Eligible enrollees in the FEHB include current federal employees, annuitants, and eligible family members. Newly hired employees have 60 days from their entry on duty date to sign up for an FEHB plan. Part-time workers are also eligible for coverage, but generally they are required to pay a larger share of premiums than fulltime employees.
In order to be eligible for FEHB in retirement, an individual (1) must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including FERS MRA + 10 retirements) and (2) must have been continuously enrolled (or covered as a family member) under FEHB for the five years of service immediately before the date the annuity starts, or for the full period(s) of service since their first opportunity to enroll (if less than five years). The five-year requirement period can also include coverage under the military TRICARE program as long as the individual was covered under FEHB at the time of retirement.
Eligible family members include a spouse (including a valid common law marriage), children under age 26 (beginning in 2011), and continued coverage for qualified disabled children 26 years or older who are incapable of self-support because of a mental or physical disability that existed before age 26. Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses (of federal employees, former employees, and annuitants) may qualify to enroll in a health benefits plan under the FEHB.
TRICARE- and Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)- eligible FEHB annuitants, survivors, and former spouses may suspend their FEHB enrollment and then return to FEHB during the open season, or return to FEHB coverage immediately if they involuntarily lose this non-FEHB coverage. Annuitants or former spouses who are enrolled in Medicare Parts A and B may suspend FEHB enrollment to enroll in a Medicare Advantage plan (a Medicare HMO or regional preferred provider organization), with the option to re-enroll in FEHB during open season, or sooner, if they involuntarily lose coverage or move out of the Medicare Advantage plan’s service area.
Federal employee reservists who are placed in a leave without pay status when called to active duty for more than 30 days can keep their FEHB coverage for up to 18 months. The reservist is responsible for paying the enrollee share of the premium during the first 12 months, and the agency pays the agency’s share.
Finally, certain individuals may be eligible to temporarily continue their FEHB coverage after their regular coverage ends, under Temporary Continuation Coverage (TCC). TCC is similar to “COBRA” coverage offered to individuals in the private sector.
Federal employees and family members who lose their FEHB coverage because of a qualifying event, such as job loss (except for gross misconduct), may be eligible for TCC. TCC enrollees may initially enroll in any FEHB plan and may also change plans during open season, but they must pay the full premium for the plan they select (that is, both the employee and government shares of the premium) plus a 2 percent administrative charge. In general, TCC coverage is available to separating employees and their families for up to 18 months after the date of separation. Children aging out of their parent’s plan (at age 26) and former spouses can continue TCC for up to 36 months.