Key Takeaways:
- FEHB Self Plus One provides continued coverage for federal retirees and one eligible family member, with costs and eligibility determined by federal rules.
- Survivor eligibility, enrollment changes, and government contribution guidelines can significantly impact retired families’ health coverage choices.
What Is FEHB Self Plus One?
Definition of Self Plus One
FEHB, or the Federal Employees Health Benefits Program, is the primary health insurance offering for federal employees, retirees, and certain eligible family members. “Self Plus One” is one of three FEHB enrollment types. It covers you and one eligible family member—typically a spouse or a legally recognized child under 26. This option was introduced to meet the needs of those who don’t require full family coverage but want to ensure one dependent is protected alongside their own health needs.
How FEHB Coverage Works in Retirement
When you retire as a federal employee, you may continue FEHB coverage if you meet eligibility requirements. FEHB in retirement functions as it did while you were working, providing access to the same broad network and coverage. Premiums are typically deducted from your annuity payments, and you retain the ability to change plans during Open Season or in response to qualifying life events. Self Plus One allows retirees to balance coverage for themselves and one other, often reducing premium costs compared to Family enrollment.
Who Qualifies for FEHB in Retirement?
General Eligibility Requirements
To continue FEHB coverage after retirement, you must have been continuously enrolled, or covered as a family member, in FEHB for at least five years immediately before retirement—or for the full period of service if it is less than five years. Additionally, you must retire on an immediate annuity, whether under FERS, CSRS, or another qualified federal retirement system. Those who leave federal service before retirement age may lose eligibility for FEHB as retirees.
Rules for Annuitants and Survivors
Annuity recipients (retirees) can keep FEHB as long as they remain eligible under OPM (U.S. Office of Personnel Management) rules. In certain situations, a surviving spouse or child who receives a survivor annuity after a retiree’s death can continue FEHB coverage. However, this continuation is contingent upon meeting survivor annuitant eligibility rules and the retiree electing a survivor benefit at retirement.
How Are FEHB Costs Determined?
Premium Factors for Self Plus One
FEHB premiums for Self Plus One are based on several components, including the federal plan you select and the option (Standard, High, or Basic, as offered). Costs are published annually by OPM and are the result of negotiated rates with participating health insurance providers. While Self Plus One is often less expensive than Self and Family, it is generally higher than Self Only coverage, reflecting the partial extension of benefits to a dependent.
Government Contribution Guidelines
The government pays a substantial portion of your FEHB premium, both while you are working and in retirement. This contribution is calculated as a percentage of the weighted average premium across all plans and options, subject to a maximum. Retirees are responsible for the remainder of the premium, paid through deductions from the retirement annuity. The specific government contribution and your share are set each year by OPM.
Can You Change Your Enrollment Type After Retiring?
Options for Switching From Self Only
After retiring, you may find your household situation changes. FEHB permits you to change from Self Only to Self Plus One, or Self and Family, during the annual Open Season or when you experience a qualifying life event—such as marriage, divorce, birth, or adoption. This flexibility allows you to adjust your coverage as your personal needs evolve in retirement.
Rules for Moving to Self Plus One or Family
If you wish to change from Self Plus One to another enrollment type, similar rules apply. Any change outside of Open Season must be prompted by a qualifying life event recognized by OPM. The new coverage generally starts at the beginning of the following pay period after your request is processed. It is important to ensure that the eligible family member is included in your coverage at the time of enrollment or during permitted changes.
What Happens to FEHB After a Spouse’s Death?
Survivor Annuitant Eligibility
If your spouse is your covered family member under Self Plus One and they pass away, FEHB coverage does not automatically continue for another dependent. Instead, you would revert to Self Only coverage unless a new eligible family member exists. However, if you were the family member on your spouse’s policy and they die, your continuation of coverage depends on your eligibility as a survivor annuitant under the rules laid out by OPM.
Coverage Transition Considerations
Transitioning FEHB after the loss of a spouse involves timely notification to OPM and, in some cases, adjusting your enrollment type. You cannot add a new dependent after your spouse’s death unless explicit eligibility rules are met. Fees and premium responsibilities may change following the transition, and the survivor annuity must be in place to continue coverage. Careful attention to OPM correspondence and deadlines is critical.
Case Study: A Typical Federal Retiree
Overview of Case Scenario
Imagine a federal retiree who worked for over 30 years, enrolling in FEHB early in their career. Upon retiring, they and their spouse enroll in FEHB Self Plus One. Both are over 65, and the retiree collects a monthly annuity, with FEHB premiums deducted automatically.
Eligibility and Cost Walkthrough
Thanks to over five years of continuous FEHB enrollment and eligibility for an immediate annuity, this retiree qualifies to continue coverage uninterrupted. Selecting Self Plus One, they keep their spouse protected without needing full family coverage. Premiums reflect the plan and federal contribution for retirees, as posted annually by OPM. If the spouse predeceases the retiree, the latter’s coverage shifts to Self Only, and premium costs adjust accordingly. If the retiree’s annuity includes a survivor benefit, the spouse may maintain coverage should the retiree pass first.
FAQ: Understanding FEHB Self Plus One in Retirement
Are There Waiting Periods for Retirees?
No new waiting period applies if you continue FEHB into retirement, provided you meet the five-year (or career-long) prior coverage rule. Gaps in coverage or breaks in service may affect eligibility, so reviewing your service record is advised before retiring.
Can Adult Children Be Covered Under Self Plus One?
Self Plus One applies to one eligible family member only. Adult children under age 26 can be named as the “plus one,” but coverage cannot be extended to multiple children or combined with a spouse under this enrollment type.
How Often Can Retirees Change FEHB Plans?
Changes to plan or enrollment type can be made annually during Open Season, or more frequently if prompted by qualifying life events. OPM’s published schedule and guidance set the permitted windows and effective dates for enrollment changes.
