FEHB and That 5-Year Requirement

By on November 26, 2012 in Human Resources, News, Retirement

FedSmith.com recently posted an article of mine (See The Five Year Requirement Under FEHB) that dealt with the requirement that an individual must have been enrolled in Federal Employees Health Benefits (FEHB) and Federal Employees Group Life Insurance (FEGLI) for the five years immediately preceding retirement in order to carry said insurance into retirement.  One of the points made regarding FEHB follows:

  • The five years refers to your enrollment.  Your spouse does not have to be enrolled for the five years immediately preceding your retirement in order to be covered.  You can bring your spouse on your insurance at any time before retirement, or even after retirement.  Do be aware that if you die after retirement but before bringing your spouse on your FEHB, your spouse will not be able to continue FEHB, even if you have elected a survivor annuity.

I was concerned that many employees who contacted me after the article appeared had been told by their human resources offices and by pre-retirement seminar providers that the five year requirement also applied to the employee’s spouse.  Some other readers said that they were told that their spouse needed to be enrolled at least one day before the employee retired.  Nothing could be further from the truth.

The Office of Personnel Management (OPM) clearly lists the requirements for a spouse to continue FEHB coverage after an employee’s or retiree’s death in both the FEHB Handbook and the FEHB FAQS.  The requirements are as follows:

  • The spouse must be enrolled on a self and family plan as of the date of the employee/retiree’s death.
  • The spouse must be entitled to receive a survivor annuity.

That’s it.  OPM lists no further requirements.  As long as the two requirements above are met as of the date of the employee/retiree’s death, it does not matter whether or not the spouse was enrolled at the time of retirement or five years before.

John Grobe’s latest book, The Answer Book on Your Federal Employee Benefits, has just been released by LRP Publications. The book is written in an easy to understand question and answer format and covers all areas of federal benefits from the perspective of an employee at various stages of their career. Order your copy at shoplrp.com.

© 2016 John Grobe. All rights reserved. This article may not be reproduced without express written consent from John Grobe.

About the Author

John Grobe is President of Federal Career Experts, a consulting firm that specializes in federal retirement and career transition issues. He is also affiliated with TSP Safety Net. John retired from federal service after 25 years of progressively more responsible human resources positions. He is the author of Understanding the Federal Retirement Systems and Career Transition: A Guide for Federal Employees, both published by the Federal Management Institute. Federal Career Experts provides pre-retirement seminars for a wide variety of federal agencies.

35 Replies

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  1. Ed says:

    Hi John,
    I’ve been retired for about 18 years. In 1997 DOD offered a buyout. I had not had 5 years in FEHB because I was on my wife’s medical plan. As a condition of taking the buyout, I asked if they would also offer medical coverage for my wife and me during our retirement, and they agreed.

    I just wanted to let you know that there was (or is) at least one other exception to the 5-year rule.

  2. Laurib says:

    Will there ever be another enrollment period for the FEGLI? I did not sign up for this when I started because we had coverage elsewhere but now I want to sign up for it.

  3. GCScorpio says:

    Hi my call sign is Gary Chavis, Should I get the Federal FEHB insurance, I am retired military and now have Tri Care for me and my family and I have about 6 years before I plan to retire from civil service. Would it be wise for me to sign up for this FEHB health insurance. My health is not that great now, High Blood Pressure , Diabeates … I am trying to make sure I am cover well for old age. But not paying for something that wouldn’t do me much good and be over coverage or duplicate what I am already covered for.

  4. Hostess1953 says:

    From a retirement column: The five years refers to enrollment in the program.  You do not have to remain in the same plan for five years. The five years refers to your enrollment.  Your spouse does not have to be enrolled for the five years immediately preceding your retirement in order to be covered.  You can bring your spouse on your insurance at any time before retirement, or even after retirement.  Do be aware that if you die after retirement but before bringing your spouse on your FEHB, your spouse will not be able to continue FEHB, even if you have elected a survivor annuity. If you are enrolled as a family member on the FEHB policy of your spouse, that counts towards the five-year period the same as if you were enrolled on your own. Tricare is viewed as equivalent to FEHB, and time spent on Tricare counts towards the five years as long as you are covered by FEHB when you retire. A major exception to the five-year rule is in the case of a reduction-in-force.  OPM routinely waives the five-year requirement in the result of RIFs. Another exception is for a former federal employee who returns to federal employment.  As long as they sign up for FEHB immediately upon their return, they do not have to have it for five years.  For example, if an employee returned to federal employment in January 2010 and retired in December 2012, they could carry their FEHB into retirement if they enrolled in FEHB when they were re-employed.

