Everything feds need to know about enrolling in the federal employee health benefits (FEHB) program

This is part eight of our series on OPM’s FEHB Handbook,

The previous sevens parts went over the following topics –

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
Part Seven: Eligibility

This article reviews the types of enrollment and rules related to enrolling in the health insurance program for federal workers and retirees.

Learn all about FEHB plans, TriCare, FEDVIP coverage, and Medicare at our no-cost webinar -

Before diving in, it is important to note that USPS enrollment rules are different for FEHB plans. Additionally, they will not be eligible for FEHB benefits starting in 2025 and will be moving to the new Postal Service Health Benefits (PSHB) program.

Enrollment Types

The three types of enrollment for FEHB plans include

Self-only plans,
Self plus One plans, and
family coverage.

For married couples where both spouses are federal employees or retirees, it is usually cheaper for each to have their own self-only plan instead of a single self plus one plan.

Qualifying Life Events

Up to 60 days after becoming eligible for FEHB plans, the participant must enroll and pick a FEHB plan or elect to not enroll. This decision is irrevocable unless the individual experiences a qualifying life event (QLE) or during the annual open season that takes place in November each year. During the open season each year, most adjustments to coverage can be made through the online “employee express” service.

If there is a QLE, any changes to enrollment, including canceling coverage for a family member, must be made within 60 days after the given event. Once an enrollment type is selected or changed, it goes into effect on the first day of the first pay period after the employing agency was properly notified. If the enrolled fed does not participate in premium conversion, FEHB coverage can be decreased at any point.

Qualifying life events include:

New employment (feds who are reemployed after a break-in-service longer than three days in non-retirement status are considered new employees when enrolling in FEHB.)
Moving from a temporary position to a permanent full-time or part-time job – enrollment type must be selected within first 60 days of new position.
Marriage – enrollment type can be changed as early as the pay period before the expected marriage date.
Divorce – although some ex-spouses might be eligible for FEHB as a former spouse, their FEHB enrollment is typically revoked upon the date of divorce.
Birth/adoption of new dependent: enrollment type can be changed from 31 days before adoption/birth to 60 days after.
Death of spouse or dependent
A dependent reached age 26
A dependent younger than 26 gets married
A dependent age 26 or older receives court order to remain eligible for FEHB coverage
Employee moves out the geographical location of their current HMO
Separation from federal service when employee or spouse is pregnant (Temporary Continuation of Coverage, or TCC, can be granted)
FEHB enrollee has become eligible for Medicare and want to switch plans

Dual Enrollment

When a federal employee is enrolled in two FEHB plans, it is usually not allowed. One of the plans is voided and any overpayment of premiums are refunded. Dual enrollment is only allowed if a family member would otherwise lose their health insurance. These cases include when the fed and their spouse are legally separated or fully divorced and their child would lose coverage if not dually enrolled. Another instance is when a dependent covered by FEHB is under 26 but has their own dependents who are covered under their own health insurance. Or, if a dependent under 26 moves outside of the geographical area of their parent’s HMO, they can enroll their own individual insurance. The last situation where dual enrollment is excused is when there is a brief overlap as spouses consolidate their own FEHB self only plans into one Self plus one or family plan.

FEHB Eligibility and Enrollment in Retirement

To be eligible for FEHB in retirement, the federal retiree must have maintained continuous coverage by an FEHB plan in their last five years before retiring from the government. The five years must be continuous, but breaks in service don’t count. This means if you worked 10 years, maintained FEHB coverage in that time, left federal service for 2 years and didn’t have FEHB, but then returned to federal service for 1 year and enrolled back in the FEHB program, you would still be eligible. FEHB eligibility for retirees is only available if you left under an immediate retirement or a postponed FERS retirement. If you deferred your pension, you can re-enroll in FEHB upon retiring. If eligible, feds are automatically enrolled in their previous FEHB plan upon retiring.

Enrolling in Federal Employee Health Benefits (FEHB)

Some important sidenotes regarding enrollment in the FEHB program-

Dropping coverage - An FEHB enrollee may drop their current coverage if they’re terminated, have a change of residence, or switch to their spouse’s non-FEHB health insurance. Terminated feds might be eligible for a TCC and if their job is “restored,” their FEHB enrollment will be retroactively reinstated. There might also be a refund of premiums paid during TCC status. TCC could also be granted to feds serving an interim appointment.
Overseas Positions - If transferring to or from an overseas position, a federal employee has from 31 days before leaving their old post to 60 days after arriving at their new post to make enrollment changes/elections.
Leave Without Pay - Federal employees can typically keep their FEHB coverage for up to 365 days while in Leave Without Pay (LWOP) status.
Confinement - If confined to a hospital, jail, or other institution when FEHB coverage ends, continuation of that plan can be extended up to 91 days after the last day of their enrollment.

Upcoming articles in this FEHB series will be going over LWOP, TCC, and more! In the meantime, don’t forget to register for our next FEHB Webinar!

The information has been obtained from sources considered reliable but we do not guarantee that the foregoing material is accurate or complete. Any opinions are those of Serving Those Who Serve writers and not necessarily those of RJFS or Raymond James. Any information is not a complete summary or statement of all available data necessary for making an investment decision and does not constitute a recommendation. Investing involves risk and you may incur a profit or loss regardless of strategy suggested. Every investor’s situation is unique and you should consider your investment goals, risk tolerance, and time horizon before making any investment or financial decision. Prior to making an investment decision, please consult with your financial advisor about your individual situation. While we are familiar with the tax provisions of the issues presented herein, as Financial Advisors of RJFS, we are not qualified to render advice on tax or legal matters. You should discuss tax or legal matters with the appropriate professional. **