Health coverage is one of the best-known and most beloved perks of working for the federal government. The Office of Personnel Management (OPM) can help you to continue to enjoy those health coverage benefits even after you leave federal employment (e. g. not retire). Ending your service does not have to mean ending your coverage.
Temporary Continuation of Coverage
If you depart from Federal Service, you could be eligible for Temporary Continuation of Coverage (TCC) for up to 18 months under the Federal Employee Health Benefits (FEHB). Temporary Continuation of Coverage exists as a feature of the FEHB Program. It lets certain former employees temporarily continue their FEHB coverage after regular coverage ends. However, they must exhaust TCC eligibility as one condition for guaranteed access to individual health coverage. This is according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Temporary Continuation of Coverage enrollees are required to pay the full premium for any plan they select. In other words, a former employee will have to pay both the employee and the government shares of the premium. In addition, they must pay a 2% administrative charge.
Federal employees and any of their family members who lose their FEHB coverage due to a qualifying event can be eligible for TCC. The only qualifying event is leaving federal employment. For their family members, qualifying events include: for spouses, marriages ending by some means other than death (e. g. divorce or annulment); for children, attaining the age of 26, losing status as a stepchild or foster child or recognized natural child (this can happen if the parents go through a divorce or a foster child is adopted by another or a parent gives up all parental rights, even to a biological child), recovering from a disability, or loss of a survivor annuity (or disqualification from same) .
Former federal employees can be eligible for temporary continuation of coverage even if their separation from federal employment was involuntary. The only time there is a disqualification is in the case of a termination for gross misconduct.
Other ineligible (for temporary continuation of coverage) persons include:
- A federal employee who transfers to a position which is excluded from FEHB coverage by law;
- The former employee works as a compensationer ( a federal employee entitled to workers’ compensation who cannot return to work per the Department of Labor) and you lose coverage in the event that your compensation terminates;
- The employee loses their coverage after 12 months in a leave without pay status;
- A family member who loses coverage because the enrollee has changed to a Self Only enrollment, separated from service and did not opt for TCC, or cancelled coverage;
- A spouse will lose coverage due to the death of an employee or annuitant (many surviving spouses can continue to have regular coverage as survivor annuitants. Therefore, they don’t need TCC);
- The surviving spouse has a terminating annuity or
- A child of the federal employee who enters military service while still an eligible child (e. g. younger than age 26).
Temporary continuation of coverage can be a quite literal life saver if you lose your federal job or leave it for a new opportunity without health benefits, such as freelancing. As in all things, know your rights.
Janet Gershen-Siegel, Esq., has an MS in Communications from Quinnipiac University, and a JD from Widener Law School. She has been admitted to practice law for over 30 years, with a focus on litigation. She is the author of The Definitive Guide to the Merit Systems Protection Board, and regularly writes for www.MSPBAttorneys.com, whose attorneys focus on federal employee and whistleblower representation.