  5. Gladly Retired Fed says:

    If you are a fed/retiree who loses health benefits (divorce, fed spouse drops you, allowing you to convert to two self only plans), you do not need to meet the five year rule.  The state of federal personnel advisory services is very dismal indeed.  I agree you should be smart enough to understand the brochures, but  we could make better use of federal payroll dollars if we didn’t hire “HR generalists: who have no idea what they are talking about..  cut the 

  6. Ehren Clovis says:

    Coverage under the FEHB as a family member counts the same as coverage under your own enrollment; coverage as a SPOUSE is the same as being the actual enrollee. For a couple where both individuals are federal employees entitled to their own immediate retirement benefit, this means the spouse does NOT have to be entitled to a survivor annuity to continue FEHB upon death of the enrollee. As long as the spouse was continuosly covered under FEHB on his/her own enrollment OR as a spouse for the 5 years before his/her own retirement, AND the spouse leaves (or left) service eligible for an immediate annuity, lifetime FEHB coverage is assured.

    • Opinionated_Lady says:

      Ehren, I’d add that the spouse has to be either continuously covered as a family member, or enrolled during their retirement.  If covered as a family member, the spouse could then enroll in their own right as a federal annuitant, should the enrolled spouse pre-decease them.  (Linda O)

  7. Berubefin says:

    Isns’t it a shame that the individual agency retirement offices don’t even know their own rules.  As far as Air force civilians, they don’t even have an HR entitlements office to counsel employees, they have to call Randolf AFB for any information which is rare that they know what they are talking about.   Seems like after someone has dedicated 30-40 years of their life to the govenermnet that OPM and the DoD agencies would provide them a real person to meet with and discuss their retirement options with.  I guess DoD doesn’t think much of their employees.

    • $15300432 says:

      If you can’t read the benefits booklet published by OPM than maybe you should look for another career. This isn’t rocket science besides DOD offers retirement seminars that are free

  8. Lferguison says:

    You said that the retiree must be enrolled in the self and family plan, does that include the “self plus one” plan?

    • msgrowan says:

      The self plus one coverage option only pertains to FEDVIP dental and vision plans.  The FEHB has two coverage options self only and self and family; the latter of the two covers one or more family member enrollees in addition to the primary account holder.

  9. sandiegoret says:

    Good information.  Another thing to remind people is that it is very difficult to get a waiver of the five-year rule.  Some agency administrators mistakenly believe they will have influence with OPM and be able to get a waiver of the five-year rule for the employee.  Often this involves an employee who has become disabled and does not meet the five-year rule.  That is incorrect and those employees become retired without health insurance.  

    • Hostess1953 says:

      From OPM website:

      Who Makes the Determination?
      At retirement, your employing office will tentatively determine if you are eligible to continue your enrollment. OPM’s Office of Retirement Programs (or your retirement system) will review your retirement and health benefits documents and make a final determination of your eligibility to continue your FEHB enrollment into retirement.
      Waiver of 5-Year Enrollment Requirement
      Public Law 99-251 gave OPM the authority to waive the 5 years of service requirement when, in its sole discretion, it determines that it would be against equity and good conscience not to allow a person to be enrolled in the FEHB Program as an annuitant.
      Your failure to satisfy the 5-year requirement must be due to exceptional circumstances. If you request a waiver, you must provide OPM with evidence that:
      you had intended to have FEHB coverage as a retiree; the circumstances that prevented you from meeting the 5-year requirement were essentially outside your control; and you acted reasonably to protect your right to continue FEHB coverage into retirement. (This includes reading and acting on information provided and requesting information if none is given automatically.)
      How OPM Applies Its Waiver Authority
      OPM’s approval of your waiver request depends on the extent to which you could have controlled the events leading to the loss of coverage at retirement. When OPM reviews a waiver request, it considers:
      whether you had a compelling reason to believe you were covered as a family member of another person enrolled in FEHB during the time in question; evidence that your employing office would not allow you to enroll; the extent to which you could have controlled the events that led up to the loss of the right to continued FEHB coverage; whether you had acted to gain FEHB coverage at the earliest opportunity after learning of the loss of benefits or possible loss of future rights; whether you had substantial FEHB coverage during your career even though there was a break in continuity during the last 5 years of service. Current Waiver PolicyWhile Public Laws 103-226 and 104-208 authorized Government-wide voluntary separation incentive payments (VSIPs), more recently, Congress has been authorizing buyouts for individual agencies. Each agency’s VSIP legislation specifies different beginning and ending dates.OPM’s current waiver policy provides pre-approved waivers for any employee who has been covered under the FEHB Program continuously since October 1, 1996, or the beginning date of an agency’s latest statutory buyout authority, whichever is later.To be eligible for a pre-approved waiver, you must:retire during your agency’s statutory buyout period; and
      receive a buyout under the agency’s statutory buyout authority; or
      take early optional retirement as a result of early-out authority in your agency; or
      take a discontinued service retirement based on an involuntary separation due to reduction in force, directed reassignment, reclassification to a lower grade, or abolishment of position.If you meet these requirements, you do not need to write a letter requesting a waiver. Instead, your agency must attach a memorandum to your retirement application stating that you meet the requirements for a pre-approved waiver by OPM as set forth in Benefits Administration Letter (BAL) 00-220. The memorandum should provide the number of the Public Law granting your agency VSIP authority and the beginning and the ending dates of your agency’s statutory buyout period.If You Do Not Qualify for a Pre-approved WaiverSome employees who retire during a buyout period will not be eligible for a pre-approved waiver. This includes employees who retire on a regular optional retirement but do not qualify for a VSIP. If you do not qualify for a pre-approved waiver, you may ask OPM to waive the participation requirements in your case. OPM will consider each case on its own merits, based on the criteria that are applied to all other retiring employees. You should explain why you believe OPM should consider you for a waiver (e.g. why you are unable to meet the 5-year requirement or why meeting it would be harmful to you) and send your waiver request to the following address:

