Reg Jones Expert's View

Last week I wrote about how survivor benefits are affected if you marry, divorce or die. Let’s take a look now at how life events can affect your health benefits.

Marriage
If you aren’t enrolled in the Federal Employees Health Benefits (FEHB) program at the time of your marriage, you can enroll upon marriage and select a plan and an appropriate coverage option. If you were already enrolled upon marriage, you can change plans and/or coverage. For example, if you were single, you can change from Self Only to Self Plus One. If you were enrolled in Self Plus One to cover a dependent child, you can change to Self and Family. You would make these changes by submitting an enrollment change from 31 days before the marriage to 60 days after it. Standard Form 2809, Health Benefits Election Form, available at www.opm.gov/forms. If you miss that time frame, you’d have to wait until the next open season.

If you were already enrolled in Self and Family at marriage to cover an eligible child/children, all you have to do is add your new spouse (and any eligible children of that spouse, if applicable) to your coverage. You would do this by contacting your health plan.

Separation, Annulment or Divorce
If you are legally separated or are in the process of getting an annulment or a divorce and are enrolled in either the Self Plus One or Self and Family option, your spouse is eligible to continue that coverage during that process. However, federal law mandates that FEHB coverage end at midnight of the day your annulment or divorce is final. That’s true even if a court order requires that your ex-spouse be covered by your FEHB enrollment. Note: He or she can receive health benefits coverage under the spouse equity act, the temporary continuation of coverage (TCC) provision or by converting to an individual policy with your FEHB carrier. For more information on these options, go to www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/former-spouses.

If no one else is covered under your enrollment when the annulment or divorce is final, you can switch to Self Only. You can also switch to another plan.

However, if you have additional family members, you can continue under the Self and Family option or, if there is only one eligible member, move to Self Plus One. You have 60 days after the event to make a change. You can do that by completing a Standard Form 2809 and submitting it to your agency personnel office (or OPM, if you are a retiree). That form is at www.opm.gov/forms.

Death
If you were enrolled in the Self Plus One or the Self and Family option when you died, anyone covered under your enrollment and who is eligible for a survivor benefit can continue coverage. An FEHB eligible survivor is entitled to the same benefits and government share of the contributions as a current or retired employee enrolled in that plan. As a rule, the premiums would be deducted from his or her annuity payment. If the annuity is too small to cover the premiums, your survivor could pay them directly to OPM.

If you were enrolled in the Self Only option (or were not enrolled at all) any otherwise eligible survivor would not be able to enroll.