Understanding Your FEHB Coverage as a Survivor Annuitant: Continuing Federal Benefits
As a federal employee, it is crucial to have a good understanding of your Federal Employee Health Benefits (FEHB) coverage. This becomes even more important if you are a survivor annuitant, which means you are the surviving spouse or eligible family member of a deceased federal employee or retiree. Did you know that a surviving spouse can be removed from FEHB if the federal annuitant predeceases him/her? Proper planning and knowledge of your federal benefits can prevent this huge mistake.
Today, our attention will be directed toward maintaining FEHB coverage for a survivor annuitant. For a more comprehensive understanding of CSRS, CSRS-Offset, and FERS survivor benefits, please explore a detailed explanation here.
Importance of FEHB Coverage
Having eligibility for FEHB self and family coverage in retirement ensures that you and your family will have access to quality health care. As a surviving spouse or annuitant, you are entitled to continue your FEHB coverage even after the death of the federal employee or retiree.
By continuing your FEHB coverage, you can keep the peace of mind that comes with knowing your health needs will be addressed. FEHB provides financial security, as medical expenses can be a significant burden without proper insurance coverage. Currently, the federal government pays between 72-75% of the FEHB premium even in retirement! Therefore, it is important for surviving family members to understand the eligibility criteria and the process of continuing FEHB enrollment.
FEHB Coverage as a Survivor Annuitant
Definition of Survivor Annuitant
A survivor annuitant is entitled to receive the maximum 50% survivor benefit unless the survivor agrees to a lesser amount by notarized acknowledgement on the federal employee’s retirement paperwork. The survivor annuity is a monthly payment made to the surviving spouse or eligible family member of a deceased federal employee or retiree. The annuity provides financial support to the survivor in the amount of 50% or 25% of the gross FERS pension amount. Under CSRS, you can select any portion of your annuity up to 55% of your annuity and as little as 55% of $22.00, which results in a $1.00 per month survivor annuity.
Annuitant Eligibility for FEHB in Retirement
A retired annuitant is eligible to maintain FEHB coverage in retirement if the following requirements are met:
- Retirement eligbility meets one of the following:
- Immediate pension
- MRA +10 which can be an immediate reduced pension OR postponed retirement
- Opt for the Voluntary Early Retirement Authority (VERA) program
- Disability retiree
- Enrolled in FEHB for 5 consecutive years before retirement (5-year rule)
Eligibility for FEHB as a Surviving Annuitant
A surviving spouse is eligible to continue FEHB coverage if the following requirements are met:
- The deceased retirement annuitant is eligible for FEHB in retirement
- The surviving family member is entitled to a survivor annuity
- FEHB covered the surviving spouse, either through Self + One or Self and Family
If eligibility is met, you can continue coverage even after the death of the retired annuitant.
FEHB for Retired Military on TRICARE
If you are on TRICARE consider signing up for FEHB coverage in your last year of civilian service. After you retire, you can suspend FEHB coverage and continue using TRICARE without the commitment of paying FEHB premiums in retirement. The file and suspend method will allow you to start FEHB in the future if you ever need to. TRICARE will satisfy the 5-year rule.
Learn more about FEHB File & Suspend Strategy here.
Eligibility for FEHB When Both Spouses are Feds (Dual-Feds)
A survivor benefit is not required to maintain FEHB when both spouses are eligible for a pension in their own right. The following requirements must be met by both retirees:
- Retirement eligiblity meets one of the following:
- Immediate pension
- MRA +10 (immediate reduced pension or postponed retirement)
- Opt for the Voluntary Early Retirement Authority (VERA) program
- Disability retiree
- Enrolled in FEHB for 5 consecutive years before retirement
If you are on the deceased spouse’s FEHB, you will still qualify for the 5-year requirement since you were eligible to be on your own Self-Only plan. If the primary payor of FEHB passes away, the surviving spouse can switch to their own FEHB plan right away since death falls under a qualifying event.
Enrollment Process in the Event of Death
If Death Occurs After FERS Retirement
Complete SF-3104 – Application for Death Benefits.
If Death Occurs During FERS Service
If Death Occurs During CSRS Service or After Retirement
Complete SF-2800, Application for Death Benefits.
Attach a copy of the employee’s death certificate and a copy of the certificiate of marriage to the widow or widower. A widow or widower who is claiming benefits for himself/herself and on behalf of children should file one application.
If you wish to cancel FEHB you must fill out form SF 2809 which can be found here.
What Happens in the Event of Death Before Deferred or Postponed Annuity Begins
Death Before Deferred Annuity Received
Generally, the employee who receives a deferred annuity will not receive FEHB in retirement. As a result, the spouse will not receive FEHB. There may be an exception through the FEHB spouse equity provisions which you can check out here.
Death Before Postponed Annuity Received
The spouse or survivor annuitant is eligible for FEHB when their survivor annuity begins. This applies to federal employees who have postponed their annuity at MRA+10 and have met the 5-year rule. There may be a waiting period of when FEHB coverage begins depending on the commencement of the annuity. The survivor annuitant will need to file form RI92-19 to begin the pension and activate FEHB. You can find form RI92-19 here.