      • sandiegoret says:

        I’m not sure what you’re citing but it looks basically good and like it’s some operations manual.  It provides a lot of information about waivers during buyouts that will be of value to a lot of people now so it’s good to bring that to people’s attention.  But the ultimate decision on the waiver is still OPM no matter who makes the “tentative determination.”

        5 C.F.R. §890.108 Will OPM waive require- ments for continued coverage dur- ing retirement?
        (a) Under 5 U.S.C. 8905(b), OPM may waive the eligibility requirements for health benefits coverage as an annu- itant for an individual when, in its sole discretion, it determines that due to exceptional circumstances it would be against equity and good conscience not to allow a person to be enrolled in the FEHB Program as an annuitant.
        § 890.109
        (b) The individual’s failure to satisfy the eligibility requirements must be due to exceptional circumstances. An individual requesting a waiver must provide OPM with evidence that:
        (1) The individual intended to have FEHB coverage as an annuitant (re- tiree);
        (2) The circumstances that prevented the individual from meeting the re- quirements of 5 U.S.C. 8905(b) were be- yond the individual’s control; and
        (3) The individual acted reasonably to protect his or her right to continue coverage into retirement.
        [72 FR 19100, Apr. 17, 2007]
        and 5 U.S.C § 8905(b)(2) as a member of the family of an employee or annuitant;
        may continue his enrollment under the conditions of eligibility prescribed by regulations of the Office. The Office may, in its sole discretion, waive the requirements of this subsection in the case of an individual who fails to satisfy such requirements if the Office determines that, due to exceptional circumstances, it would be against equity and good conscience not to allow such individual to be enrolled as an annuitant in a health benefits plan under this chapter.What is now missing is the explicit language that used to be in the CFR that stated becoming disabled is NOT a reason to grant a waiver.  I do not know what OPM has been doing about waivers in the past few years but I never saw one granted during my career.  (That doesn’t mean I didn’t believe that some of them should have been granted–it’s just that OPM took a very hard line on the waiver issue.)

  10. Get over it says:

    That is what I was told as well.  Tricare Prime counts as a federal health plan and therefore counts towards the five year requirement.  You must be enrolled in the FEHB and have made at least one payment prior to retirement.  You can then suspend the FEHB and restart at a later date. 

  11. William S Grergg says:

    OK… I’m currently on TRICARE Prime because my spouse is a retired militay member.  I was told that because I’m currently on TRICARE and have been for over 5 years that all I have to do is be enrolloed in FEHB at the time of retirement.  

  12. Lferguison says:

    You said that the retiree must be enrolled in the self and family plan, does that include the self plus one plan?

    • $15300432 says:

      sure if your a contractor

    • P Curley says:

      There is no such plan in the FEHB.  It is either single or family. The vision program does have a self plus one but not the regular FEHB plan.  Also, an employee only has to be in a single plan for the 5 years to qualify for carryover into retirement. I worked with someone who was not in FEHB at all, as he was under his wife’s plan at a non-federal job. So far,so good. But with 4 years left until he was eligible,  he discovered that he would not be covered under her plan after she retied. He had to get his own FEHB but had to  “tough it out” for an additional year beyond his eligibility. His manager was making is life a living hell and he had to put up with it for an additional year.

  13. Joyce says:

    My husband and I both are Federal employees.  I am enrolled in FEHB through my husband.  Niether of us plans to elect the survivor annuity for the other.  Without having the survivor annuity election, will I be able to continue enrollment under the FEHB even if my spouse dies or we divorce after retirement?

