FEHB and the Five Year Requirement

By on August 25, 2015 in Current Events, Pay & Benefits with 40 Comments

With Federal Employees Health Benefit (FEHB) open season approaching in November, it might be helpful to take a look at the “five-year requirement”.

Most federal employees are aware that, in order to carry your FEHB into retirement, you have to have been enrolled for the five-year period immediately preceding retirement (with few exceptions). There is generally a great advantage in being able to carry your FEHB into retirement. Uncle continues paying his share for as long as you remain enrolled.

A few things of which you should be aware are:

  • 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 generally applies to former federal employees who return to federal employment after a break in service. They do not need five consecutive calendar years of FEHB coverage. As long as they were enrolled in FEHB when they left federal service and signed up for FEHB immediately upon their return, they will be able to take their FEHB into retirement as long as they had five continuous years of coverage during their federal service, even if they did not have five consecutive calendar years of coverage due to their break in service.

I wrote an article similar to this one 2 ½ years ago and, after it appeared I was contacted by many readers who had been told by their HR 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.  We can assume that the new self-plus-one plans will be treated just like self-and-family plans for the purpose of FEHB regulations.

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.