Federal Retiree Center

The 5-year rule

Hello! So, your 65^th birthday is almost here and you’re ready to take on the next exciting chapter in your life. You’ve selected an FEHB health plan but keep hearing about the 5-year rule. Ask yourself:

• What is it?
• How does it affect my eligibility in the Federal Employees Health Benefits (FEHB) program after retirement?
• What does this mean for me?

Let’s get some answers for you.

What are the requirements for health benefits after retirement?

You can continue your FEHB coverage after you retire if you meet these two conditions:

1. You retire on an immediate pension under the Federal Employees Retirement System or the Civil Service Retirement System
2. You are continuously enrolled in any FEHB plan for the five years of service immediately before your retirement date, or for the full period(s) of service since your first chance to sign up (if less than 5 years)

Example with a break in service

You enrolled in FEHB from 2010 to 2012. You left Federal employment but returned in 2017 and enrolled in FEHB again from 2017 to 2020. The two years you were enrolled in FEHB from 2010 to 2012 plus the three years in FEHB from 2017 to 2020 means you meet the 5-year rule. But what if you were continuously employed and eligible for FEHB but had a break in your coverage from 2010 to 2016 because you cancelled your FEHB? Then you must begin the five-year period over again.

What type of coverage counts towards the 5-year rule?

• Your own FEHB coverage
• Coverage as a family member (e.g. you’re covered by your spouse’s FEHB plan)
• Coverage under TRICARE as long as you were covered under an FEHB plan at the time of your retirement

Don’t meet these requirements? You may be eligible for other forms of coverage. For instance, Temporary Continuation of Coverage.

How do I get a waiver of the 5-year coverage requirement?

Waivers come from the Office of Personnel Management. Usually they only issue waivers due to special circumstances. If you think you might qualify for a waiver, contact your Human Resources Office. If you meet the requirements, your agency will attach a memo to your retirement application stating that you meet the requirements for a waiver.

Now that you know what the 5-year rule is, you can relax. Since you qualify for FEHB after retirement, you can plan your well-deserved vacation – worry free.

And when you’re ready to talk about your health plan options, set up a one-on-one meeting to speak with an Aetna Federal Plans Team member. We’ve got you covered.

Till next time,
Rick

©2020 Aetna Inc.
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