FEDweek

The Five-Year Rule, and Its Exceptions

By law (5 U.S. Code 8905(b), you can continue your coverage under the Federal Employees Health Benefits program in retirement if you have been enrolled continuously in the program for either the five years immediately preceding retirement or since your first opportunity to enroll in it. You don’t have to be enrolled in a specific plan for that period of time. In fact, you could change plans every year and still meet the "five year or first opportunity" requirement.

Originally, this was the only way you could be sure that you’d be able to carry your health benefits coverage into retirement. Then OPM was given the authority to grant waivers of the five-year requirement to individuals who applied for one. However, the criteria imposed by the Congress were so narrow that few waivers were ever granted.

Then, when early outs and buyouts became the order of the day, OPM was granted additional authority to grant waivers. That’s because the Congress realized that one of the major impediments to downsizing was the large number of employees who wouldn’t leave government because they didn’t meet the five-year requirement and would lose their health insurance coverage.

As a result of that additional authority, OPM can grant pre-approved waivers of the five-year requirement to any employee who has been:

*covered under the FEHB program continuously since the start date of either his agency’s latest statutory buyout authority or an OPM-approved early retirement or buyout authority; and

*receives a buyout, takes early optional retirement, or takes discontinued service retirement when faced with involuntary separation resulting from a RIF, directed reassignment, reclassification to a lower grade or abolishment of position.

If you don’t meet the criteria in the law and your retirement opportunity fits the above criteria, you won’t have to write OPM and request a waiver. Under the new rules, your agency will have to attach a memorandum to your retirement papers stating that your retirement meets the requirements for a pre-approved waiver.

Just remember, these waivers only apply in the circumstances described above. So, if you decide to retire, don’t meet the requirements in law and don’t meet the pre-approved waiver criteria, the odds are that you’ll be out of luck.