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You need to complete the SF 2809 if you change your enrollment from Self and Family to Self Only or vice versa.
For example, if you have Self and Family coverage and you plan to keep Self and Family coverage, you do not need to complete any forms. You must let the health plan know the date of the divorce so that your ex-spouse can be removed from your enrollment. If you have Self and Family coverage and you now plan on enrolling in Self Only coverage, you must notify your Human Resources Office. You will have to complete an SF 2809.
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Spouse equity is a provision of the law that allows the former spouse of a Federal employee or annuitant to enroll in FEHB if he or she meets certain requirements.
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Contact your ex-spouse's agency Human Resources Office (or retirement system, if applicable) for information on how to enroll. You will need to document your eligibility. You will be required to submit a certified copy of the court order to the US Office of Personnel Management, Court Ordered Benefits Branch, P.O. Box 17, Washington DC 20044-0017. This office will review the court order to determine if you qualify to enroll. The Court Ordered Benefits Branch will issue a letter notifying you of their findings. Since it may take a few months for this notification to be sent, you should contact your former spouse's Human Resources Office and request to enroll in TCC. The notification from the Court Ordered Benefits Branch will provide instructions on enrolling under the Spouse Equity provisions of the law.
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The employing office has 14 days to notify you of your TCC rights and send you an election form. You must return the election form and a certified copy of your divorce decree within 60 days from your divorce date or 65 days after the date of the employing office notice, whichever is later. Your coverage will be effective the day after your 31-day extension of coverage as a family member ends.
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Your spouse is eligible for coverage while you are in the process of getting divorced and even while you are legally separated. Your spouse loses eligibility for coverage as a family member when your divorce is final. Your spouse can apply for coverage in the FEHB Program under the
Spouse Equity or
Temporary Continuation of Coverage provisions of the FEHB law. Your spouse should contact your HR office to apply.
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Generally, your coverage continues for 36 months from the date of your divorce or annulment, as long as you pay your premiums on time.
After your TCC enrollment ends:
- you get a 31-day extension of coverage, and
- you may convert to an individual contract offered by your health benefits plan,
unless you lose coverage because you canceled your enrollment or didn't pay your premiums.
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To qualify for Spouse Equity coverage, submit an application to your former spouse's Human Resources Office (or, if applicable, the former spouse's retirement system) within 60 days after your divorce. To be eligible, you must have been covered as a family member under your spouse's FEHB Program enrollment at least one day during the 18 months prior to divorce and you must have future entitlement to receive a portion of your spouse's retirement annuity or a survivor annuity. Also, if you remarry prior to age 55 you will lose this coverage. If you do not qualify under the Spouse Equity provisions, you may be eligible for coverage under the Temporary Continuation of Coverage provisions. You may also convert to a private policy.
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You must apply within 60 days of:
- the date your marriage ended, or
- the date the employing office notified you that your qualifying court order (or your former spouse's election) entitled you to coverage, whichever is later.
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As long as your spouse has a Self and Family enrollment and you are still married to your spouse, you will be covered under the enrollment. Your eligibility for coverage under your spouse's Self and Family enrollment will cease after a divorce or annulment. You may, however, be eligible for FEHB coverage under either the Spouse Equity provisions or the Temporary Continuation of Coverage provisions of the law. You would be enrolled in your own right and would pay both the Government and employee shares of the premium yourself.
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Although you cannot remain covered as a family member under your spouse's Self and Family enrollment (even if a court order requires it), you may be eligible for FEHB Program coverage under either the
Spouse Equity provisions or the
Temporary Continuation of Coverage provisions of the law. You would be enrolled in your own right and would pay both the Government and employee shares of the premium yourself.
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The "Federal Employees Health Benefits Children's Equity Act of 2000" requires mandatory Self and Family enrollment coverage for FEHB-eligible employees who do not comply with a court or administrative order to provide health insurance coverage for their child(ren). You should send a copy of the court order to your ex-spouse's Human Resources Office. They will ensure that your ex-spouse has an FEHB Self and Family enrollment that provides coverage for the children.
