Federal Insurance Reform: Navigating The Path To Change

Changes to federal insurance in the United States can be made during the annual Open Season, which usually occurs in mid-November through mid-December. During this period, individuals enrolled in the Federal Employees Health Benefits (FEHB) program can make changes to their coverage. However, outside of Open Season, changes to federal insurance are generally allowed only when an individual experiences a qualifying life event (QLE). These QLEs include changes in family status, such as the birth or adoption of a child, or changes in employment status, such as a break in service or a return to pay status after a leave of absence. It's important to note that individuals usually have 60 days from the life event to make changes to their federal insurance coverage.

Changes to Federal Insurance during Open Season

Open Season is an annual event that allows changes to the Federal Employees Health Benefits (FEHB) program. The open season typically occurs from mid-November to mid-December. During this period, individuals can make changes to their FEHB coverage, such as enrolling, changing their enrollment, or cancelling their coverage.

It is important to note that outside of Open Season, changes to federal insurance are generally limited to specific "qualifying life events" (QLEs). These events include changes in family status, such as the birth or adoption of a child, or changes in employment status, such as a break in service or a return to pay status after a period of leave without pay.

During Open Season, individuals have the flexibility to make adjustments to their FEHB coverage according to their needs. They can choose to enrol in a new plan, switch to a different option within their current plan, or cancel their coverage altogether. It is essential to carefully consider your options during Open Season, as voluntary cancellation of enrollment may permanently bar reenrollment in the FEHB program.

In addition to the annual Open Season, there may be special circumstances where individuals can make changes to their federal insurance outside of this period. These are known as "qualifying life events" and typically involve significant changes in an individual's life, such as changes in family composition, employment status, or the loss of existing health coverage.

Overall, Open Season provides an opportunity for federal employees and eligible family members to review and adjust their FEHB coverage. By understanding the options available during this period, individuals can make informed decisions about their health insurance choices.

Changes to Federal Insurance outside of Open Season

Outside of Open Season, federal employees can only make changes to their health insurance coverage if they experience a Qualifying Life Event (QLE). QLEs are certain events that permit enrollment or changes in enrollment. These include:

Change in family status:

• Birth or adoption of a child
• Acquisition of a foster child
• Death of a spouse or dependent

Change in employment status:

• Reemployment after a break in service of more than 3 days
• Return to pay status after coverage termination during leave without pay status or after more than 365 days in leave without pay status
• Increase in pay, resulting in the withholding of premiums
• Transition to a civilian position after serving in the uniformed services
• Change from a temporary appointment to an appointment with a government contribution
• Switch to or from part-time career employment

Loss of FEHB or other coverage:

• Termination, cancellation, or change to Self Only under another FEHB enrollment
• Moving or changing worksite outside of the HMO's enrollment area when enrolled in a prepaid health maintenance organization (HMO)
• Enrollment in another federally-sponsored health benefits program, Medicaid, CHAMPVA, TRICARE, or TRICARE-for-Life
• Previous suspension of FEHB coverage to participate in one of the above programs
• Termination of membership in the employee organization sponsoring the FEHB plan
• Enrollment under a non-Federal health plan

When one of these qualifying life events occurs, individuals may:

• Increase their enrollment
• Switch their designated family member under a Self Plus One enrollment when the current designated family member experiences certain QLEs
• Change their enrollment to another FEHB plan or option
• Decrease or cancel their enrollment
• It is important to note that a decrease to Self Only is permitted only if the QLE leaves the enrollee as the last eligible family member under the FEHB enrollment. A decrease to Self Plus One is allowed only if the QLE leaves only one eligible family member covered in addition to the enrollee. Cancellation is permitted only if the enrollee can demonstrate that, as a result of the QLE, they and all eligible family members now have other health insurance coverage.

How to change your Federal Insurance enrollment

If you are a federal employee, retiree, or dependent, you can enroll in the Federal Employees Health Benefits (FEHB) Program. This program offers a broad selection of health plans, including Consumer-Driven and High Deductible health plans (CDHP/HDHP), Health Savings/Reimbursable Accounts (HSA/HRA), Fee-for-Service (FFS) plans with Preferred Provider Organizations (PPO), and Health Maintenance Organizations (HMO). You can compare the costs, benefits, and features of different FEHB plans using the Plan Comparison Tool.

During the annual FEHB Open Season, anyone eligible for the FEHB Program can enroll, change health plans or options, cancel or suspend their enrollment, and change their participation in premium conversion. Outside of Open Season, you can still make changes to your FEHB enrollment if you experience certain qualifying life events (QLEs), such as a change in family or employment status, or loss of FEHB or other health coverage.

