Retirement Policy

The annual open season is when most enrollment changes in the Federal Employees Health Benefits program occur, but certain changes are allowed at other times when an individual experiences a “qualifying life event.” The major events that permit enrollment or change in enrollment are:

• A change in family status, including marriage, birth or adoption of a child, acquisition of a foster child, legal separation, divorce, or death of a spouse or dependent.

• A change in employment status, meaning when you are reemployed after a break in service of more than three days, you return to pay status after your coverage terminated during leave without pay status or because you were in leave without pay status for more than 365 days, your pay increases enough for premiums to be withheld, you are restored to a civilian position after serving in the uniformed services, you change from a temporary appointment to an appointment that entitles you to a government contribution, or you change to or from part-time career employment.

• You or a family member lose FEHB or other coverage under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to self only, under another federally sponsored health benefits program, under Medicaid or similar state-sponsored program for the needy, because your membership terminates in the employee organization sponsoring the FEHB plan, or under a non-federal health plan.

When one of these events occurs, you may enroll, change your enrollment from self only to self and family, change your enrollment to another FEHB plan or option, change your enrollment to self only, or cancel your enrollment. However, a change to self only may be made only if the event causes the enrollee to be the last eligible family member under the FEHB enrollment. Also, a cancellation may be made only if the enrollee can show that as a result of the qualifying life event, he or she and all eligible family members now have other health insurance coverage.

Canceling Enrollment–You may voluntarily cancel your enrollment at any time. However, if you do so, you and any family member under your enrollment will not be able to convert to a nongroup contract or enroll for temporary continuation of coverage. Generally, voluntary cancellation of enrollment permanently bars reenrollment in the FEHB program. If you ask OPM to cancel your enrollment, OPM will give you a complete explanation of the effect of cancellation on your rights.

Suspending Enrollment–You may want to suspend your enrollment. Usually, enrollments are suspended because the enrollee wants to join a Medicare managed care plan or be covered as a family member under another person’s self and family FEHB program enrollment.