FEHB Benefits and Cost for Retirees and Annuitants
As an annuitant, you are entitled to the same FEHB benefits and government contribution as non-Postal active employees enrolled in the same plan.
Your share of the enrollment cost also continues to be the same as for a non-Postal employee and is deducted from your annuity payments.
For most employees and annuitants, the federal government contribution equals the lesser of:
72 percent of amounts OPM determines are the program-wide weighted average of premiums in effect each year, for self only and for self and family enrollments, respectively, or
75 percent of the total premium for the particular plan an enrollee selects.
If you are a part-time career employee, the government contribution toward your health benefits is prorated in proportion to the percentage of full-time service you are regularly scheduled to perform.
During each pay period in which your FEHB enrollment is in effect, you are responsible for paying all premiums in excess of the Government contribution, usually 25% of the total premium.
Withholdings from your annuity
When you retire, your employing office's responsibility for withholdings and contributions depends on when your annuity starts.
If your annuity starts after the end of your final pay period, your employing office will make withholdings and contributions for the entire final pay period.
If your annuity starts before the end of your final pay period, your employing office will make withholdings and contributions through the day before the starting date of your annuity, using the Daily Proration Rule.
Mary Helen is retiring on May 31. The pay period begins on May 25 and ends on June 7. The biweekly employee share of her health benefits plan premium is $32.26 and the biweekly Government share is $61.51.
The daily withholding rate is $2.30 ($32.26 x 26 ÷ 364) and the daily contribution rate is $4.39 ($61.51 x 26 ÷ 364).
Her employing office will make withholdings and contributions for the period from May 25 through May 31 (7 days), calculated as follows:
Withholdings: $2.30 daily rate x 7 days = $16.10
Contributions: $4.39 daily rate x 7 days = $30.73
If your annuity is not large enough to cover your share of the premiums for your plan, you may either change to a lower-cost plan or option (one in which your share of the premium is low enough to be withheld from your annuity) or choose to pay your premiums directly to your retirement system. Even if your employing office thinks that your annuity will not cover your share of the premiums, it will transfer your existing enrollment to your retirement system. Your retirement system will notify you of your options and take whatever actions you request.
Direct Premium Payments
If you decide to pay your share of premiums directly to your retirement system, your retirement system will establish a payment schedule for you. You must continue to make premium payments directly for the length of your enrollment even if your annuity increases enough to cover your premiums.
Nonpayment of Premiums
If you are making direct payments and your retirement system doesn't receive your premium payment by the due date, it must notify you in writing that you must make payment within 15 days (45 days if you live overseas) for your coverage to continue. If you don't make payment, your retirement system will terminate your enrollment 60 days (90 days if you live overseas) after the date of the notice. Your coverage will be terminated retroactive to the end of the last pay period in which you made the payment. You may not reenroll, unless nonpayment was for reasons beyond your control.
If you weren't able to make timely payment for reasons beyond your control, you may write to your retirement system to ask that your coverage be reinstated. You must file the request within 30 days from the date your enrollment was terminated and provide proof that the nonpayment was beyond your control. Your retirement system will determine if you are eligible for reinstatement of coverage. If it decides to allow reinstatement, it will be restored retroactive to the termination date. If your request is denied, you may request that your retirement system reconsider its initial decision.
|Related Articles & Resources|
· FEHB Premium Conversion
· How to Continue Your FEHB Health Benefits Coverage After Retirement
· Eligibility for FEHB Health Benefits After Retirement
· FEHB Program Features
· Changing FEHB Enrollment During Open Season