5 C.F.R. Subpart B—Eligibility
Title 5 - Administrative Personnel
(a) If you are a Federal civilian or Postal employee whose current position conveys eligibility for Federal Employees Health Benefits under part 890 of this chapter, you are also eligible to apply for coverage, with the following exceptions: (1) If you are a District of Columbia employee or retiree, you are not eligible to apply for coverage, regardless of whether you are eligible for Federal Employees Health Benefits coverage. There is a related exception, however: D.C. government employees and retirees who were first employed by the D.C. government before October 1, 1987 are eligible to apply for coverage. (2) If you are a Tennessee Valley Authority employee or retiree, you are eligible to apply for coverage, even though you may not be eligible for Federal Employees Health Benefits coverage. (3) If you are a Non-Appropriated Fund (NAF) employee or retiree you are eligible to apply when the Secretary of Defense determines such eligibility for the NAF instrumentality that employs you, and you will be treated the same as a Federal civilian employee or retiree (as applicable) under this Part. (b) If you are a Federal civilian or Postal employee whose current position is excluded from Federal Employees Health Benefits eligibility under §890.102 of this chapter, you are excluded from applying for coverage unless paragraph (a)(2) of this section applies. (c) If you are an annuitant reemployed by the Federal Government, you may apply for coverage as an employee. [68 FR 5534, Feb. 4, 2003, as amended at 70 FR 30607, May 27, 2005] If you are a Federal annuitant, including a survivor annuitant, a deferred annuitant, or a compensationer, you are eligible to apply for coverage. Separated Federal employees with title to a deferred annuity may apply for coverage, even if they are not yet receiving that annuity. [68 FR 5534, Feb. 4, 2003, as amended at 70 FR 30607, May 27, 2005] If you have separated from service under the FERS Minimum Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C. 8412(g), and have postponed receiving an annuity under that provision, you are eligible to apply for coverage under this part. For underwriting purposes, you will be considered an annuitant. (a) You are eligible to apply for coverage if you are on active duty or full-time National Guard duty for more than a 30-day period. (b) You are eligible to apply for coverage if you are a member of the Selected Reserve, which consists of: (1) Drilling Reservists and Guardsmembers assigned to Reserve Component Units; (2) Individual Mobilization Augmentees who are Reservists assigned to Reserve Component billets in Active Component units (you may be performing duty in a pay or non-pay status); and (3) Active Guard and Reserve members who are full-time Reserve members on full-time National Guard duty or active duty in support of the National Guard or Reserves. (c) You are not eligible to apply for coverage if you belong to the Individual Ready Reserve. The Individual Ready Reserves includes Reservists who are assigned to a Voluntary Training Unit in the Naval Reserve and Category E in the Air Force Reserve. (a) You are eligible to apply for coverage if you are a retired member of the uniformed services entitled to retired or retainer pay (including disability retirement pay). (b) You are eligible to apply for coverage if you are a retired reservist who is currently receiving retirement pay. (c) You are eligible to apply for coverage as a retired (“grey”) reservist, even if not yet receiving retirement pay. [68 FR 5534, Feb. 4, 2003, as amended at 70 FR 30607, May 27, 2005] (a) As a new, newly eligible, or returning active workforce member, you may apply as follows: (1) If you are a new active workforce member entering a position that conveys eligibility, you may apply for coverage within 60 days after becoming eligible. (2) If you are entering a position that conveys eligibility as an active workforce member from a position that did not convey eligibility, you may apply for coverage within 60 days after becoming eligible. (3) If you return to active service after a break in service of 180 days or more to a position that conveys eligibility, you may apply for coverage within 60 days after becoming eligible. (b) Your spouse may also apply during that 60-day period after you become eligible. (c) The underwriting requirements that will be required will be those applicable to active workforce members and their spouses during the last open season for enrollment before the date of your application. (d) After the 60-day period ends, you may still apply for coverage, as may your spouse, but full underwriting requirements will apply. (e) If your employing office determines that you were unable, for a cause beyond your control, to submit an application during the initial 60-day period, you may submit an application within 