Eligibility for federal employee health benefits (FEHB) - After a long pause, we’re resuming our deep dive into the FEHB program’s handbook. This article reviews which employees of the federal government are eligible for FEHB, and which aren’t.
Back in the fall, we started a series breaking down OPM’s FEHB Handbook, which is a dense document that details all the technicalities around health insurance for active and retired federal workers, and their family members. The goal was to cover the entire handbook during the FEHB open season but the density of the document had been underestimated. To review, the previous six parts covered:
- Part One: General Overview
- Part Two: Legal Responsibilities
- Part Three: FEHB Premiums and Premium Conversion
- Part Four: FEHB Withholding, Contributions, and the Daily Rate
- Part Five: Types of Health Plans Available
- Part Six: FEHB Coordination with Other Health Insurance
So, after a few months, we are now resuming our breakdown of the handbook into more digestible chunks with part Seven on eligibility for federal employee health benefits.
Learn all about FEHB plans, TriCare, FEDVIP coverage, and Medicare at our no-cost webinar -
Similarly to FEGLI eligibility, it might be easier to focus more on which federal employees are not eligible. But unlike the federal employee life insurance program, there is a larger group of exceptions. Most part-time and full-time federal employees are eligible unless their position is excluded by law or regulations. This is determined by the employing agency, but OPM makes the final determination.
The following types of employees are almost definitely not eligible:
- Feds employed by the Tennessee Valley Authority
- Employees technically employed by a corporation that is supervised by the Farm Credit Administration (FCA)
- Patient employees in government hospitals or homes
- Federal contractors (most likely not eligible)
The following types of employees might be eligible depending on the exceptions:
- Employees of a county committee – if that committee was established under section 8(b) of the Soil Conservation and Domestic Allotment Act.
- US commissioners – if subject to Civil Service Retirement or Federal Employee Retirement laws.
- Presidential appointees – if their term doesn’t expire.
- Temporary employees – if they’ve received a provisional appointment or have completed one year of continuous employment.
- DC Government employees – if first employed before October 1st, 1987. (OR – if you are employed at St. Elizabeth’s Hospital. There are also some exceptions for some criminal justice positions.)
- Student employees under “Pathways Program” even if it is a temporary position that is less than one year of continuous employment.
- Designated staff of Congressmembers – if they have worked 130 hours per month for at least 90 days.
Every other federal employee not mentioned in the two lists above should be good to go – except if their employing agency or OPM has decided that their position is excluded either by law or some other government regulation. Also, starting 2025, USPS employees and retirees will be required to enroll in a new Postal Service Health Benefits (PSHB) program.
Upcoming articles in this FEHB series will be focusing on health plan eligibility and enrollment. In the meantime, don’t forget to register for our next FEHB Webinar!
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