What Is the Federal Employees Health Benefits Program?

The Federal Employees Health Benefits Program is the group health insurance system that covers most civilian federal workers, retirees, and their families, offering roughly 180 private plan choices with the federal government paying a majority share of the premium. About 8.3 million people are covered.¹ The Office of Personnel Management runs the program and negotiates the annual contracts with carriers. Coverage is not automatic when you start a federal job, and the enrollment windows, premium formulas, and coordination rules have real financial consequences if you get them wrong.

Who Qualifies

Most permanent, full-time civilian federal employees are eligible. Part-time career employees also qualify but pay a proportionally larger share of the premium. Temporary and seasonal employees can enroll only if the employing office expects them to work at least 130 hours per calendar month and the appointment will last at least 90 days.²

Your children are covered as family members until they turn 26, including stepchildren and foster children living with you in a parent-child relationship.³

Certain former spouses can enroll on their own under the Spouse Equity provisions. They must have been covered as a family member under an FEHB enrollment at least one day during the 18 months before the divorce, must be entitled to a portion of the employee’s annuity or survivor annuity, and must not have remarried before age 55.⁴

Eligible family members of a deceased employee or retiree can continue FEHB if the deceased was enrolled in a Self and Family plan and the survivor receives a survivor annuity. The premium share stays the same amount the employee was paying and comes out of the survivor annuity payment.⁵

One boundary worth flagging: postal employees and postal retirees are no longer eligible for FEHB. As of January 1, 2025, they transitioned to the separate Postal Service Health Benefits Program created by the Postal Service Reform Act of 2022.⁶ A postal employee covered as a family member under a non-postal spouse’s FEHB enrollment can stay on that coverage.

The Five-Year Rule for Retirees

Carrying FEHB into retirement takes planning. To keep coverage as a retiree, you need an immediate annuity (one that starts accruing no later than a month after you separate) and you must have been continuously enrolled in any FEHB plan for the five years of service immediately before retirement. If you had less than five years of federal service, you satisfy the rule by staying enrolled from your first opportunity through your retirement date.⁷ Miss this rule and you permanently lose access to FEHB in retirement.

Types of Plans

Federal law groups FEHB plans into several categories, and premiums, provider flexibility, and out-of-pocket costs vary a lot between them.⁸

Fee-for-Service plans let you see any provider, though using the plan’s preferred network lowers your costs. Some are open government-wide; others are limited to members of specific employee organizations or unions.
Health Maintenance Organizations require you to use a defined network within a specific geographic area. Premiums tend to be lower, but out-of-network care is generally not covered.
Point-of-Service plans are a hybrid that lets you use HMO-style in-network care or go out of network at higher cost.
High Deductible Health Plans have lower premiums and higher deductibles, and can be paired with a Health Savings Account funded by pre-tax contributions from you and the government.
Consumer-Driven Health Plans work similarly to HDHPs, but the carrier typically funds a personal care account to help you cover costs before the deductible applies.

FEHB plans may include some dental or vision benefits, but comprehensive dental and vision coverage comes from the separate Federal Employees Dental and Vision Insurance Program, which has its own carriers and enrollment.⁹

What It Costs

The government and employee split every FEHB premium. By law, the government’s share cannot exceed 75 percent of a given plan’s premium or 72 percent of the program-wide weighted average premium, whichever is less.¹⁰ You pay at least 25 percent, and more if you pick a plan whose premium is well above the weighted average.

For 2026, the biweekly weighted average premiums (combining the employee and government shares) are $451.05 for Self Only, $987.73 for Self Plus One, and $1,080.60 for Self and Family.¹⁰ The overall average premium rose about 10.2 percent for 2026, and the average employee share went up 12.3 percent.

Most employees pay their share on a pre-tax basis through premium conversion, which reduces federal income tax, Social Security and Medicare taxes, and in most jurisdictions state and local income taxes.¹¹ You are enrolled in premium conversion automatically unless you waive it.

Enrollment Types

FEHB offers three enrollment levels:

Self Only covers you alone.
Self Plus One covers you and one eligible family member you designate. It has been available since January 2016 and is typically cheaper than Self and Family when only one dependent needs coverage.¹²
Self and Family covers you and all eligible family members. The premium is the same whether you have two family members or six.

Many people stay on Self and Family out of habit even after children age out. Reviewing your enrollment type at Open Season is one of the easiest ways to save.

When and How to Enroll

New employees have 60 days from their appointment date to enroll.¹³ Coverage does not start on its own. Take no action within that window and you are considered to have declined; you would then wait until the next Open Season to enroll.¹⁴

The annual Federal Benefits Open Season is when current enrollees can change plans, switch enrollment types, or enroll for the first time if they previously declined. For plan year 2026, Open Season ran from November 10 through December 8, 2025.¹⁵ Open Season changes take effect on the first day of the first pay period beginning in January.

Outside those windows, a change requires a qualifying life event. Marriage, birth or adoption of a child, loss of other health coverage, and a spouse’s change in employment all qualify. You generally have 60 days from the event to submit the change.¹⁶ Becoming eligible for Medicare is itself a qualifying event and opens a one-time chance to switch plans starting 30 days before your Medicare eligibility date.¹⁷

Enrollment runs through Standard Form 2809 (Health Benefits Election Form) or, at many agencies, through the Employee Express portal.¹⁸ You need the three-digit enrollment code for the plan you want, along with full legal names, Social Security numbers, and dates of birth for everyone to be covered. For life-event changes, keep supporting documentation such as a marriage certificate or birth record. Retirees usually mail SF-2809 to the OPM retirement office. After any change, check your Leave and Earnings Statement to confirm the premium deduction matches the plan you chose.