CSRS Survivor Benefits in the Event of Death While Working
Spouse – CSRS or CSRS-Offset
If the employee died while covered under CSRS or CSRS-Offset, recurring monthly payments may be made to the surviving spouse if the deceased employee completed at least 18 months of civilian service. The following requirements apply to the spouse:
- Married at least 9 months
- The 9-month requirement does not apply if the death was accidental, or there is a child born of the marriage
Survivor benefit payments and FEHB will begin immediately. The survivor benefit is calculated as follows:
- 55% of the amount the deceased employee would receive had he/she retired at the time of death
- OR the lesser of: 22% of deceased employee’s high-3 OR 55% of the amount your annuity would had been if you continued working until age 60 at the same high-3
A spouse’s survivor annuity will begin immediately and will end at the surivor’s death or remarries before age 55.
FERS Survivor Benefits in the Event of Death While Working
Spouse – FERS
If the employee died while covered under FERS, recurring monthly payments may be made to the surviving spouse if the deceased employee completed at least 10 years of creditable service (18 months of which must be civilian service). The following requirements apply to the spouse:
- Married at least 9 months
- The 9-month requirement does not apply if the death was accidental, or there is a child born of the marriage
Survivor benefit payments and FEHB will begin immediately. The survivor benefit is equal to 50% of the deceased federal employee’s annuity. The calculation is based on the years of service and high-3 without a reduction for age.
Former Spouse
A survivor annuity may be paid in whole or in part to a former spouse if a court-ordered entitlement to a survivor is on file at OPM. Former spouses will be unable to continue FEHB coverage.
Insurable Interest
A survivor annuity may be paid to a person with insurable interest, however, FEHB is unable to be maintained if the person of insurable interest is not on the federal employee’s FEHB.
Learn more about insurable interest survivor benefits here.
Children
The government will not award children’s survivor benefits automatically. The surviving parent or guardian must complete an Application for Death Benefits. For CSRS, form SF-2800 which you can find here. For FERS, form SF-3104 which you can find here.
A benefit may be payable to the child of an employee if the child is:
- An unmarried dependent up to age 18
- An unmarried dependent from age 18 to age 22 if attending an accredited educational institution full-time
- Unmarried disabled dependent children may receive recurring monthly benefits if the disability occurred before age 18
A “child” includes an adopted child, stepchild, or recognized child born out of wedlock
The combined benefit of all the children is reduced by the total amount of child’s insurance benefits that are payable (or would, upon proper application, be payable) under Title II of the Social Security Act for the same month to all children of the deceased (including those of a former marriage who may not be living with the current spouse) based on the total earnings of the deceased. In many cases, the FERS children’s benefit is reduced to $0.
Waiver of 5-Year Enrollment Requirement
Public Law 99-251 gave OPM the authority to waive the 5 year service requirement when, in its sole discretion, it determines that it would be against equity and good conscience not to allow a person to be enrolled in the FEHB Program as an annuitant. An employee’s failure to satisfy the 5-year requirement must be due to exceptional circumstances. Employees requesting a waiver must provide OPM with evidence that:
- the employee intended to have FEHB coverage as a retiree;
- the circumstances that prevented the employee from meeting the 5-year requirement were essentially outside of the employee’s control; and
- the employee acted reasonably to protect the right to continue FEHB coverage into retirement. (This includes reading and acting on information provided and requesting information if none is given automatically.)
- Quoted from OPM FEHB Program Handbook
How OPM Applies Its Waiver Authority
OPM’s approval of a waiver request depends on the extent to which the individual could have controlled the events leading to the loss of coverage at retirement. When OPM reviews a waiver request, it considers:
- whether the individual had a compelling reason to believe he/she was covered as a family member of another person enrolled in FEHB during the time in question;
- evidence that an individual’s employing office would not allow him/her to enroll;
- the extent to which an individual could have controlled the events that led up to the loss of the right to continued FEHB coverage;
- whether the individual had acted to gain FEHB coverage at the earliest opportunity after learning of the loss of benefits or possible loss of future rights; and
- whether the individual had substantial FEHB coverage during his/her career even though there was a break in continuity during the last 5 years of service.
- Quoted from OPM FEHB Program Handbook
Reach Out to Us!
If you have additional federal benefit questions, contact our team of CERTIFIED FINANCIAL PLANNER™ (CFP®) and Chartered Federal Employee Benefits Consultants (ChFEBC℠). At PlanWell, we focus on retirement planning for federal employees. Learn more about our process designed for the career federal employee.
Preparing for federal retirement? Check out our scheduled federal retirement workshops. Sign up for our no-cost federal retirement webinars here! Make sure to plan ahead and reserve your seat for our FERS webinar, held every three weeks. Want to have PlanWell host a federal retirement seminar for your agency? Reach out, and we’ll collaborate with HR to arrange an on-site FERS seminar.
Want to fast-track your federal retirement plan? Skip the FERS webinar and start a one-on-one conversation with a ChFEBC today. You can schedule a one-on-one meeting here.