• Identify the type of change you want to make: Are you enrolling in a new plan, changing your current plan, or canceling/suspending your enrollment? Knowing the specific change you want to make will help you navigate the process more efficiently.
• Determine the timing: Is it currently within the annual FEHB Open Season, or do you need to make changes outside of this period? If it is during Open Season, you have more flexibility to make changes. Outside of Open Season, changes are typically limited to newly eligible employees, those who have moved outside of their plan's coverage area, or those who qualify for a Special Enrollment Period due to a qualifying life event.
• Understand qualifying life events (QLEs): QLEs are specific events that allow you to make changes to your FEHB enrollment outside of Open Season. These include changes in family status (such as the birth or adoption of a child) and changes in employment status (such as a break in service or a return to pay status after leave without pay). Losing your current health coverage or experiencing a change in income may also qualify you for a Special Enrollment Period.
• Review the required documentation: Depending on the nature of your change, you may need to submit certain forms or provide specific information. For example, if you are enrolling in a new plan during Open Season, you will need to know the plan you want, the type of coverage (Self Only, Self Plus One, or Self and Family), and the enrollment code. If you are changing your plan due to a QLE, you may need to provide details about the event, such as a birth certificate or proof of a change in employment status.
• Submit your changes: There are several ways to submit changes to your FEHB enrollment, depending on your specific situation and agency. You may be able to enroll online using Employee Express or agency-specific systems, such as the DoD automated enrollment system for Department of Defense employees or MyPay for Health and Human Services employees. Alternatively, you can submit Standard Form 2809, Employee Health Benefits Election Form, to your Human Resources Office. During Open Season, annuitants can also use OPM's Open Season Online system or call the dedicated Open Season Express line.
• Follow up as needed: After submitting your changes, ensure that they have been processed correctly. Review your paystubs or benefits statements to confirm that your new plan is reflected and that any necessary adjustments have been made to your premiums or contributions. If you have any questions or concerns, don't hesitate to contact your agency's Human Resources Office or the relevant government office, such as the Retirement Information Center or the Office of Personnel Management.

Remember, it's important to stay informed about your insurance options and to make changes that align with your healthcare needs and preferences.

Cancelling your Federal Insurance plan

Understand the timing:

Outside of the annual Open Season, you can generally only cancel your Federal Employees Health Benefits (FEHB) plan if you experience a "qualifying life event" (QLE). This could include events such as a change in family status (marriage, birth, adoption, etc.), a change in employment status, or losing your current FEHB coverage.

Know the consequences:

Before cancelling your Federal Insurance plan, it is essential to understand the potential consequences. Voluntary cancellation of your FEHB enrollment may permanently bar you from reenrollment in the program. Additionally, if you cancel your insurance, you and your family members may not be able to convert to a nongroup contract or enroll for Temporary Continuation of Coverage (TCC).

Secure alternative coverage:

Before ending your current Federal Insurance plan, ensure that you have alternative health coverage in place. This is crucial, as you don't want to be left without health insurance. Once you cancel your coverage, you might have to wait for the next Open Enrollment Period to enroll in a new plan.

Follow the official procedure:

To cancel your Federal Insurance plan, you will need to follow the official procedure. This typically involves contacting the appropriate government agency or your health insurance marketplace/company. You may need to fill out specific forms, such as the Health Benefits Election Form (SF 2809), and submit them within the required timeframe.

Understand your rights:

It is important to know your rights when it comes to health insurance cancellation. Your state's consumer protection laws and insurance regulators can provide guidance and assistance if needed. Additionally, your insurance company cannot cancel your coverage simply because of an honest mistake on your application. They must provide you with at least 30 days' notice before cancelling your coverage.

Special Enrollment Periods

There are 13 qualifying life events that trigger SEPs for ACA-compliant plans. Normally, coverage is only available for purchase during the annual open enrollment period, but a special enrollment period allows people to sign up for coverage outside of that annual window, as long as they have a qualifying event. In the case of involuntary loss of coverage, the special enrollment period begins in advance of the loss of coverage so that enrollees can purchase a new plan with no gap in coverage. The rest of the qualifying events trigger a special enrollment period that begins on the date of the event and continues for 60 days.

Job-based plans must provide a Special Enrollment Period of at least 30 days. If you qualify for a Special Enrollment Period, you may have 60 days before or 60 days following the event to enrol in a plan. You can enrol in Medicaid or the Children's Health Insurance Program (CHIP) at any time.

There are also other situations that may qualify you for a Special Enrollment Period, such as gaining membership in a federally recognized tribe, becoming a U.S. citizen, leaving incarceration, or starting or ending service as an AmeriCorps member.

Frequently asked questions