60 days after your employing office advises you of that determination. Similarly, your employing office may make this determination if your spouse is unable to submit an application during the same time period for a cause beyond his/her control. This employing office authority only applies within 6 months after the beginning date of the initial eligibility period. The underwriting requirements will be as specified in paragraph (c) of this section. (f) Your other qualified relatives may apply for coverage at any time. They will be subject to full underwriting requirements. [68 FR 5534, Feb. 4, 2003, as amended at 70 FR 30607, May 27, 2005] (a) If you return to a pay status from nonpay status during the open season, you have 60 days from the date of your return, or until the end of the open season, whichever gives you more time, to apply for coverage pursuant to the open season underwriting requirements for Federal civilian or Postal employees and members of the uniformed services. (b) If you return to pay status from nonpay status after the open season, you have 60 days from the date of your return to apply for coverage pursuant to the underwriting requirements specified for Federal civilian or Postal employees and members of the uniformed services in the immediately preceding open season. (c) Paragraphs (a) and (b) of this section apply only when you have been in nonpay status for more than one-half of an open season, unless you went into nonpay status for a reason beyond your control. You may not apply as a qualified relative if the workforce member on whom you are basing your qualified relative status died prior to the time you apply for coverage, unless you are receiving a survivor annuity as the spouse of a deceased workforce member. In this case, your adult children and your current spouse are also considered to be qualified relatives. [68 FR 5534, Feb. 4, 2003, as amended at 70 FR 30607, May 27, 2005] (a) When you submit your application for coverage, you must make known your status as a member of an eligible group. (b) If the Carrier finds that you misrepresented your eligibility status, the Carrier has the right to void your coverage and return to you any premiums you paid, without interest. The incontestability provisions in §875.409 do not apply to this section. (a) You must be eligible at the time of your application and at the time your coverage is scheduled to go into effect. Except as noted in paragraph (b) of this section, if you lose your status as part of an eligible group before your coverage goes into effect, you are no longer eligible for FLTCIP coverage. You are required to inform the Carrier that you are no longer eligible. (b) In two instances, you will continue to be eligible for coverage even if you lose your status as part of an eligible group after you submit an application for coverage, but before your coverage becomes effective. The two instances are: (1) When you are involuntarily separated from Federal civilian service (except for misconduct) or from the uniformed services (except for a dishonorable discharge). In either of these events, your qualified relatives will continue to be eligible. (2) When you are the qualified relative of a workforce member who dies. (a) If you applied as an active workforce member, and separate from service under the MRA+10 provisions of 5 U.S.C. 8412(g), or retire after you submit an application for coverage, but before your coverage becomes effective, you must reapply as an annuitant and submit to full underwriting requirements. (b) If you applied as an active workforce member, and otherwise separate from service, but you are a qualified relative of another workforce member, you must reapply based on the additional underwriting requirements specified for that type of qualified relative. [70 FR 30607, May 27, 2005] Yes, there is a minimum application age. You must be at least 18 years old at the time you submit an application for coverage.
Title 5: Administrative Personnel
PART 875—FEDERAL LONG TERM CARE INSURANCE PROGRAM
Subpart B—Eligibility
§ 875.201 Am I eligible as a Federal civilian or Postal employee?
§ 875.202 Am I eligible as a Federal annuitant?
§ 875.203 Am I eligible if I separated under the FERS MRA+10 provision?
§ 875.204 Am I eligible as a member of the uniformed services?
§ 875.205 Am I eligible as a retired member of the uniformed services?
§ 875.206 As a new active workforce member, when may I apply?
§ 875.207 What happens if I am in nonpay status during an open season?
§ 875.208 May I apply as a qualified relative if the person on whom I am basing my eligibility status has died?
§ 875.209 How do I demonstrate that I am eligible to apply for coverage?
§ 875.210 What happens if I become ineligible after I submit an application?
§ 875.211 What happens if my eligibility status changes after I submit my application?
§ 875.212 Is there a minimum application age?
