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Federal Employees Health Benefits Coverage After Separation From Employment
The Federal Employees Health Benefits (FEHB) coverage of civilian employees who separate from Federal employment terminates on the last day of the pay period in which the separation occurs. Each separated employee then receives an automatic 31-day extension of coverage during which insurance continues at no cost. During the 31-day period, employees may apply to convert to a nongroup contract with their health plan carrier or apply for coverage under Temporary Continuation of Coverage (TCC). There is no requirement to pass a physical and no pre-existing condition restriction on coverage for separating employees (and family members) applying to continue coverage in the FEHB program via conversion to a nongroup contract or temporary continuation of coverage.
Difference between Nongroup Contract and Temporary Continuation of Coverage (TCC)
The level of benefits under the nongroup contract usually decreases. Under TCC, the level of benefits is the same as for any employee enrolled in that health plan. Both are costly because you pay the full premium. In addition, TCC enrollment ends after 18 months, while benefits under a nongroup contract can go on indefinitely. Whether you choose a nongroup contract or a TCC enrollment is up to you. If you enroll in the nongroup contract first, you may not enroll in TCC later. However, if you enroll under TCC first, you will receive another 31-day free extension of coverage when the TCC enrollment ends, and at that time you will have another opportunity to convert to a nongroup contract with the health plan carrier (unless the TCC enrollment ends due to cancellation or failure to pay the premiums).
Nongroup Contract
To convert to a nongroup contract, you must write to your health plan within 31 days of the effective date of the termination of your health insurance coverage and request information on converting to a nongroup contract. (The health plan address is in your health plan brochure.) The plan will provide you with an application for conversion as well as information on benefits available and costs. The benefits offered by the nongroup contract will most likely be different from your current FEHB enrollment in both the level of coverage and cost. It is important that you closely review the benefits and cost data your health plan will provide. Additional information on the conversion process is contained in Part B on page 2 of the Standard Form (SF) 2810 (Notice of Change in Health Benefits Enrollment). Air Force-serviced civilian employees: The Benefits and Entitlements Service Team (BEST) will provide you with the SF 2810 after you separate from employment. The SF 2810 documents the termination of your FEHB enrollment and the effective date.
Temporary Continuation of Coverage (TCC)
Employees who lose their FEHB coverage due to separation from Federal service may enroll under the TCC provision of the FEHB law to continue their coverage for up to 18 months. You are eligible for TCC when you separate from Federal service, voluntarily or involuntarily, unless your involuntary separation is due to gross misconduct, and if you would not otherwise be eligible to continue FEHB enrollment (not counting the 31-day extension of coverage). If your separation is due to retirement, you are eligible for TCC only if you are not eligible to continue FEHB coverage into retirement. TCC allows separated employees to continue the same level of health benefits coverage enjoyed while employed. The TCC family enrollment covers the same family members as those covered while employed. Enrollment under TCC is limited to a maximum of 18 months. In addition, you will pay both the employee and government shares of the premium, plus an additional 2% administrative fee. Exception: Department of Defense (DoD) employees who are involuntarily separated due to reduction-in-force (RIF), resign after receipt of a RIF separation notice, volunteer for RIF, or voluntarily separate from a position that has been identified as surplus for RIF purposes, pay only the normal employee share of the FEHB premium for the 18 months of TCC coverage. The Government pays its share plus the 2% administrative fee. Exception: Employees who are involuntarily separated between 1 Sep 2008 and 31 May 2010 may be eligible for TCC premium assistance under the American Recovery and Reinvestment Act of 2009. See information below on these special provisions. You must apply for TCC within 60 days after separation from employment, or 65 days from the date you are notified of your eligibility to elect TCC, whichever is later. Notification includes, but is not limited to, your receipt of the SF 50 (Notification of Personnel Action) documenting your separation from employment. When enrolling in TCC, you may select any of the FEHB health plans in your servicing area. To select a health plan, review the Office of Personnel Management (OPM) Guide to Federal Benefits For Temporary Continuation of Coverage (TCC) and Former Spouse Enrollees (RI 70-5). The guide provides general information about the available health plans and costs. Once you narrow your choices to a few plans, be sure to review the individual health plan brochures for in-depth information about the level of benefits provided for each. The guide and individual health plans are located on the OPM website. Air Force-serviced civilian employees who separate from employment will submit their application for TCC coverage to the Benefits and Entitlements Service Team (BEST). To apply, complete the following items:
- A Request for Coverage under TCC, attached below
- One copy of Standard Form 2809 (Health Benefits Election Form)
- Applicable supporting documentation
Mail all three items to BEST at: AFPC/DPIRB, 550 C Street West Ste 57, Randolph AFB TX 78150-4759, or fax to DSN 665-2936 or (210) 565-2936. If you have questions or need assistance prior to separation, you may call 1-800-525-0102 and follow the prompts to enter your Social Security Number (SSN) and PIN. Once you have separated, your SSN will no longer be in the automated system. If you need assistance dial 1-800-525-0102, press 2 for civilian employees, then 3 for all other human resources programs, and 2 for all other inquires. BEST will review your request for TCC coverage to ensure all information necessary to determine eligibility has been included and forward it to the National Finance Center (NFC) in New Orleans for processing. The NFC will, in turn, mail you a package outlining the procedures for collecting premiums. Enrollment in TCC is effective the day after the automatic 31-day extension of coverage expires. Coverage and premiums are retroactive to that date, even if the enrollment processing is completed later. However, the 31-day period is considered the first month of the 18-month period of eligibility allowed under TCC.
