EmpowHR: Section 8 - ESS

Health Benefits

Any Federal Employees Health Benefits (FEHB) program change request entered during Open Season will be effective Pay Period 01. If you meet the criteria for a qualifying life event (QLE) and wish to have your FEHB change effective on a different date, please see your servicing personnel office. The major QLEs that permit enrollment or change in enrollment outside of open season are:

• Change in family status:
  • Marriage
  • Birth or adoption of a child
  • Acquisition of a foster child
  • Legal separation
  • Divorce
  • Death of a spouse or dependent
• Change in employment status:
  • Reemployed after a break in service of more than 3 days.
  • Return to pay status after your coverage terminated during LWOP status or because you were in LWOP status for more than 365 days.
  • Pay increases enough for premiums to be withheld.
  • Restored to a civilian position after serving in the uniformed services.
  • Change from a temporary appointment to an appointment that entitles you to a Government contribution.
  • Change to or from part-time career employment.
• Employee or a family member lose FEHB or other coverage:
  • Under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to self only.
  • Under another Federally-sponsored health benefits program.
  • Under Medicaid or similar State-sponsored program for the needy because your membership terminates in the employee organization sponsoring the FEHB plan.
  • Under a non-Federal health plan.

When one of these events occur, the employee may:

• Enroll
• Change enrollment from self only to self and family
• Change enrollment to self only
• Cancel enrollment

  Note: A change to self only may be made only if the QLE causes the enrollee to be the last eligible family member under the FEHB enrollment. A cancelation may be made only if the enrollee can show that as a result of the QLE, he or she and all eligible family members now have other health insurance.