The upcoming OPM-sponsored 2024 benefits open season (November 11 through December 9, 2024) will be a busy time for federal employees and retirees. They must decide whether to change their Federal Employees Health Benefits (FEHB) program health plan for the 2025 plan year. They need to decide whether to enroll, disenroll or change their dental insurance and/or vision insurance offered through the Federal Employee Dental and Vision Insurance Program (FEDVIP). Employees (but not retirees) need to decide whether to enroll or reenroll in the health care flexible spending account (HCFSA) and/or dependent care flexible spending account (DCFSA) offered through the FSAFEDS program.
There is another group of individuals who will need to make decisions about their health, dental and vision insurance benefits for 2025 during the upcoming benefits open season. These individuals are spousal survivor annuitants. This column discusses continued enrollment in the FEHB program and FEDVIP for family members, including eligibility and cost.
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Requirements for Continued FEHB Enrollment
If a federal employee or an annuitant dies while enrolled in FEHB with self plus one or self and family coverage and all the requirements are met, then the enrollment will continue for eligible family members who become survivor annuitants under a qualifying retirement system (for most employees, that is either the Civil Service Retirement System or the Federal Employees Retirement System). If the enrollment continues, eligible survivors are entitled to the same FEHB program benefits and federal government contributions as employees and annuitants in the same plan (the government pays on average 72 to 75 percent of the FEHB premiums, and employees and annuitants pay the other 25 to 28 percent) . The survivor annuitant’s share of the FEHB program premiums normally is deducted from the survivor annuitant’s monthly annuity payments.
For surviving family members to continue FEHB health benefits enrollment after an employee’s or an annuitant’s death), both of the following requirements must be met:
• The deceased employee or annuitant must have been enrolled in self plus one or self and family coverage at the time of his or her death, and
• At least one family member (the spouse) must be entitled to a survivor annuity as a survivor annuitant.
Any survivor who meets the definition of a “family member” can continue his or her FEHB Health coverage under the deceased enrollment as long as any surviving family member is entitled to a survivor annuity. If the survivor annuitant is the only eligible family member, the retirement system will automatically change the enrollment to self only.
Under FERS, the surviving spouse who is entitled to a Basic Employee Death Benefit (BEDB) may continue the deceased’s FERS program health benefits enrollment by paying the premiums directly to OPM. The deceased spouse who was a FERS-covered employee had to have at least 18 months of federal service at the time of death in order for the surviving spouse to receive the BEDB. If the deceased FERS employee had at least 10 years of FERS service at the time of death, then the surviving spouse would be eligible for a FERS spousal survivor annuity from which the monthly FEHB program insurance premiums would be deducted..
Surviving children of deceased federal employees or retirees who receive “children survivor benefits” (offset by children’s Social Security survivor benefits) may continue the deceased parent’s FEHB program health benefits. Self only monthly FEHB program premiums are deducted from the child(ren)’s monthly annuity.
If the spousal survivor annuity (or the child’s survivor annuity), will not be large enough to cover the survivor’s share of the premiums for his or her FEHB program health plan, then the survivor may either change the health plan to a lower-cost plan or option, or choose to pay the premiums directly to the retirement system.
When the surviving spouse will not receive any surviving annuity benefit because a former spouse has a court-ordered entitlement to a survivor annuity, then the surviving spouse can continue FEHB program coverage if the deceased enrollee or retiree had self plus one or self and family enrollment. The retirement system will notify the surviving spouse of his or her options in order to perform whatever actions are requested.
If No Survivors Are Eligible to Continue the Enrollment
If no survivors are eligible to continue the enrollment (for example, the deceased employee or annuitant had a self only FEHB program enrollment, then the deceased’s employing office will note in the “Remarks” section of the Individual Retirement Record the following: “No survivor is eligible to continue health benefits.” The employing office will terminate the enrollment on the Notice of Change in Health Benefits Enrollment (Form SF 2810) by commenting in the “Remarks” section: “Enrollee died (date)” and leave all health benefit documents in the Official Personnel Folder.
