What Changes in FEHB Enrollment Are Permitted During — and Outside — of Open Season?

[ NOTE:  The OPM-sponsored annual federal benefits open season will occur this year Nov. 9, through Dec. 14, 2020.]

During the benefits open season, federal employees and annuitants can make changes to their Federal Employees Health Benefits (FEHB) program insurance, and enroll, change or disenroll from their dental and vision insurance offered through the Federal Employees Dental and Vision Insurance Program (FEDVIP). Employees can also enroll and re-enroll in the Health Care Flexible Spending Account (HCFSA) or limited expense flexible spending account (LEXFSA) and/or the dependent care flexible spending account (DCFSA) offered through the FSAFEDS program.

This is the second of five columns discussing what employees and annuitants should be considering in making their insurance choices during the 2019 benefits open season, and discusses the changes in FEHB enrollment permitted during open season and those enrollment changes permitted outside of open season.

SEE ALSO:  2020 FEHB Plan Comparison Tools, Brochures, Premium Rates Now Available

An employee may enroll for the first time in the FEHB program during an open season (held every year from the second Monday of November through the second Monday of December). Those employees who are enrolled in the FEHB program may change FEHB plans, options, types of enrollment, or their premium conversion status during open season.

A non-enrolled annuitant is not permitted to enroll in the FEHB program during an open season unless the annuitant had “suspended” FEHB enrollment to join a Medicare managed care plan (Medicare HMO, Medicare Part C), or if eligible enrolled in TriCare, or because of eligibility under Medicaid or a similar state-sponsored program of medical assistance for the needy.

It is important to note the effective dates of the annual open season enrollments and changes in enrollment, as listed below:

• A new enrollment is effective the first day of the first pay period that begins in the following year and that follows a pay period during any part of which an employee was in pay status.

Note: The 2020 leave year begins on Sunday, Jan. 5, 2020. This means if an employee makes a new FEHB program enrollment during the 2019 open season, and assuming the employee is in pay status during pay period 26 of the 2019 leave year, the employee’s new enrollment becomes effective Jan. 5, 2020.

• A change in an employee’s FEHB enrollment (type of FEHB plan, options, and premium conversion status) is effective the first day of the first pay period that begins in the following year, regardless of whether the employee is in pay status.

• When an employing office accepts a late open season enrollment or change in enrollment, the change is effective retroactive to the same date that it would have been effective if it had been received on time.

• An annuitant’s change in enrollment becomes effective on January 1 following the end of the open season.

Changes in Family Status

An employee may enroll, decrease enrollment, change from one plan to another, change from one option to another, or make any combination of these changes during the period beginning 31 days before and ending 60 days after a change in the employee’s family status. A change of family status includes: (1) Marriage; (2) birth or adoption of a child; (3) acquisition of a foster child; (4) legal separation; (5) divorce; or (6) death of a spouse or dependent. An employee can change enrollment only once during this time period, unless there is another event during this time that would permit an enrollment change.

An employee or annuitant who changes enrollment because of the birth or adoption of a child will have an effective date of the enrollment change on the first day of the pay period in which the child becomes a family member.

New Spouse

If an employee or annuitant wants to provide immediate coverage for a new spouse, the employee or annuitant may submit an enrollment request during the pay period (for an employee), or month (for an annuitant), that occurs before the anticipated date of the marriage. If the effective date of the change is before the marriage date, then the new spouse does not become eligible for coverage until the actual date of the marriage.

If an employee or annuitant changes his or her enrollment before the date of the marriage and intends to change his or her name, then the employee or annuitant must note on the request: “Now: (Current Name) will be: (Married Name). The reason for the change and the date of the marriage must be given in the request.

Divorce or Separation

In the case of a legally separated federal employee/annuitant, the employee’s or annuitant’s spouse is still considered a family member and eligible for coverage under self plus one or self and family coverage. Upon a final divorce decree, the spouse is no longer an eligible family member and is no longer enrolled under the employee’s or annuitant’s self plus one or self and family enrollment. If there are two or more children enrolled under self and family enrollment, the employee/annuitant will have to maintain self and family enrollment status.

Opportunities to Enroll or to Change Enrollment – Former Spouse

A former spouse of a federal employee or annuitant who has coverage under the spouse equity provisions of FEHB law (to be discussed in a future MFR column) may increase enrollment (add a child to coverage) or to change from one plan or option to another, or both, within 60 days after the birth or acquisition of an eligible child. To be eligible, the child must be that of both the former spouse and the employee/annuitant on whose service the former spouse’s FEHB coverage is based.