    • Hostess1953 says:

      Why are you under his plan anyhow?  I looked at premiums and it would be cheaper for each of you to have your own single plan; that way, you could both take your own coverage into retirement.

      • Joyce says:

        My husband carries family coverage for himself, me and our 2 children.  You’re correct that if we did not have children, it would be cheaper for us to each have our own individual coverage under the FEHB.  However, since we have children, family coverage is cheaper for us.

    • P Curley says:

      I would say that you should get your own insurance, unless your husband elects a survivor annuity for you. If y0u do as you planned, you would not be eligible for coverage as a surviving spouse. You would have to be covered in your own right, and have to deal with the 5 year rule. If you don’t have the 5 years at time of intended retirement, you would have to either tough it out until you have your 5 years in FEHB, or, have your husband elect a survivor annuity. You didn’t say how long you have until each of you are eligible. If that were me, I would get into FEHB with the cheapest plan, just to get my 5 years in the system.   

      • Joyce says:

        I have 20 plus years as a Federal Employee and have been enrolled in the FEHB for the entire time.   My husband has 11 plus years as a Federal Employee and has been enrolled in FEHB for the entire time.  We both have at least 10 years until we can retire.  I was planning to do as you suggested- -enroll in the FEHB plan for the 5 years prior to my eligibility for retirement.  Howevever, based on the post by Federal Benefit Specialist above, I don’t have to do this.   

    • Federal Benefit Specialist says:

      Coverage under your spouse counts toward your eligibility to continue FEHB after retirement.  As long as you were covered under your spouse for at least 5 years prior to your retirement and you’re covered on the date of his death, you would be eligible to enroll in your own plan upon your spouse’s death even if he doesn’t leave you a survivor annuity because you have your own eligibility as a federal employee. The same goes if you were to divorce.

  14. Kevin Campbell4 says:

    Ok, but what constitutes the spousal entitlement?

    • Hostess1953 says:

      What spousal entitlement?

      • Kevin Campbell4 says:

        The entitlement John mentioned in the article…..

        The spouse must be enrolled on a self and family plan as of the date of the employee/retiree’s death.
        The spouse must be entitled to receive a survivor annuity.

        • Hostess1953 says:

          After your death, your eligible family members will continue to be covered if:
          1) You were enrolled for Self and Family, and
          2) A family member receives a survivor annuity.
          The coverage ends if the survivor annuity terminates. The survivors share of the cost of the plan is the same amount you are paying and will be deducted from the survivor annuity payment. If there is only one survivor annuitant and no other family member is eligible for continued coverage, we will change the enrollment to Self Only coverage. If you die and none of your family members receives a monthly survivor benefit, the family enrollment ends.

  15. Gary Rosendahl says:

    I was told in a FERS pre-retirement class that if I enrolled in the FEHB program and had been in it for at least a month I could carry it into retirement…. I am a retired military member, so I am currently enrolled in Tricare Prime.  The example I was given was as follows:  proposed retirement date: 28 Feb,  I was told to enroll in the FEHB during the open enrollment period in December, and to ensure that at least one months premium was paid, at that time I could SUSPEND my enrollment in the FEHB and  at that time I could carry the FEHB into retirement, true or not true?

    • Hostess1953 says:

      If that were true, I’d have retired 3 years ago.  I’m only working to hit 5 years in FEHB so that I can take it into retirement per the OPM rules.

    • Federal Benefit Specialist says:

      The 5 year requirement period can include the following: the time you are
      covered as a family member under another person’s FEHB enrollment; or the time
      you are covered under the Uniformed Services Health Benefits Program (also known
      as TRICARE) as long as you were covered under an FEHB enrollment at the time of
      your retirement. The Office of Personnel Management has issued a final rule to allow TRICARE and
      CHAMPVA eligible FEHB Program annuitants, survivors, and former spouses to
      suspend their FEHB enrollments, and then return to the FEHB Program during the
      Open Season, or return to FEHB coverage immediately if they involuntarily lose
      this non-FEHB coverage. The intent of this rule is to allow eligible
      beneficiaries to avoid the expense of continuing to pay FEHB Program premiums
      while they are using the non-FEHB coverage, without endangering their ability to
      return to the FEHB Program in the future. http://www.opm.gov/insure/heal

  16. John Balis says:

    The spouse must be entitled to receive a survivor annuity.
    Mr. Grobe,
    does the above mean that you signed up for your spouse to receive an annuity or that they are eligible to be signed up?

    • grannybunny says:

      The information he cited applies to the period of time after the retiree’s death, so the spouse would no longer be eligible to be signed up for survivor’s benefits.

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