Temporary loss of health coverage


Q. I am a retired foreign service officer whose spouse is still an active federal employee working for an agency other than the State Department. To save money, we decided to move from one self-and-family policy under my name to separate self-only plans. I opted for a completely different carrier, while my wife chose to stay with the one we had had for six years.

We had not counted, however, on the fact that this year, there would be a nearly two-week gap between the time frame for changes for retirees and for active employees. The end result has been that my self-and-family coverage ended Dec. 31, but my wife’s self-only coverage will only begin with the start of a new pay period Jan. 13. I confirmed with my former carrier that, despite having a record of her new enrollment, there was nothing it could do to continue her coverage without some sort of code or certification from my wife’s agency or the Office of Personnel Management. State essentially confirmed this and added that it would only have been able to modify my wife’s action had she also worked for State. My wife’s agency, meanwhile, seems to have been caught flat-footed by this problem and, after initially pronouncing her out of luck, claims to be researching her situation and that of a few others similarly affected.

This sort of Catch-22 is quite frustrating, not to mention upsetting. Neither my wife nor I saw any information during the open season warning of this potential pitfall much less guidance on how to avoid it. I advised State human resources, when I filed my change, that my wife would drop from my coverage to obtain her own through her agency. She, however, did not do so since her agency’s online enrollment procedure did not seem to allow for that.

Can you please advise as to how this should have been handled and what sort of remedial action (OPM code, certification) is possible? My wife is in good health and could probably make it to the 13th without problem, but her lack of coverage during an emergency is worrying. She has also already had to postpone seeking an elective appointment and been declined insurance coverage for a prescription she rushed to have filled on the 31st. It is hard to believe that the Federal Employees Health Benefits plan regulations would not address such a gap, greater this year than in most, given the number of mixed marriages between active and retired feds.

A. What happened is unfortunate. However, I’m not aware of any action you could take that would change that.


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Reg Jones was head of retirement and insurance policy at the Office of Personnel Management. Email your retirement-related questions to fedexperts@federaltimes.com.

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