PERMISS

Temporary Continuation of Coverage under the Federal Employees Health Benefits Program

Temporary Continuation of Coverage (TCC) is a feature of the Federal Employees Health Benefits (FEHB) Program that allows employees and their eligible family members who lose their FEHB coverage because of a qualifying event, to continue health coverage.

Cost:

TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative charge. If the employee is involuntarily separated due to a Reduction in Force (RIF), the agency pays the Government share of the premium and the administrative charge. Employees can review the cost at http://www.opm.gov/insure, click "premium" under the HEALTH column.

Qualifying events:

For employees, the only qualifying event is separation from the Federal service. However, employees are not entitled to TCC if the separation is involuntary due to gross misconduct. Otherwise, the reasons for the separation don't matter. Employees' servicing personnel office is responsible for deciding whether conduct that leads to an involuntary separation is "gross misconduct." If the servicing personnel office decides that employee was separated because of gross misconduct, it must notify the employee of that fact and explain what the employee can do to appeal the decision.

For children, the qualifying events are:

  • reaching age 26,
  • loss of status as stepchild, foster child, or recognized natural child, and
  • in the case of children whose coverage has continued beyond age 26 because of their inability to support themselves due to a disability occurring before they reached age 26, recovering from the disability or becoming self-supporting.
  • death of the employee or annuitant if the child does not qualify for a survivor annuity, and
  • survivor annuity stops for any reason, including because he or she is no longer a full-time student.

Spouses are not eligible for TCC in their own right, even if the employees separate and decide not to elect TCC or if the employees die. However, if the marriage ends other than by death, the former spouse is eligible for TCC. The qualifying events are:

  • divorce, and
  • annulment of the marriage.

Former spouse must have been covered under the employee's FEHB family enrollment at some time during the 18 months before the marriage ended. (The term "former spouse" does not include widows or widowers.)

Who is covered under a TCC family enrollment:

For a former employee, a TCC family enrollment covers the same family members as were covered under the regular family enrollment and the family members must continue to meet the same requirements as under a regular family enrollment. A new family member, such as a new spouse or a newborn child, who is added during the period of TCC enrollment, is also covered as a family member.

For "children" who have a TCC family enrollment, the enrollee's spouse and children are covered family members.

For former spouses, family members are limited to those individuals who are children of both the Federal employee and the former spouse. The new husband or wife of a remarried former spouse is not covered as a family member.

Length of Coverage under TCC:

Separated employees can continue TCC for up to 18 months after the date of separation.

Children and former spouses can continue TCC for up to 36 months after:

  • the date of the qualifying event if the qualifying event occurs while the child or former spouse is covered as a family member of an employee or annuitant under a regular FEHB enrollment, or
  • the date of the employee's separation if the qualifying event occurs while the child or former spouse is covered under the TCC enrollment of a former employee.

If employee child's or former spouse's qualifying event occurs while the employee is enrolled for family coverage under TCC, the child or former spouse may elect TCC in his or her own right; however, the TCC coverage may not continue beyond 36 months after the date of employee separation.

Time Frame for Enrollment:

Employee: The local servicing personnel office must notify the employee within 61 days after the regular FEHB enrollment terminates or the employee opportunity to enroll under TCC. Generally, the employees have 60 days after getting the notice or 60 days after separation, whichever is later, to enroll under TCC. It's a good idea that servicing personnel office provides TCC information to the employee on the day of separation. TCC enrollments and premiums always begin on the 32nd day after regular coverage ends (which happens on the last day of the pay period in which the employee separates). The earlier the employee submits the enrollment form, the earlier the Army Benefits Center-Civilian can process it, and the less likely it will be for the employee to receive a large bill for retroactive TCC coverage.

However, if employee retires and is eligible to continue regular FEHB coverage as a retiree, the employee is not eligible for TCC. Employees should ask their servicing personnel office if they are retiring and aren't sure whether they are eligible to continue regular FEHB coverage as a retiree.

Children: If the employee's child wants TCC, it is the employee's responsibility to notify ABC-C within 60 days after the qualifying event and supply the child's mailing address. (Since the enrollment will be in the child's name, the child must complete the election form and the child will be billed for the coverage.)

Within 14 days after ABC-C receives the information about the child, the ABC-C must notify the child of his or her TCC rights. The child must make his or her election within 60 days after the later of:

  • the date of the qualifying event, or
  • if the employee notified ABC-C within 60 days after the qualifying event, the date the child receives the notice about TCC rights from ABC-C.

