You can use Standard Benefits to administer and manage employee enrollment in Federal Employee Health Benefits (FEHB) plans and options based on the full range of Office of Personnel Management (OPM) qualified life events.
The employee's work or residence location determines the employee's plan enrollment eligibility. Employees participating in FEHB may elect predefined plans and options specific to their state or county of residence, or to their work location. (Overseas employees can elect nationwide plans only.)
In certain situations, you may need to override the eligibility results. For example, if you extend an employee's Leave Without Pay (LWOP) beyond 365 days, the employee may become ineligible for FEHB. If this extension occurs, you can grant an exception so that the employee can enroll in a plan or option.
In other situations, you may need to waive someone's eligibility. For example, if OPM removes a plan from a FEHB program, an employee can neither select nor remain with the plan. In that case, you can waive the employee's participation in the plan so that the employee can enroll in another plan.
See: Overriding Enrollment Results for a Plan
Electable benefit choices occur as a result of one of the OPM defined life events. The application triggers a life event when the employee initiates a change in health benefits through SSHR or when you:
Process an Appointment, Conversion to Appointment, or Extension action that gives the employee an opportunity to enroll in health benefits
Update an RPA to the database that changes the employee's eligibility, such as a NOAC 781 Change in Work Schedule
Initiate a potential life event through the benefits user interface, such as a life event for someone who now qualifies for medicare (Employee Becomes Eligible for Medicare life event)
Additional non-OPM life events ensure smooth transitions, such as the continued coverage for rehires and transfers, the termination of life events for separation actions, and opening the enrollment period for an employee on after tax deductions.
The following table lists life events and indicates which life events the HR administrator manually initiates (HR) and which life events the application initiates as a result of actions such as RPA updates. Life event codes starting with 1 denote employees participating in premium conversion (pre tax deductions), and codes starting with 5 denote employees who declined participation in premium conversion (after tax deductions).
| Life Event Name | Life Event Code | Life Event Triggered (Auto/HR) |
|---|---|---|
| Initial Opportunity to Enroll | 1A / 5A | Auto |
| Open Season | 1B / 5B | Auto (time period specified by customer) |
| Change in Family Status | 1C / 5C | HR |
| Change in Employment Status Affecting Entitlement to Coverage | 1D / 5D | Auto |
| Change in Employment Status Affecting Cost of Insurance | 1E | Auto |
| Employee Returns from Uniformed Service | 1F | HR |
| Begin or Return from Non-Pay Status or Insufficient Salary - Coverage Continued | 1G | HR |
| Salary of Temporary Insufficient to Make Withholdings for Plan in Which Enrolled | 1H / 5M | HR |
| Employee/Family Member Moves Outside HMO Enrollment Area | 1I /5J | HR |
| Transfer From a Post of Duty Within US to Post of Duty Outside US or Vice Versa | 1J / 5F | Auto |
| Separation from Federal Employment When Employee or Spouse is Pregnant | 1K / 5E | HR |
| Employee Becomes Eligible for Medicare | 1L / 5K | HR |
| Employee/Family Member Loses Coverage Under FEHB or Another Group Plan | 1M / 5G | Auto |
| Loss of Coverage Under a Non-Federal Health Plan-Moves Out of Commuting Area | 1N / 5I | HR |
| Employee/Family Member Loses Coverage Due to Discontinuance of an FEHB plan | 1O / 5H | HR |
| Employee/Family Member Gains Coverage Under FEHB or Another Group Insurance Plan | 1P | HR |
| Change in Spouse's/ Dependent's Coverage Under a Non-Federal Health Plan | 1Q | HR |
| Temporary Employee Completed One Year of Continuous Service - Pre-Tax Waiver | 5L | HR |
The employee has the option upon initial enrollment to choose a plan with a pre-tax deduction or after tax option. If an employee wants to change from a pre-tax to an after tax option after the period of initial enrollment has expired, the employee must wait until a valid life event occurs, such as Open Season.
If an employee chooses after tax deductions, the employee can make the following changes without waiting for a valid life event:
Terminate health benefits by declining coverage (pre-tax employees can only terminate coverage with a life event such as Open Season)
Change to a lower option, for example from Family to Self, or from a High to Low option
Change to pre-tax option
Benefits processing requires a life event, so when an employee on after-tax deductions wants to change their benefit elections, such as decline coverage, the employee must contact HR to have the HR administrator initiate an After Tax Deductions life event.
Using the benefits user interface, you can manually initiate life events for an employee, enroll an employee in a plan, and make changes to that person's benefit selections. You may need to manually initiate a life event when:
An employee does not have access to a computer
The application does not automatically detect the life event, such as an employee or eligible family member losing coverage under FEHB or another group plan
A Cancellation or Correction action requires that you back out a life event
At the time of the Appointment action, the employee wishes to continue coverage in an agency health plan, for example in a state health plan
You terminate health benefits by processing a Separation action. The application automatically initiates a Terminate Contributions life event that enters an end date for all restricted and non-restricted benefit enrollments and enters an end date for all element records.
The application determines the date on which a life event occurs based on the effective date or the user-entered date.
| Where Information Changed | Date Used |
|---|---|
| RPA action | RPA's effective date |
| Address window | From Date of the primary address |
For all Appointment actions other than transfers or rehires with a break in service of less than 3 days, the FEHB effective date is the beginning of the pay period following the receipt of the employee's elections.