Temporary Continuation of Coverage FEHB Benefits and Options

If you've recently left a job that offered Federal Employees Health Benefits (FEHB) coverage, you might be wondering what your options are for continuing your health insurance.

You can temporarily continue your FEHB coverage through COBRA or by electing into the Temporary Continuation of Coverage (TCC) program.

The TCC program is a great option if you're not eligible for COBRA or prefer not to pay the COBRA premium.

Federal employees who separate from service under certain circumstances can elect temporary continuation of coverage, also known as TCC.

Former employees are eligible for TCC if their coverage ends due to a separation from Federal service, except for involuntary separation for gross misconduct.

Children whose coverage ends because they cease meeting the requirements for being considered covered family members are also eligible for TCC.

Former spouses of employees, former employees, or annuitants who would be eligible for continued coverage under a different part of the FEHB program, except for failure to meet certain requirements, are eligible for TCC.

In the case of a child, the enrollee must provide written notice to the employing office within 60 days after the qualifying event to request information about TCC.

Spouses are not eligible for TCC in their own right, but former spouses may be eligible if their marriage ends other than by death.

Continuation of Coverage is a vital aspect of Temporary Continuation of Coverage (TCC). You can continue TCC for up to 18 months after the date of separation as a separating employee.

If you're a child or former spouse, you can continue TCC for up to 36 months after a qualifying event. This can occur in two situations: when the qualifying event happens while you're covered under a regular FEHB enrollment, or when the qualifying event happens after the employee's separation and you're covered under the TCC enrollment of a former employee.

Here's a breakdown of the 36-month timeline:

For more insights, see: Employee Benefits Liability Coverage Definition

* If your child's or former spouse's qualifying event occurs while you're enrolled for family coverage under TCC, they may elect TCC in their own right, but coverage won't extend beyond 36 months after your separation.

TCC takes effect on the day that the 31-day temporary extension of coverage ends. Coverage is retroactive to that date if the enrollment processing is completed later. This means you'll have a seamless transition into TCC, without any gaps in coverage.

To obtain Temporary Continuation of Coverage (TCC) for your child, you must notify your employing office within 60 days after the qualifying event and supply the child's mailing address. This is crucial, as the enrollment will be in the child's name and they will be billed for the coverage.

The child must complete the election form, and they will receive a notice from your employing office within 14 days after receiving the information. This notice will inform them of their TCC rights.

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The child must make their election within 60 days after the later of the date of the qualifying event or the date they receive the notice about TCC rights from your employing office. If you don't notify your employing office within the 60-day time limit, the opportunity to elect TCC ends 60 days after the qualifying event.

Here's a timeline to help you understand the process:

Keep in mind that if someone other than you notifies the employing office about your child's eligibility, your child's 60-day time limit to elect TCC begins with the qualifying event, not the date of the employing office's notice of TCC rights.

Spouse Equity enrollments can continue as long as the former spouse meets the requirements and pays the premiums when they are due.

The enrollment can continue indefinitely, but if the former spouse loses eligibility, they can change to a TCC enrollment.

Explore further: Fehb Spouse Coverage after Retirement

To change from a Spouse Equity enrollment to a TCC enrollment, the former spouse must lose Spouse Equity eligibility due to remarriage before reaching age 55 or a change in the court order.

The loss of Spouse Equity eligibility must occur during the 36-month period following the divorce or annulment.

The former spouse must notify the employing office within 60 days after eligibility for Spouse Equity coverage ends.

Here are the requirements for changing to a TCC enrollment:

And here are the conditions for making the change:

You'll receive a bill from your employing office for each pay period you're covered, typically every month. The initial bill may cover more than one month's worth of coverage if you've been covered for a while.

The employing office determines the payment schedule and procedures, which you'll need to follow. Payments are due after the month you're covered.

You'll need to make timely payments to avoid any issues with your coverage. The employing office will have a specific process for handling payments, so be sure to follow their instructions.

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Termination of enrollment can happen for various reasons, including the expiration of temporary continuation of coverage, the last day of the pay period after the enrollee dies, or the day before coverage under another provision starts.

Termination can also occur if an enrollee fails to pay premiums within the established timeframe, which is retroactive to the end of the last pay period for which payment was received. This means the enrollee and their family members are not entitled to temporary extension of coverage for conversion or to convert to an individual contract for health benefits.

Family member coverage terminates under the same conditions as the enrollee's coverage, but covered family members of former employees and former spouses are entitled to temporary continuation of coverage.

Explore further: Business Continuation Insurance

Termination can be a complex and confusing process, but let's break it down.

Your TCC coverage ends either because the period of temporary continuation expires or you cancel the enrollment. If your coverage terminates because you don't pay your premiums, it is considered a voluntary cancellation.

You are entitled to a 31-day temporary extension in the same enrollment category held at the time TCC expires for conversion to an individual contract if your enrollment ends because the TCC period expires.

A family member's TCC ends when the covering enrollment ends or when the person ceases to meet the requirements for being considered a family member.

A family member who loses the continued coverage for any reason other than cancellation of the covering enrollment is entitled to a 31-day extension of coverage for conversion to an individual contract.

The coverage of a family member terminates under the conditions set forth in § 890.304(c).

You'll be denied temporary continuation of coverage if your employer determines your removal is due to gross misconduct.

The employing office must notify you in writing of its intention to deny coverage, explaining the reason for the denial and giving you time to respond.

You'll have at least 7 days to respond to the notice, which can be oral or written, and you're entitled to be represented by an attorney or other representative.

An agency official with the authority to make a final decision will hear your oral response.

The official's decision is final and not subject to reconsideration by the Office of Personnel Management.

If you resign before the scheduled separation date, your separation is still considered involuntary for the purpose of this subpart.

You're leaving your Federal job and wondering what's next for your benefits. If you lose your FEHB coverage, you're eligible for TCC unless your separation is involuntary due to gross misconduct.

You'll get a notice from your Human Resources Office within 61 days after your regular FEHB enrollment terminates, informing you of your opportunity to enroll under TCC. You have 60 days after getting the notice or 60 days after separation, whichever is later, to enroll under TCC.

TCC enrollments and premiums always begin on the 32nd day after your regular coverage ends. The earlier you submit your enrollment form, the earlier your agency can process it, and the less likely it will be for you to receive a large bill for retroactive TCC coverage.

If you retire, you aren't eligible for TCC because your regular FEHB coverage doesn't stop. But if you're retiring and unsure whether you're eligible to continue regular FEHB coverage as a retiree, it's a good idea to ask your employing office.

You'll have a 31-day temporary extension of FEHB coverage at no cost, in the same enrollment category held at separation, if you lose coverage other than by cancellation. TCC takes effect on the day the 31-day temporary extension of coverage ends.

To enroll for TCC, complete Standard Form 2809, Employee Health Benefits Election Form, and submit it to your HR Office within 60 days of the separation notice.