FEDweek

Carrying FEHB Coverage into Retirement

As the end of the year approaches, some of you are thinking seriously about retiring. In fact, a few of you have already put in your paperwork. If you are one of them, I hope you’ve considered whether you’ll be able to continue your Federal Employees Health Benefits coverage in retirement.

You can continue that coverage if you’ve been enrolled in the FEHB program continuously for the five years immediately preceding retirement or from your first opportunity to enroll in it. This doesn’t mean that you have to have been enrolled in a specific plan for that period of time. You could have changed plans every year and still meet the five-year (or first opportunity) requirement. Note: You can count your time under Tricare toward the five-year requirement as long as you are enrolled in an FEHB plan when you retire. Being covered by a spouse’s enrollment also counts.

While the five-year or first opportunity to enroll requirement sounds hard and fast, there is an exception you need to be aware of. OPM will grant a waiver if you were covered by the FEHB program continuously since the beginning date of your agency’s latest statutory buyout authority or OPM approved buyout and early out authority and receive a buyout and retire during your that period. It also applies if you take discontinued service retirement due to a RIF, directed reassignment, reclassification of your position to a lower grade, or abolishment of your position.

If you retire under one of the conditions cited above, your agency will attach a memorandum to your retirement papers stating that your retirement meets the criteria for a pre-approved waiver of the FEHB five-year requirement.

FYI: If you decide to retire without meeting either the requirements in law or the waiver criteria cited above, you’ll probably be out of luck. Although OPM has the authority to grant individual waivers, it rarely does so. That’s because the law has set a very high threshold. Your failure to satisfy the five-year requirement must be due to circumstances so exceptional that it would be against equity and good conscience to deny you coverage.