TCC (temporary continuation of coverage) is a
feature of the Federal Employees Health Benefits (FEHB) program
that allows certain people to temporarily continue their FEHB
coverage after regular coverage ends.
How much does TCC cost?
TCC enrollees must pay the full premium for the plan they select
(that is, both the employee and Government shares of the premium)
plus a 2 percent administrative charge.
Who is eligible for TCC?
Federal employees and members of their families who lose their
FEHB coverage because of a qualifying event may be eligible for
TCC. The qualifying event must have occurred on or after January
1, 1990.
What is a qualifying event?
For employees, the only qualifying, event is separation from the
Federal service. However, employees are not entitled to TCC if
the separation is involuntary due to gross misconduct. Your
employing, office is responsible for deciding whether conduct
that leads to an involuntary separation is "gross
misconduct." If your employing, office decides that you were
separated because of gross misconduct, it must notify you of that
fact and explain what you can do to appeal the decision.
For children, the qualifying, events are:
Spouses are not eligible for TCC in their own right, even if
you separate and decide not to elect TCC or you die. However, if
your marriage ends other than by death, your former spouse is
eligible for TCC. The qualifying
events are:
Who
is covered under a TCC
family enrollment?
For a former employee, a TCC family enrollment covers the same
family members as were covered under the regular family
enrollment and the family members must continue to meet the same
requirements as under a regular family enrollment. A new family
member, such as a new spouse or a newborn child, who is added
during, the period of TCC enrollment is also covered as a family
member.
For "children" who have a TCC family enrollment, the
enrollee's spouse and children are covered family members.
For former spouses, family members are limited to those
individuals who are children of both the Federal employee and the
former spouse. The new husband or wife of a remarried former
spouse is not covered as a family member.
How long can coverage continue
under TCC?
Separating employees can continue TCC for up to 18
months after the date of separation.
Children and former spouses can continue TCC for up to
36 months after:
If your child's or former spouse's qualifying event occurs while
you are enrolled for family coverage under TCC, the child or
former spouse may elect TCC in his or her own right; however, the
TCC coverage may not continue beyond 36 months after the date of
your separation.
How to obtain TCC if you are a
separating employee?
If you lose your FEHB coverage because you leave your Federal
job, you are eligible for TCC unless your separation is
involuntary due to gross misconduct. Otherwise, the reasons for
your separation don't matter.
Your employing, office must notify you within 61 days after your
regular FEHB enrollment terminates of your opportunity to enroll
under TCC. Generally, you have 60 days after getting, the notice
to enroll under TCC, but never less than 60 days after your
separation date.
It's a good idea to ask your agency to give you your TCC
information on the day you separate. TCC enrollments-and
premiums--always begin on the 32nd day after your regular
coverage ends (which happens on the last day of the pay period in
which you separate). The earlier you submit your enrollment form,
the earlier your agency can process it, and the less likely it
will be for you to receive a large bill for retroactive TCC
coverage.
However, if you retire and you are eligible to continue your
regular FEHB coverage as a retiree, you aren't eligible for TCC
because your regular FEHB coverage doesn't stop. If you are
retirinig, and you aren't sure whether you are elicible to
continue recular FEHB coverage as a retiree, contact the Office of Personnel and
Benefits.
How to obtain TCC for children
who lose FEHB coverage
If your child wants TCC, it is your responsibility to notify your
employing, office within 60 days after the qualifying, event and
supply the child's mailing, address. (Since the enrollment will
be in the child's name, the child must complete the election form
and the child will be billed for the coverage.)
Within 14 days after it receives the information about the child,
the employing office must notify the child of his or her TCC
rights. The child must make his or her election within 60 days
after the later of:
If you don't notify your employing, office within the 60-day
time limit, the opportunity to elect TCC ends 60 days after the
qualifying, event.