The deceased’s employment agency will send the enrollee copy of the Form SF 2810 to the nearest living relative or to the representative of the enrollee’s estate. However, if it appears that a survivor who has been covered as a family member may be eligible, it will send the Form SF 2810 to him or her.
If the Deceased Employee or Retiree Was Not Enrolled
If the deceased employee was not enrolled for health benefits at death, the employing office will note in “Remarks” section of the Individual Retirement Record: “Not enrolled for health benefits.” The employing will leave all health benefit documents in the deceased’s Official Personnel Folder and take no further action on health benefits.
When an Employee is Eligible for FEHB Program Benefits Both as An Employee and a Survivor Annuitant
If an employee is eligible for FEHB program health benefits and is covered as a family member under a spouse’s self plus one or self and family enrollment and the spouse dies; then the employee is eligible to continue FEHB enrollment as a survivor annuitant. The employee has the option of cancelling FEHB enrollment as a survivor annuitant and enroll as an employee because of a change in family status has occurred (death of spouse). However, if the employee wants to participate in “premium conversion” – (having the FEHB program health plan premiums deducted from the employee’s gross salary), then the employee must be enrolled in the FEHB program as an employee and not as a survivor annuitant.
An employee enrolled in the FEHB program under a spouse’s self plus one or self and family enrollment usually becomes a survivor annuitant upon his or her spouse’s death. If the employee has his or her own FEHB program enrollment (self only enrollment) and the employee later separates from service but cannot continue the enrollment as a former employee, then the former employee can enroll as a survivor annuitant. Eligible employees can make a change from coverage as an employee to coverage as a survivor annuitant within 30 days of separation from service.
Deferred Annuity
Those employees who leave federal service and are eligible for a deferred CSRS or FERS annuity are not eligible for FEHB program enrollment when their CSRS or FERS annuity starts. A survivor spouse who receives a survivor annuity upon the death of the deferred annuitant is not eligible for FEHB program coverage, even if the survivor annuitant had FEHB program coverage as an employee. If the survivor annuitant loses FEHB program enrollment as an employee, the plan cannot be transferred to the survivor annuity.
If a departed employee is receiving a deferred CSRS or FERS annuity, his or her former spouse may be eligible for FEHB program coverage under the spouse equity provisions.
Death Before Receipt of “MRA + 10” or “MRA + 20” Annuity
If a FERS employee chooses a postponed “MRA + 10” or “MRA + 20” retirement and dies before the FERS annuity begins, then the surviving spouse is considered to be the surviving spouse of an annuitant. The surviving spouse is eligible for FEHB program coverage under the same conditions as any other survivor annuitant and may enroll in the FEHB program when his or her FERS survivor annuity begins.
Survivor Annuitant Eligibility to Enroll In the FEDVIP
The Federal Employees Dental and Vision Insurance Program (FEDVIP) is available to eligible federal and Postal Service employees, annuitants and survivor annuitants. Employees, annuitants and survivor annuitants pay the full cost of FEDVIP dental insurance and vision insurance premiums with no federal government contributions towards the premium cost.
Most employees are eligible for dental and vision coverage if they are eligible for the Federal Employees Health Benefits (FEHB) program. However, they do not have to be enrolled in the FEHB program in order to be enrolled in the FEDVIP.
A survivor annuitant must be receiving a CSRS or FERS survivor annuity in order to enroll in the federal dental and/or vision insurance plans (FEDVIP).
There are three types of enrollment coverage for the FEDVIP: (1) Self only; (2) Self plus one eligible family member (a spouse or child under age 22); and (3) Self and family – multiple eligible family members.
Survivor Annuitant Eligibility to Enroll in the FSAFEDS Program
Federal employees (but not retirees) are eligible to enroll in the FSAFEDS program. The program offers two types of flexible spending accounts: (1) Health Care Flexible Spending Account (HCFSA); and (2) Dependent Care Flexible Spending Account (DCFSA).
Upon the death of a federal employee who was enrolled in a HCFSA and/or DCFSA, a surviving spouse is not eligible to continue participation. Any funds left in either the HCFSA or the DCFSA upon the death of the employee are forfeited.