You may be covered under the Federal Employee Health Benefits Program while you’re working in your federal position, but do you know if you’ll still be covered once you retire? The eligibility requirements are straightforward, however, it’s important to fully understand them, or you may find yourself, or a spouse, without coverage.
You can continue your FEHB coverage when you retire if you meet BOTH of the following requirements:
- You must retire on an immediate pension under FERS or CSRS, AND
- As the employee, you must have been continuously enrolled in ANY FEHB plan for the 5 years of service immediately before your retirement date OR the full period of service since your first chance to sign up (if less than 5 years).
What Type of Coverage Counts for the 5 Year Rule?
- Your own FEHB coverage
- Covered as a family member (under a spouses’ plan)
- Covered under TRICARE if you were covered under an FEHB plan at the time of your retirement
FEHB Coverage Change in Open Season
Example: If you plan to retire this year, and you have been covered by FEHB for the last 20 years, and you change to a different plan in Open Season, will you lose your coverage in retirement?
No. You meet both requirements because you’ve been covered for the 5 years immediately before your retirement date and you’re retiring.
FEHB for your Spouse
If you meet FEHB eligibility requirements, your spouse isn’t subject to the prior enrollment requirements.
It’s also important to understand how a survivor benefit plays into the continuation of FEHB. If you, the retiree, passes away first in retirement, your spouse can ONLY continue their FEHB if they elected to receive a survivor benefit—unless they are also a federal retiree. Without a survivor benefit, your spouse may lose coverage 31 days after your death.
Postponing FERS Retirement
If you separate from federal service under the MRA+10 rule and qualify for a FERS pension, you may continue FEHB coverage WHEN your FERS pension, if you meet the eligibility requirements when you separated from service. If you postpone the start of your FERS pension, your FEHB coverage will end when you separate from service.
Note: You may choose to resume FEHB coverage when you start to receive your FERS pension.
Cost in Retirement
You won’t pay more in retirement. The share of cost remains the same in retirement for your FEHB benefits. However, your FEHB premiums are no longer paid with pre-tax dollars in retirement.
What About Dental and Vision Coverage in Retirement?
The Federal Employee Dental and Vision Insurance Program coverage is available to both employees and retirees and eligible dependents. To continue FEDVIP coverage in retirement, you must:
- Retire on an immediate pension under FERS/CSRS, AND
- Pay premiums during the period of finalization of your pension by OPM. You will receive bills form BENEFEDS during this period and must pay the bills promptly. After OPM finalizes your pension, premiums are automatically deducted from your pension each month.
There is no 5-year continuous enrollment requirement for FEDVIP and you can also elect or cancel coverage in Open Season.
There are many things to consider when entering federal retirement. Make sure to do your research on all your benefits to ensure that you will still be eligible to receive them once you leave federal service.