Special Provisions of the American Recovery and Reinvestment Act of 2009
The American Recovery and Reinvestment Act (ARRA) of 2009, enacted on 17 Feb 2009, provided a new health insurance opportunity for former employees who are eligible for TCC under the FEHB Program because they were involuntarily terminated between 1 Sep 2008 and 31 May 2010. Under this law, former employees may request premium assistance for their TCC. Premium assistance means your former agency will make a Government contribution of 65 percent of the TCC premiums. If you were involuntarily terminated on or after 1 Sep 2008 and are already enrolled in TCC, you may request TCC premium assistance. If your TCC enrollment is in a health plan that has a higher premium than the premium for the health plan you were enrolled in at the time you separated, you must change your TCC enrollment to a plan with a premium no higher than the premium of your prior plan in order to qualify for premium assistance. To apply for TCC premium assistance, follow the instructions in the following paragraph. If you receive premium assistance, it will be retroactive to the first coverage period that began on or after 17 Feb 2009, except if you are required to switch to a different plan with a lower premium, in which case it will be prospective only. If you are eligible for and request TCC premium assistance, the assistance will be provided for up to 15 months, or until you become eligible for other group health coverage or Medicare, or until your TCC coverage ends, whichever comes first. Note that 'group health coverage' in this instance does not include limited coverage such as that consisting of only dental, vision, counseling, or referral services; coverage under a health-care flexible spending arrangement; coverage of treatment that is furnished in an on-site medical facility maintained by the employer and that consists primarily of first-aid services, prevention and wellness care, or similar care; or a combination of any of the above. Also note that eligibility for other group health coverage will disqualify you from receiving premium assistance, regardless of whether or not you elect to enroll in the other group health coverage. To be eligible for premium assistance, you must enroll in TCC under either the FEHB plan you were enrolled in when you were separated from Federal service or another FEHB plan with an equal or lesser premium. If you receive premium assistance, your premium will be 35 percent of your FEHB TCC premium for the period in which you are eligible and enrolled. You will be billed for your premium share. Please note that receipt of premium assistance does not lengthen the 18-month period for which you are eligible for TCC. If you become eligible for any group health plan or other coverage described above that makes you ineligible for premium assistance, you must notify your FEHB Program health plan and the NFC (1-800-242-9630). You no longer may receive premium assistance for any remaining TCC period or you may be subject to a penalty of 110 percent of the premium assistance you received. You also should be aware that there may be tax consequences associated with receipt of premium assistance for certain high income individuals. The Internal Revenue Service website has information for former employees. The Guide to Federal Benefits for Temporary Continuation of Coverage (TCC) and Former Spouse Enrollees (RI 70-5), provides information regarding the health plans that are available. The Guide and individual health plans are located on the OPM website. ARRA-TCC premiums for FEHB plans are also on the OPM website; scroll down to ARRA-TCC premiums for FEHB plans and click on the link. If you are not eligible for other group health insurance coverage or Medicare and you wish to enroll in TCC and receive premium assistance, complete the attached Request for TCC Premium Assistance and a Standard Form 2809 (Health Benefits Election Form) and mail them to BEST at: AFPC/DPIRB, 550 C Street West Ste 57, Randolph AFB TX 78150-4759, or fax to DSN 665-2936, commercial (210) 565-2936. You must submit your forms to BEST within 60 days of separation from Federal service or within 60 days of receiving a letter from BEST advising you of the opportunity to request TCC premium assistance, whichever is later. Request for TCC Premium Assistance
Request for Coverage under TCC
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