Basic FEHB Eligibility
As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions. This chapter in the FEHB Handbook explains these provisions.
Retirees and Survivor Annuitants
Federal retirees and their surviving spouses retain their eligibility for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement) and must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.
Temporary Continuation of Coverage (TCC)
TCC is a feature of the FEHB Program that allows certain people to temporarily continue their FEHB coverage after regular coverage ends. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative charge.
FEHB for Dependents
Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. Your employing office will look at the child's relationship to you as the enrollee to determine whether the child is a covered family member. In determining whether the child is a covered family member, your employing office will look at the child's relationship to you as the enrollee.
Former Spouses
Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.
CHAMPUS, TRICARE and Tricare-for-Life
OPM has issued a final rule
to allow TRICARE and CHAMPVA eligible FEHB Program annuitants, survivors, and former spouses to
suspend their FEHB enrollments, and then return to the FEHB Program
during the Open Season, or return to FEHB coverage immediately if they
involuntarily lose this non-FEHB coverage.
Civilian Employees on Active Military Duty
Federal employee reservists who are placed in a leave without pay status when called to active duty for more than 30 days can keep their FEHB coverage for up to 24 months. The reservist is responsible for paying the enrollee share of the premium during the first 12 months, and the agency pays the agency's share.
Temporary Firefighters and Fire Protection Personnel
OPM has issued regulations to extend coverage under the Federal Employees Health Benefits (FEHB) program to temporary firefighters and fire protection personnel working on wildland fires across the country. Coverage became available beginning on July 17, 2012. Please find copies of the regulations and additional material explaining the new regulations by clicking the title of this section above.