When Coverage Starts

Effective dates depend on how you enrolled:

For a standard enrollment or change, coverage begins on the first day of the first pay period that starts after your employing office receives the request, provided you were in pay status during the preceding pay period.¹⁹
Open Season changes start on the first day of the first pay period that begins in January.
For a birth or adoption, coverage is retroactive to the first day of the pay period in which the child became an eligible family member.
If you move out of an HMO’s service area, new plan coverage starts the first day of the pay period after your employing office receives the change.

For most changes, expect a gap of one to two pay periods between submitting the form and coverage taking effect. Plan around that if you are transitioning from another insurer.

Keeping Coverage During Unpaid Leave

Your enrollment can continue for up to 365 consecutive days of leave without pay. At the end of that 365-day period, coverage terminates automatically.²⁰ The government keeps paying its share, but you are still responsible for your share, with three ways to handle it:

Pay-as-you-go, where you pay your share directly each pay period from after-tax money.
Catch-up, where your agency advances your share and you repay through payroll deductions after you return.
Prepay, where you pay premiums in advance before starting LWOP. Not all agencies offer this option.

If you do not make arrangements, your enrollment ends. That matters especially in the five years before retirement, because a break can disqualify you from carrying FEHB into retirement permanently.

FEHB and Medicare in Retirement

Federal retirees can keep FEHB alongside Medicare, and many do. Once you have Medicare, it becomes the primary payer and FEHB becomes secondary. Many FEHB plans waive deductibles, copayments, and coinsurance when Medicare pays first, which can substantially reduce your out-of-pocket costs.¹⁷

Your FEHB premium does not change once Medicare is primary. Because your actual costs under FEHB may drop once Medicare pays first, it is worth reviewing your FEHB plan choice at that point. A less expensive plan that would be risky as sole coverage can work well as a Medicare supplement.

Retirees who join a Medicare Advantage plan can suspend rather than cancel their FEHB enrollment, which preserves the right to re-enroll later. Suspension requires completing the Health Benefits Cancellation/Suspension form (RI 79-9) with documentation of your Medicare Advantage enrollment; a Medicare card alone is not enough.²¹

Temporary Continuation of Coverage

Temporary Continuation of Coverage is the federal equivalent of COBRA. It lets certain people keep FEHB after they lose eligibility, but you pay the full premium (both the employee and government shares) plus a 2 percent administrative charge.²² Maximum duration depends on who is enrolling:

Former employees get up to 18 months from the date of separation, provided the separation was not for gross misconduct.²³
Children aging out get up to 36 months from the date they stopped being an eligible family member.
Former spouses who do not qualify under Spouse Equity get up to 36 months from the date of divorce or annulment.

TCC is priced to be bridge coverage rather than a long-term solution. At the 2026 Self Only weighted average, the full premium plus the 2 percent charge would run roughly $460 biweekly.

Disputing a Denied Claim

If your plan denies a claim or pays it in a way you disagree with, the first step is not OPM. You have to request reconsideration directly from your plan carrier. Each plan brochure has a disputed claims section that lays out the specific procedure and timelines.²⁴

Reference the specific coverage provisions in your plan brochure that you believe support the claim. If the carrier denies a second time, the denial letter will explain how to escalate to OPM for an independent review, which is the final administrative step before any further legal remedy.

1
U.S. Office of Personnel Management. Federal Employees Health Benefits (FEHB) Program Carriers
2
eCFR. 5 CFR 890.102 – Coverage
3
U.S. Office of Personnel Management. FastFacts – Child Turning Age 26
4
U.S. Office of Personnel Management. Former Spouses
5
U.S. Office of Personnel Management. Information for Retirees and Survivor Annuitants (RI 79-2)
6
U.S. Office of Personnel Management. Postal Service Health Benefits (PSHB) Program
7
U.S. Office of Personnel Management. Frequently Asked Questions – Health Insurance
8
Office of the Law Revision Counsel. 5 USC 8903 – Health Benefits Plans
9
U.S. Office of Personnel Management. How Do the FEDVIP Plans Differ From the Dental and Vision Benefits FEHB Plans Provide
10
U.S. Office of Personnel Management. Premiums
11
eCFR. 5 CFR 892.102 – What Is Premium Conversion and How Does It Work
12
U.S. Office of Personnel Management. The New Self Plus One Enrollment Type – FEHB Program
13
U.S. Office of Personnel Management. Enrollment
14
U.S. Office of Personnel Management. New Federal Employee Enrollment
15
U.S. Office of Personnel Management. Federal Benefits Open Season Highlights 2026 Plan Year
16
U.S. Office of Personnel Management. Changes You Can Make Outside of Open Season
17
U.S. Office of Personnel Management. Medicare
18
Employee Express. Employee Express
19
eCFR. 5 CFR 890.301 – Opportunities for Employees to Enroll or Change Enrollment; Effective Dates
20
U.S. Office of Personnel Management. Leave Without Pay Status and Insufficient Pay
21
U.S. Office of Personnel Management. Frequently Asked Questions – FEHB Open Season Online
22
U.S. Office of Personnel Management. Temporary Continuation of Coverage
23
U.S. Office of Personnel Management. Termination, Conversion and Temporary Continuation of Coverage
24
U.S. Office of Personnel Management. I Dont Agree With the Way the Plan Paid My Claim – What Can I Do