If you are a federal employee who is about to retire, you may have heard that you’ll no longer be able to receive your Federal Employee Health Benefits (FEHB) once you make the transition.
However, in certain situations, you are actually allowed to keep those benefits through your retirement. In this article, we’ll let you know how.
How To Keep FEHB When You Retire
In order to keep your benefits, you must meet the following criteria:
- You are retiring on an immediate pension under FERS or CSRS ; AND
- You, as the employee, must have been continuously enrolled in ANY FEHB plan for the 5 years of service immediately before your retirement date OR for the full period(s) of service since your first chance to sign up (if less than 5 years).
Note: If you had a break in service during the 5 year period, be sure and ask about your eligibility because breaks in service do not necessarily count against meeting the requirements of the 5-year rule.
If you meet one of the above criteria, the Office of Personnel Management (OPM) states that you do not need to do anything in order to keep your FEHB benefits in retirement, and it should automatically enroll you into the FEHB program even though you are retired.
Do Spouses Have to Meet Eligibility Requirements?
No. You do not have to be on a family plan at the time of the retirement, you only have to make sure you are eligible and on the plan yourself to maintain coverage.
You may request changes (such as the type of family plan) or add a spouse during any Federal Benefits Open Season.
What Are The Qualifying Systems for FEHB Coverage in Retirement?
The OPM has stated Civilian systems include, but are not limited to, the following:
- Civil Service Retirement System (CSRS)
- Federal Employees Retirement System (FERS)
- Board of Governors of the Federal Reserve System
- CIA Retirement System
- District of Columbia Courts Judges Retirement System
- Federal Judiciary Retirement System
- Financial Institutions Retirement Fund System
- Foreign Service Pension System
- Foreign Service Retirement System
- Judiciary of the Territories Retirement System
- Lighthouse Retirement System
- Military Court of Appeals Judges Retirement System
- National Oceanic and Atmospheric Administration System
- Nonappropriated Fund Retirement System
- Officers of the Public Health Service System
- Policemen and Firemen of the District of Columbia Retirement System
- Public School Teachers of the District of Columbia System
- Teachers Insurance Annuity Association and Collegiate Retirement Equities Fund Retirement System
- U.S. Court of Veterans Appeals Judges Retirement System
- U.S. Tax Courts Judges Retirement System
For FEHB purposes, you must retire under a civilian retirement system for Federal or District of Columbia Government employees.
Is There A Difference in FEHB Costs in Retirement?
Good news: the cost of health insurance remains the same for federal employees under FEHB in retirement.
Why Would Someone Be Denied FEHB Coverage in Retirement?
Common reasons that OPM would deny coverage for a retiree could be:
- They were not enrolled since the first opportunity
- They were not enrolled at least 5 years
If this happens to you, you may be able to take additional actions to gain supplemental coverage while you search for a different plan. If it is determined that you are ineligible for health benefits,you may have an option to enroll for up to 18 months in the Temporary Continuation of Coverage (TCC) under the TCC provision of the FEHB law.
Are There Exceptions To the 5-Year Rule?
There are exceptions to the FEHB 5-year rule if you have the documentation to prove that you are eligible for coverage.
Exceptions include:
- Being able to show that you intended to have FEHB coverage when you retired.
- Proving that you had experienced circumstances beyond your control that prevented you from adhering to the 5-year rule; and
- You can prove that you have shown initiative in trying to gain more information about continuation of coverage. You must show that you reasonably acted to protect your rights to your FEHB coverage for retirement – by actions such as reading all information provided, asking questions and asking for related information to ensure you could maintain your health benefits in your situation.
Click here to read the FEHB Handbook for more information.
Kate writes about retirement benefits for retirementinsurance.org. She has a Masters Degree in Social Work (MSW). She has over a decade of experience in assisting elderly and disabled populations navigate governmental and private programs to obtain the monetary assistance they need to lead better lives. As she watched her parents begin their own retirement journeys and navigate similar systems to obtain Social Security, Medicare and other retirement benefits, she gleaned a further personal knowledge about the topic and is eager to share what she has learned with others.