If the employee does not notify ABC-C within the 60-day time limit, the opportunity to elect TCC ends 60 days after the qualifying event.

If someone other than the employee notifies ABC-C about the child's eligibility, ABC-C will notify the child of his or her TCC rights, but the child's 60-day time limit to elect TCC begins with the qualifying event, not the date of ABC-C notice of TCC rights.

Former spouse: If the employee's former spouse wants TCC, the employee and his/her former spouse share the responsibility for notifying ABC-C within 60 days after the qualifying event (divorce or annulment) and supplying the former spouse's mailing address. Within 14 days after ABC-C receives the notice from the employee or the former spouse, ABC-C must notify the former spouse of his or her TCC rights. The former spouse must elect TCC within 60 days after the later of:

  • the date of the divorce or annulment; or
  • if the employee or the former spouse notified the agency within the 60-day time limit given above, the date he or she receives the notice of TCC rights from the employee's employing office.

If the employee's former spouse becomes eligible for TCC, and the employee or the former spouse do not notify ABC-C within the 60-day limit, the opportunity to elect continued coverage ends 60 days after the divorce or annulment.

Note: If someone other than the employee or the former spouse notifies ABC-C about the former spouse's eligibility, ABC-C will notify the former spouse of his or her TCC rights, but the former spouse must elect continued coverage within 60 days after the divorce or annulment, not 60 days after ABC-C's notice.

The Spouse Equity Provisions:

The spouse equity provisions of law allow the former spouse of a Federal employee or annuitant to enroll in FEHB if he or she meets the following requirements:

  • Was covered under FEHB as a family member at some time during the 18 months before the marriage ended,
  • Has not remarried before reaching age 55, and
  • Has a qualifying court order (that is, a court order that awards the former spouse a portion of the employee's or retiree's annuity benefit or a survivor benefit based on the employee's or retiree's Federal service).

The cost of coverage under the spouse equity provisions is slightly less than under TCC. Spouse equity enrollees pay the full premiums (both the employee and Government shares), but they do not pay the extra 2 percent administrative charge.

Coverage under a spouse equity enrollment does not begin until after the Office of Personnel Management has reviewed the court order to determine if it is "qualifying" and the employing office gets both the election form and proof that the former spouse is eligible for coverage under the spouse equity provisions. The former spouse can enroll under TCC while waiting for the spouse equity coverage to begin and thereby avoid any gap in health insurance coverage.

There is no specific time limit on how long spouse equity enrollments can continue. The enrollment can continue as long as the former spouse meets the requirements given above and pays the premiums when they are due. If the former spouse loses eligibility under the spouse equity provisions (for example, he or she remarries before reaching age 55) before the 36-month period for TCC runs out, the former spouse can change to a TCC enrollment, which can continue for the remainder of the 36-month period.
If you need more information about the spouse equity provisions, see the Federal Employee s Health Benefits (FEHB) Handbook at
http://www.opm.gov/insure/health/reference/handbook/FEHB31.asp

How to apply for TCC:

  • Applicant/Employee must send an SF 2809, Health Benefits Registration Form and the supporting documentation (please see below) to the Army Benefits Center-Civilian (ABC-C), 301 Marshall Avenue, Ft. Riley, KS 66442-5004. The SF 2809 must contain the applicant's information in Part A, Item 1 through 6, and must be signed by the person applying for TCC. Only Copy 1 of the SF 2809 is needed.
  • Once application is received the request will be reviewed to insure it contains all the information necessary to determine eligibility and forwarded to the National Finance Center (NFC) for processing.
  • The NFC will, in turn, mail the applicant a package outlining the procedures for collecting the premiums for the FEHB plan chosen.

Enrollees are not limited to the plan or option in which they were covered when the regular FEHB coverage ended. The employee (or employee's child or former spouse, as applicable) may enroll in any plan for which otherwise qualified. (Some plans require that enrollees live in a certain geographic area or belong to the sponsoring employee organization.)

Enrollees may elect either a self or self and family enrollment; however, the individuals who qualify as family members under a TCC family enrollment vary depending on whether the enrollee is a former employee, a child, or a former spouse.

If a person who is eligible for TCC can't make an election on his or her own behalf because of a mental or physical disability, a court-appointed guardian may file an election for that person.

