cancel your enrollment, change to self-only, or change to a plan that does not serve the area in which the child or children live, unless you provide documentation that you have other coverage for the children. If the court or administrative order is still in effect at the time you retire, and if at least one child is still eligible for FEHB, you must continue FEHB into retirement (if eligible) and cannot make any of these changes after retirement for as long as the order remains in effect and the child continues to be eligible.

If you go into an unpaid status, or if your salary becomes insufficient to make the premium withholdings, you must continue the coverage and either make direct premium payments or incur a debt to the government. If after retirement your annuity remains subject to such a court or administrative order but your annuity is insufficient to make the premium withholdings, you must continue the coverage and make direct premium payments for as long as the order remains in effect and the child continues to be eligible.

Employees who are subject to a court order to provide health benefits for their children and who are eligible to continue their coverage into retirement cannot make any changes that would affect their children’s FEHB coverage after retirement.

Federal agencies will respond to a National Medical Support Notice, which provides a standardized format of instructions concerning an employee’s obligation to provide health insurance coverage for one or more children.

Coverage Procedures

Coverage begins on the first day of the pay period after the agency’s employment office or the retirement system receives all properly completed qualifying documents—i.e., a Standard Form 2809 or a signed statement with enough information to execute enrollment—and satisfactory proof of eligibility. Former spouses whose divorce occurred during the spouse’s federal service should contact the employing agency, while former spouses whose divorce occurred after the spouse’s retirement should contact the Office of Personnel Management, Court-Order Benefits Branch, P.O. Box 17, Washington, DC 20044-0017, phone (202) 606-0218 and ask for that branch.

To avoid a potential break in coverage, former spouses might want to apply for temporary continuation of FEHB coverage pending a decision on their eligibility for ongoing coverage as a former spouse; see Temporary Continuation of Coverage in Chapter 2, Section 1.

Former spouses who do not meet the criteria for ongoing FEHB coverage may continue temporary coverage for three years from the date the marriage ended. To be eligible for temporary continuation, they need only have been covered by FEHB at some time during the 18 months before the marriage dissolved. The application must be filed within 60 days after the divorce or annulment. They are eligible to convert to a non-group health benefits contract when their temporary continuation of coverage ends.

A former spouse who meets the requirements for ongoing FEHB coverage may elect self-only or family insurance. A family enrollment covers only the former spouse and the natural or adopted dependent children of both of the former marriage partners. A child must be under age 26 or incapable of self-support because of a mental or physical disability existing before age 26. A child cannot be covered by more than one FEHB enrollment.

A former spouse’s entitlement to FEHB coverage, if based on entitlement to survivor benefits, normally continues for life. However, a former spouse’s FEHB enrollment may end, subject to a 31-day coverage extension for conversion to an individual contract, if:

• a court order ceases to provide entitlement to a survivor annuity or to a portion of a retirement annuity;
• the former spouse remarries before age 55;
• the employee or annuitant on whose service the benefits are based dies and no survivor annuity is payable to the former spouse;
• a separated employee on whose service the benefits are based dies before the requirements for a deferred annuity have been met;
• an employee on whose service benefits are based leaves federal service before establishing title to an immediate or deferred annuity; or
• a refund of retirement contributions is paid to the separated employee on whose service the benefits are based.

If any of those events occur before the three-year eligibility for temporary continuation of coverage expires, the former spouse can change to temporary continuation enrollment for the remainder of that period.

The coverage of a former spouse’s family member ends, subject to a 31-day extension of coverage for conversion to an individual contract, when the individual ceases to be an eligible family member (as defined above) or when the former spouse ceases to be enrolled, unless the family member is entitled as a survivor annuitant to continued enrollment or is entitled to continued coverage under the enrollment of another person.

A former spouse may cancel enrollment at any time. However, former spouses who cancel their enrollment may not later re-enroll. A former spouse whose enrollment is terminated because of nonpayment of premiums generally may not re-enroll. Further information is at www.opm.gov/faqs (search for “divorce”).

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