Former Spouses May be Eligible to Enroll in the FEHB Program

The Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615) was enacted on Nov. 8, 1984. Under this act – now referred to as the “spouse equity provisions” – certain former spouses of federal employees, former employees and annuitants may qualify to enroll in a health insurance plan under the Federal Employees Health Benefits (FEHB) program. If these qualifying former spouses are currently enrolled in the FEHB program, then they can make enrollment changes like other currently FEHB program enrolled employees, annuitants and survivor annuitants. This column discusses the spouse equity and FEHB program rules for former spouses.

A former spouse is eligible to enroll in the FEHB program under the spouse equity provisions if the following conditions are met:

(1) The federal employee, former employee or annuitant and former spouse were divorced after being married during the employee’s, former employee’s, or annuitant’s federal employment;

(2) the former spouse was covered as a family member under an FEHB enrollment at least one day during the 18 months before the marriage ended;

(3) the former spouse is entitled to a portion of the employee’s or former employee’s CSRS or FERS annuity; and

(4) the former spouse has not remarried before age 55.

The employee’s or former employee’s employing office while the employee/former employee/ annuitant and former spouse were married will determine whether the former spouse is eligible to enroll in the FEHB program.

The former spouse loses FEHB program coverage as a family member upon divorce, subject to a 31-day extension of coverage. Unfortunately, the former spouse’s FEHB program enrollment under the spouse equity provisions may not begin for several months after the divorce. This depends on how long it takes to establish eligibility for FEHB program re-enrollment. To avoid a gap in health insurance coverage, the former spouse may: (1) Convert to a non-group contract during the 31-day extension of coverage; or (2) continue FEHB coverage under the temporary continuation of coverage (TCC) provision of the FEHB program. The TCC option requires the former spouse to pay both the employee’s and the federal government’s portion of the FEHB premiums, plus a two percent administrative charge. If the former spouse seeks coverage under the spouse equity provisions, it is advisable to stay with the same FEHB plan.

If the former spouse act promptly, he or she may request retroactive enrollment once the application for enrollment under the spouse equity provisions has been approved. For enrollment to be retroactive, the employing office must receive an appropriate request and satisfactory proof of eligibility within 60 days after the day of divorce.

Enrolling under the spouse equity provisions is a three-step process, namely:

1.  Formal application to enroll within the time limit. A former spouse’s application to enroll can either be a completed Health Benefits Election Form (SF 2809) or a written notice of intent to apply for health benefits. The former spouse’s name, date of birth and Social Security number are entered on Part A of the SF 2809. The employee’s, former employee’s or annuitant’s name and date of birth must be entered in the Remarks section.

A former spouse must apply for health benefits within: (1) 60 days after the marriage ends; (2) 60 days after the date of OPM’s notice of his or her eligibility to enroll based on a qualifying court order awarding entitlement to a portion of the employee’s CSRS or FERS annuity; or (3) 60 days after the date of the notice of the former spouse’s eligibility to enroll based on entitlement to a former spouse annuity under another retirement system for Government employees.

2.  Establish eligibility to enroll. When a former spouse applies for eligibility to enroll under the spouse equity provisions, the employing office of the individual the former spouse was married to must first verify that the individual was employed by the agency at the time of divorce. If the individual separated from federal service before becoming eligible for an immediate annuity, then the former spouse is eligible to enroll in the FEHB program only if the marriage ended before the individual left federal service.

The employing office must then determine if the former spouse is eligible to enroll. To be eligible, the former spouse must meet all of the following requirements: (1) Must not have remarried before age 55; (2) must have been covered as a family member in an FEHB program plan at least one day during the 18 months before the marriage ended; and (3) must provide documentation from OPM (or the CIA or Foreign Service retirement systems, if applicable) of entitlement to a portion of the individual’s (the person the former spouse was married to) future annuity (CSRS or FERS) or a former spouse CSRS or FERS survivor annuity.

3.  Written confirmation for FEHB program health benefits and enrollment. If a former spouse is eligible for health benefits coverage, the employing office will provide the former spouse: (1) Written confirmation of its decision; (2) a premium payment schedule; and (3) a certification form stating the requirements for continued enrollment. The former spouse must sign and date the certification form. If the former spouse did not submit a Health Benefits Election Form (SF 2809) or other enrollment request as the application to enroll, he or she must complete one to enroll.

The effective date of enrollment is the first day of the fist pay period after the employing office received the Form SF 2809 and has approved eligibility. If the former spouse requests immediate coverage, and the employing office receives Form SF 2809 and satisfactory proof within 60 days after the date of the divorce, the enrollment may be made effective on the same day that temporary continuation of coverage under the FEHB program would otherwise take effect.

During an open season, the former spouse may increase enrollment type, change from one plan or option to another, or make any combination of these changes. With a self plus one or self and family enrollment, the only eligible family members that can be added to self plus or self and family enrollment are the natural or adopted children of the former spouse and the federal employee or annuitant on whose service the former spouse’s coverage is based. An “open season” enrollment is effective on the first day of the first pay period in January of the following year.

Premium Payments

The former spouse must pay the employee and government shares of the FEHB program health insurance premium for every pay period he or she is entitled. There is no government contribution. The employing office must establish a premium payment schedule and is responsible for collecting the premiums.

If the employing office does not receive a premium payment by a due date, it must notify the former spouse in writing that he or she must pay within 15 days (45 days if he or she lives overseas) after he or she receives the notice in order for the coverage to continue. The notice must state that if he or she does not make payment within this time frame, he or she is considered to have voluntarily canceled the enrollment.

Termination of a Former Spouse’s FEHB Enrollment

A spouse equity enrollment terminates subject to the 31 day extension of coverage at midnight of the last pay period in which: (1) a qualifying court order ceases to provide entitlement to a portion of a retirement annuity (CSRS or FERS) or a former spouse survivor annuity under a retirement system for government employees; (2) the former spouse remarries before age 55; (3) the former spouse dies; (4) the employee on whose service the benefits are based dies and no survivor annuity is payable; (5) the separated employee on whose service the benefits are based dies before meeting the requirements for a deferred annuity; (6) the employee on whose service the benefits are based leaves federal service before establishing title to an immediate annuity or a deferred annuity; or (7) the retirement system pays a refund of retirement contributions to the separated employee on whose service the benefits are based.