Supporting Documentation Required:

  • Former Spouse - Copy of the divorce decree and the Federal employee's Social Security Number
  • Former Employee - Separation Notification of Personnel Action (NPA)
  • In addition, all enrollees must complete the TCC Addendum form located on the ABC-C website: https://www.abc.army.mil
  • If former spouse is applying for TCC under Spouse Equity, former spouse must complete the Statement of Understanding and Certification form located on the ABC-C website: https://www.abc.army.mil and the approval letter from the Office of Personnel Management (OPM).

Effective date of coverage:

An enrollee who loses FEHB coverage other than by cancellation (including cancellation by nonpayment of premiums) has a 31-day temporary extension of coverage, at no cost, in the same enrollment category held at separation for the purpose of converting to a nongroup contract with the current health benefits plan. This is true even when the enrollee also has the right to elect temporary continuation of FEHB coverage. 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.
As previously discussed, depending on the circumstances, a timely election can be made up to 120 days after the qualifying event. A person who waits that long to enroll is billed for the entire 89-day period of retroactive coverage. In cases where NFC accepts a belated election, the period of retroactive coverage for which the enrollee is billed is even longer. If the enrollee does not pay the bill for the retroactive coverage, the TCC enrollment is canceled retroactively to the beginning date and the person is not eligible to reenroll.

Opportunities to change enrollment:

After the initial enrollment, a TCC enrollee may change enrollment during the annual FEHB open season or, generally, when an event occurs that would allow an employee to change enrollment.

A TCC enrollee may change enrollment from self and family to self only at any time. Family members who lose coverage because an enrollee changes enrollment from self and family to self only are entitled to the 31-day temporary extension of coverage for conversion to an individual contract, but are not eligible to enroll under TCC in their own right.

A TCC enrollee may change coverage during the annual FEHB open season or when one of the following events occurs:

  • Change in family status
  • Move from area served by comprehensive plan
  • Termination by an employee organization plan
  • Termination of the plan in which enrolled
  • Eligible for Medicare coverage
  • Child's coverage under another enrollment ends
  • Change to self only coverage (can be made at any time)


Changing from a spouse equity enrollment to a TCC enrollment:

A former spouse enrolled under the spouse equity provisions may be able to change to a TCC enrollment if he or she loses spouse equity eligibility because--

  • he or she remarries before reaching age 55
    OR
  • the court order is changed in such a way that it is no longer a "qualifying" court order.

A former spouse can change from a spouse equity to a TCC enrollment if:

  • the loss of spouse equity eligibility occurs during the 36-month period following the divorce or annulment (or following the employee's separation if the marriage ended while the former spouse was covered under a TCC family enrollment); and
  • the divorce or annulment occurred on or after January 1, 1990.

The former spouse must notify the employing office within 60 days after eligibility for spouse equity coverage ends. The employing office will give the former spouse details about how to change to a TCC enrollment. The TCC enrollment cannot continue beyond 36 months after the divorce or annulment (or the employee's separation,
if applicable).

Termination of enrollment or coverage:

A TCC enrollee's coverage ends either because the period of temporary continuation expires or the enrollee cancels the enrollment. (Coverage also stops when enrollees don't pay premiums. Termination of coverage because of nonpayment of premiums is considered a voluntary cancellation.) If the enrollment ends because of the expiration of the period of TCC, the enrollee is entitled to a 31-day temporary extension in the same enrollment category held at the time TCC expires for conversion to an individual contract.

TCC coverage of family members 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 and may be eligible for TCC in their own name. To be eligible for TCC in their own name, the family members must lose family member status because of a qualifying event that occurs while they are covered under the TCC family enrollment of a separated employee.

Thirty-one-day temporary extension of coverage and conversion to a nongroup contract:

An enrollee who loses FEHB coverage other than by cancellation (including cancellation by nonpayment of premiums) has a 31-day temporary extension of coverage, at no cost, in the same enrollment category held at the time of separation for the purpose of converting to a nongroup contract with the current health benefits plan. This is true even when the enrollee also has the right to elect temporary continuation of FEHB coverage. 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.

An enrollee who elects TCC instead of the conversion policy has another 31day extension of coverage, at no cost, in the same enrollment category held at the time TCC expires and another opportunity to convert to a nongroup contract when the temporary continuation ends (other than for cancellation).

Additional information about the TCC Program can be located at http://www.opm.gov/insure/health/


For additional information or assistance call ABC-C at 877 276 9287 for additional information or assistance.

ABC-C Benefits Counselors are available from 6:00 a.m. to 6:00 p.m., Central Time, Monday through Friday except on Federal Holidays.


Content last reviewed: 9/21/2012-VOH