If someone other than you (the employee)
notifies the employing office about your child's eligibility,
your employing office will notify your child of his or her TCC
rights, but your child's 60-day time limit to elect TCC begins
with the qualifying event, not the date of the
employing office's notice of TCC rights.
How to obtain TCC for former
spouses
If your former spouse doesn't meet all the requirements for
enrollment under the spouse equity provisions of law see spouse equity provisions,
he or she may be eligible for TCC. To be eligible for TCC, your
former spouse must have been covered under your FEHB family
enrollment at some time during the 18 months before your marriage
ended. (The term "former spouse" does not include
widows or widowers.)
If your former spouse wants TCC, you and your former
spouse share the responsibility for notifying your employing
office within 60 days after the qualifying event (divorce or
annulment) and supplying the former spouse's mailing
address. Within 14 days after your employing office receives the
notice from you or your former spouse, it must notify your former
spouse of his or her TCC rights. Your former spouse must elect
TCC within 60 days after the later of:
If your former spouse becomes eligible for TCC, and you or
your former spouse do not notify your employing office within the
60-day limit, the opportunity to elect continued coverage ends 60
days after the divorce or annulment.
Note: If someone other than you or your former spouse notifies
your employing office about your former spouse's eligibility, the
employing office will notify your former spouse of his or her TCC
rights, but your former spouse must elect continued coverage
within 60 days after the divorce or annulment, not 60 days after
the employing office's notice.
What
are the spouse equity
provisions?
The spouse equity provisions of law allow the former spouse of a
Federal employee or annuitant to enroll in FEHB if he or she
meets the following requirements:
The cost of coverage under the spouse equity provisions is
slightly less than under TCC. Spouse equity enrollees pay the
full premiums (both the employee and Govemment shares), but they
do not pay the extra 2 percent administrative charge.
Coverage under a spouse equity enrollment does not begin until
after the Office of Personnel Manaoement has reviewed the court
order to determine if it is "qualifying" and the
employing office gets both the election form and proof that the
former spouse is eligible for coverage under the spouse equity
provisions. The former spouse can enroll under TCC while waiting,
for the spouse equity coverage to begin and thereby avoid any gap
in health insurance coverage.
There is no specific time limit on how long spouse equity
enrollments can continue. The enrollment can continue as long as
the former spouse meets the requirements given above and pays the
premiums when they are due. If the former spouse loses
eligibility under the spouse equity provisions (for example, he
or she remarries before reaching age 55) before the 36-month
period for TCC runs out, the former spouse can change to a TCC
enrollment, which can continue for the remainder of the 36-month
period. See, "Changing
From a Spouse Equity Enrollment to a TCC Enrollment".
If you need more information about the spouse equity provisions,
ask your employing office.
Enrollment options under TCOC
To enroll for TCC, you (or your child or former spouse, as
applicable) complete Standard
Form 2809, Health Benefits Registration Form, and submit it
to your employing office within the time limit explained above.
Employing offices can accept belated enrollments in very limited
circumstances. Contact your employing office for further
information.
Enrollees are not limited to the plan or option in which they
were covered when the regular FEHB coverage ended. You (or your
child or former spouse, as applicable) may enroll in any plan for
which otherwise qualified. (Some plans require that enrollees
live in a certain geographic area or belong to the sponsoring
employee organization.)
Enrollees may elect either a self or self and family enrollment;
however, the individuals who qualify as family members under a
TCC family enrollment vary depending on whether the enrollee is a
former employee, a child, or a former spouse. See "Who is covered under a TCC
family enrollment".
if a person who is eligible for TCC can't make an election on his
or her own behalf because of a mental or physical disability, a
court-appointed guardian may file an election for that person.
Effective date of coverage
An enrollee who loses FEHB coverage other than by cancellation
(including cancellation by nonpayment of premiums) has a 31-day
temporary extension of coverage, at no cost, in the same
enrollment category held at separation for the purpose of
converting to a nongroup contract with the current health
benefits plan. This is true even when the enrollee also has the
right to elect temporary continuation of FEHB coverage. TCC takes
effect on the day that the 31 -day temporary extension of
coverage ends.