Change in Employment Status

In general, an employee may enroll or increase enrollment, decrease enrollment, change from one plan or option to another, or make any combination of these changes within 60 days after a change in the employee’s employment or health insurance status. The following are examples of changes in employment or health insurance status, together with the allowable enrollment changes that an employee may make.

• Return to pay status after 365 days in leave without pay status or terminating during leave without pay status. If an employee’s enrollment terminated because: (a) the employee had been in a leave without pay status for 365 days; (b) the employee entered leave without pay status; or (c) at any time during the employee’s first 365 days in leave without pay status the employee was terminated; then the employee may enroll in self only, self plus one or self and family coverage in any available plan or option when the employee returns to pay status. If the employee was not enrolled in the FEHB program at the time of leave without pay status began, the employee may enroll upon return to pay status only if a qualifying event occurred while the employee was on leave without pay.

• Reemployment after more than a 3 day break in service. If an employee moves from one employing office to another, other than by retirement, with a break in service of more than three days, the employee may enroll the same as a new employee. A Nonappropriated Fund (NAF) employee who returns to Federal employment is eligible for coverage, even if the employee had continued coverage under the NAF retirement system.

• Return from military service. A federal employee who is restored to a civilian position after service in the uniform services under conditions the entitled the employee to benefits under 5 CFR part 353 or similar authority, the employee may enroll in any option of any available plan after returning to civilian duty.

• Transfer to or from overseas employment. An employee may enroll or change enrollment when the employee transfers from a duty post within the United States to a duty post outside the United States or the reverse. The employee has 31 days before the date the employee is expected to leave the former duty post and 60 days after arrival at the new duty post to enroll or change enrollment.

• Change to or from part-time career employment. When an employee changes to part-time career employment (16 to 32 hours a week) with a break in service of three days or less, the employee may enroll or change FEHB enrollment within 60 days from the change in employment status. Similarly, when the employee changes from part-time to full-time employment, the employee may enroll or change enrollment.

• Termination of membership in employee organization. If an employee is enrolled in a plan sponsored by a union or employee organization and the employee stops being a member of that organization, the plan can ask the employee’s employing office to terminate the FEHB program plan’s subject to a three day extension of coverage. The employee can then reenroll in another FEHB program plan within 60 days of termination of the previous FEHB program plan.

• An employee or annuitant is enrolled in a plan that is discontinued. An employee may change to another plan when the employee is enrolled in a plan that is discontinued, in whole or in part. If the FEHB program plan is discontinued at the end of a contract year, the employee must change enrollment during “open season” unless OPM establishes a different time.

• An employee’s or an employee’s spouse’s loss of non-federal health insurance coverage is due to a move outside of the commuting area. In that case, the employee must enroll or change FEHB program enrollment within the period beginning 31 days before the date of the change in employment in the old commuting area and ending 180 days after entering, on duty, at the place of employment in the new commuting area.

• Lost of coverage under spouse’s non-federal health insurance plan. In that case, an employee or annuitant may enroll immediately in a FEHB program plan for both the employee or annuitant and the spouse.

• Move from an HMO’s service area. An employee who is enrolled in an HMO and moves or becomes employed outside the HMO’s service area may change enrollment. The employee or annuitant may also change enrollment if an enrolled family member moves outside the service area. The employee must notify his or her employing office of the move. The annuitant must notify OPM of the move.

• An employee or annuitant becomes eligible for Medicare. An employee or annuitant who becomes eligible for Medicare may change his or her FEHB program enrollment to any options of any available plan at any time. This begins on the 30^th day before coming eligible for Medicare and ending 30 days after enrolling in Medicare. This enrollment change under this event may only be made once.

While new enrollments (new employees) and other permissible enrollment changes (as discussed above) can be made as usual during the open season, these should not be identified as open season changes on the appropriate request. This is because open season changes do not take effect until the first day of the new leave year in January. Open season changes made during the 2019 open season (Nov.11 – Dec. 9, 2019), becomes effective Jan. 5, 2020, the first day of the 2020 leave year. Employees and annuitants should make sure that they specify the reasons for their enrollment changes on their enrollment requests, using Form SF 2810 (Notice of Change in Health Benefits Enrollment) or at some agencies through an electronic method such as “Employee Express” or “My Pay”.