Learn about Temporary Continuation of Coverage (TCC) for FEHB, helping federal employees and spouses maintain coverage after losing eligibility to the FEHB program.
Understanding Temporary Continuation of Coverage for Federal Employees Health Benefits
The Federal Employees Health Benefits (FEHB) program is a crucial component of the benefits package offered to federal employees, providing comprehensive health insurance. However, circumstances such as job loss, divorce, or other life changes can lead to the loss of regular FEHB coverage. In such cases, the Temporary Continuation of Coverage (TCC) allows individuals to temporarily continue their FEHB coverage. This article reviews the workings, eligibility criteria, enrollment process, costs, and what happens when TCC coverage ends.
FEHB Coverage After Regular Coverage Ends: How Does TCC Work?
TCC is a feature of the FEHB program that allows individuals who lose their FEHB coverage due to specific qualifying events to continue their health insurance coverage temporarily. Unlike regular FEHB coverage, TCC is not a permanent solution but rather a bridge that provides continued access to health benefits during transitional periods. The primary distinction between TCC and regular FEHB coverage lies in its temporary nature and the fact that individuals must pay the full premium, including both the employee and government shares, plus a 2% administrative fee.
Information About TCC Coverage
While regular FEHB coverage is subsidized by the government, TCC requires individuals to bear the full cost of the premium with after-tax dollars. This means that those electing TCC must pay both the employee and government portions of the premium, along with an additional 2% administrative fee. This cost structure makes TCC more expensive than regular FEHB coverage, but it provides a vital safety net for federal employees or family members covered under FEHB who lose their coverage due to qualifying events.
Features to Keep in Mind if You’re Entitled to TCC
TCC is designed to offer a temporary solution for individuals who lose their FEHB coverage. Key features include the ability to continue health insurance coverage for up to 18 months, with the possibility of extending it to 36 months for certain qualifying events (divorce, annulment, or loss of dependent child status). TCC is available to federal employees, their spouses (including recently divorced spouses who had coverage under the health insurance program because of the marriage), and dependent children who meet specific eligibility criteria. It is important to note that TCC is not automatic; individuals must elect TCC within31 – 60 days of losing their regular FEHB coverage. In general, TCC coverage cannot be extended beyond the initial period of 18 or 36 months, depending on the qualifying event. Individuals must plan for the transition to alternative health insurance options before TCC coverage ends to avoid gaps in coverage.
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Eligibility for Temporary Continuation of Coverage
TCC is a program that allows certain people to temporarily continue their FEHB coverage instead of losing their health plan immediately. You cannot apply for TCC if:
- If you lose your federal job due to gross misconduct.
- If moving from a position that is eligible for FEHB to a position that is not.
- If health coverage is lost after 12th month in LWOP (leave without pay).
- If you are covered as a family member and lose FEHB enrollment because covered federal worker or annuitant moves to “Self” or “Self+1” plan during open season.
- Surviving spouse loses survivor pension.
Don’t Miss Your Opportunity to Enroll: TCC Eligibility Criteria for Federal Employees
Federal employees may be eligible for TCC if they lose their FEHB coverage due to separation from service, except in cases where the fed was involuntarily separated due to gross misconduct. To qualify, employees must have been covered under the FEHB program at the time of separation. It is important for employees to review the TCC pamphlet and consult with their human resources department to understand their eligibility and the steps required to elect TCC. One condition for guaranteed access to FEHB after a federal employee is separated is that the separation cannot be involuntary due to gross misconduct.
Family Member Status, Spouse Equity, and Coverage for Former Spouses
Former spouses and dependent children can qualify for TCC under certain conditions. A former spouse is eligible for guaranteed access to individual health coverage with a TCC unless the marriage didn’t end in divorce or annulment, provided they were covered under the FEHB program at the time of the event. Spouses are not eligible if the marriage ends because the federal employee dies, although they might be eligible for FEHB if receiving survivor benefits. Dependent children who lose self and family enrollment can also qualify for TCC if they lose their status as a dependent, such as a child or foster child reaching age 26 (a dependent can keep FEHB after this age if they are incapable of self-support due to a mental or physical disability that was diagnosed before 26). It is essential for these individuals to understand their rights and the process for electing TCC in their own right.
Which Qualifying Event Allows Eligible Individuals to Temporarily Continue Health Coverage?
Qualifying events for TCC eligibility include separation from federal service, divorce, annulment, and loss of dependent child status. These events trigger the opportunity for individuals to elect TCC and temporarily continue their FEHB coverage. It is crucial for individuals to act promptly, as they must elect TCC within 60 days of the qualifying event to ensure uninterrupted health insurance coverage. Recently separated feds, unless the separation is involuntary due to performance, have 31 days to apply for TCC.
How to Enroll in TCC for FEHB Program with Office of Personnel Management
Enrollment Process for Eligible Individuals to Temporarily Continue FEHB Coverage
The enrollment process for TCC involves notifying the appropriate agency or human resources department of the intent to elect TCC within 60 days of the qualifying event. Individuals must complete the necessary forms and submit them along with any required documentation. It is important to adhere to the specified timelines to ensure successful enrollment in TCC. To enroll in TCC, individuals must provide documentation that verifies their eligibility and the qualifying event. This may include separation notices, divorce decrees, or other relevant documents. It is advisable to consult with the human resources department to obtain a comprehensive list of required documents and ensure a smooth enrollment process.
How to Apply for TCC after a Qualifying Event
After a qualifying event, such as when a marriage ends other than by death, you must apply for TCC by completing the necessary forms (contact your employing office) and submitting them to the appropriate agency or human resources department. It is crucial to act within the 31 or 60-day window following the qualifying event to secure TCC coverage. Failure to apply within this timeframe may result in the loss of the opportunity to temporarily continue FEHB coverage.
What are the Costs and Premiums Associated with TCC?
TCC coverage comes with specific costs and premiums that individuals must consider when electing this option. TCC premiums are calculated based on the full cost of the health insurance coverage, including both the employee and government shares, plus a 2 percent administrative fee. This means that individuals electing TCC will pay more than they did under regular FEHB coverage. It is important to review the cost implications and budget accordingly to maintain continuous health benefits.
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