Coverage is retroactive to that date if the enrollment processing
is completed later.
As previously discussed, depending on the circumstances, a timely
election can be made up to 120 days after the qualifying event. A
person who waits that long to enroll is billed for the entire
89-day period of retroactive coverage. In cases where the
employing office accepts a belated election, the period of
retroactive coverage for which the enrollee is billed is even
longer. If the enrollee does not pay the bill for the retroactive
coverage, the TCC enrollment is canceled retroactivly to the
beginning date and the person is not eligible to reenroll.
Premium payments
The employing office (or its agent if it has made arrangements
for some other office to handle its TCC accounts) bills the
enrollee for each pay period (generally each month) he or she is
covered. The initial bill may include more than one month's
coverage if more than one month has passed since the effective
date. Payments are due after the month during which the TCC
enrollee is covered and in accordance with the schedule and
procedures established by the employing office.
Opportunities to change
enrollment
After the initial enrollment, a TCC enrollee may chanae
enrollment during the annual FEHB open season or, generally, when
an event occurs that would allow an employee to change
enrollment.
A TCC enrollee may change enrollment from self and family to self
only at any time. Family members who lose coverage because an
enrollee changes enrollment from self and family to self only are
entitled to the 31-day temporary extension of coverage for
conversion to an individual contract, but are not eligible to
enroll under TCC in their own right.
A TCC enrollee may change coverage during the annual FEHB open
season or when one of the following events occur:
Changing
from a spouse equity
enrollment to a TCC enrollment
A former spouse enrolled under the spouse equity provisions may
be able to change to a TCC enrollment if he or she loses spouse
equity eligibility because--
OR
A former spouse can chance from a spouse equity to a TCC
enrollment if:
The former spouse must notify the employing office within 60
days after eligibility for spouse equity coverage ends. The
employing office will give the former spouse details about how to
change to a TCC enrollment. The TCC enrollment cannot continue
beyond 36 months after the divorce or annulment (or the
employee's separation, if applicable).
Termination of enrollment or
coverage
A TCC enrollee's coverage ends either because the period of
temporary continuation expires or the enrollee cancels the
enrollment. (Coverage also stops when enrollees don't pay
premiums. Termination of coverage because of nonpayment of
premiums is considered a voluntary cancellation.) If the
enrollment ends because of the expiration of the period of TCC,
the enrollee is entitled to a 31-day temporary extension in the
same enrollment category held at the time TCC expires for
conversion to an individual contract.
TCC coverage of family members ends when the covering enrollment
ends or when the person ceases to meet the requirements for being
considered a family member. A family member who loses the
continued coverage for any reason other than cancellation of the
covering enrollment is entitled to a 31-day extension of coverage
for conversion to an individual contract and may be eligible for
TCC in their own name. To be eligible for TCC in their own name,
the family members must lose family member status because of a
qualifying event that occurs while they are covered under the TCC
family enrollment of a separated employee.
Thirty-one-day temporary extension
of coverage and conversion to a
nongroup contract
An enrollee who loses FEHB coverage other than by cancellation
(including cancellation by nonpayment of premiums) has a 31-day
temporary extension of coverage, at no cost, in the same
enrollment category held at the time of separation for the
purpose of converting to a nongroup contract with the current
health benefits plan. This is true even when the enrollee also
has the right to elect temporary continuation of FEHB coverage.
TCOC takes effect on the day that the 31-day temporary extension
of coverage ends. Coverage is retroactive to that date if the
enrollment processing is completed later.
An enrollee who elects TCC instead of the conversion policy has
another 31-day extension of coverage, at no cost, in the same
enrollment category held at the time TCC expires and another
opportunity to convert to a nongroup contract when the temporary
continuation ends (other than for cancellation).