If your ex-spouse does not have a Self and Family enrollment, his Human Resources Office will enroll him in the Self and Family option of his current FEHB plan. If his current plan is an HMO and the child(ren) don't live within the service area of this plan, they will enroll him in the Basic Option of the Blue Cross and Blue Shield Service Benefit Plan. Please be sure to include your home address in your notification so that the Human Resources Office can make this determination.
The Human Resources Office will send you a copy of the SF 2809, Health Benefits Election Form. They will also send a copy to the FEHB plan so the plan can update their records and send ID cards to you. The Human Resources Office will flag your ex-spouse's health insurance records to prevent him from making a change to a Self Only enrollment for as long as the court order requires him to provide health insurance coverage to your child(ren) or until the youngest child reaches age 26, whichever occurs first.
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The time limit for notification is 60 days from your divorce or annulment. Either you or your former spouse must notify the employing office in writing that you want TCC. If your former spouse is retired, notify the retirement system.
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No. According to the FEHB law, if you or your former spouse didnt notify the employing office within the 60-day limit, your opportunity to elect TCC ends 60 days after your divorce or annulment.
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You are no longer an eligible family member when your divorce or annulment becomes final. You get a 31-day extension of your health benefits plans coverage after that date. You may convert to an individual contract offered by your health benefits plan, if you don't qualify for or don't want FEHB coverage through Spouse Equity or TCC.
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You can keep your Spouse Equity coverage indefinitely if you pay your premiums on time, don't remarry before age 55, and don't lose your entitlement to an annuity or survivor annuity.
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Yes. Spouses of federal annuitants are covered under a family enrollment in the Federal Employees Health Benefits (FEHB) Program during the divorce process and during a legal separation. Spouses of annuitants lose eligibility for FEHB coverage when the divorce is final. Former spouses of annuitants can apply for coverage in the FEHB Program under the
Spouse Equity or
Temporary Continuation of Coverage provisions of the FEHB law. Former spouses of annuitants must contact the annuitant’s retirement system within 60 days after the divorce to apply.
For more information on divorce after retirement, please visit
http://www.opm.gov/insure/health/faq/divorce.asp.
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Spouse Equity:
- If you qualify for Spouse Equity, you can elect FEHB coverage in your own right.
- Your coverage continues indefinitely, as long as you continue to meet the requirements (see next section) and pay your premiums.
- You must pay both the employee and government shares of your plans FEHB premium.
- You do not have to pay the extra 2% administrative charge.
TCC:
- Your coverage is limited. It will end 36 months after your divorce or annulment, or earlier if you do not pay your premiums.
- You must pay both the employee and government shares of your plans FEHB premium, plus an administrative charge equal to 2% of total plan premiums.
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Only you and the children born to or adopted by you and your former spouse (the Federal employee or annuitant) are covered.
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Only you and the children born to or adopted by you and your former spouse (the Federal employee or annuitant) are covered under a Self and Family enrollment. Your child must be under age 26 or be incapable of self-support because of a mental or physical disability that existed before age 26.
Your children cannot be covered under more than one FEHB enrollment. If the employee or annuitant covers the children under his/her FEHB enrollment, your Spouse Equity enrollment should be for Self Only coverage.
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No, the children are entitled to receive benefits under only one enrollment. Generally, when divorce occurs, one parent will enroll in Self Only coverage and the other parent will enroll in Self and Family coverage to provide benefits for the children. If there is a reason for both parents to enroll in Self and Family coverage (i.e., both parents have remarried and need Self and Family enrollments to cover their new spouses and stepchildren), each enrollee must notify his or her insurance carrier of the name(s) of the child(ren) to be covered under his/her enrollment to prevent ant child from receiving dual coverage under FEHB (which is prohibited by Federal law).
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