2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
PSHB Facts
Page 12
PSHB Facts
Page 12
- When you retire
When you retire, you can usually stay in the PSHB Program. Generally, you must have been enrolled in the FEHB and/or PSHB Program for the last five years of your Federal service. If you do not meet this requirement, you may be eligible for other forms of coverage, such as Temporary Continuation of Coverage (TCC).
When you lose benefits
- When PSHB coverage ends
You will receive an additional 31 days of coverage, for no additional premium, when:
- Your enrollment ends, unless you cancel your enrollment; or
- You are a family member no longer eligible for coverage.
Any person covered under the 31-day extension of coverage who is confined in a hospital or other institution for care or treatment on the 31st day of the temporary extension is entitled to continuation of the benefits of the Plan during the continuance of the confinement but not beyond the 60th day after the end of the 31-day temporary extension.
If you are eligible for coverage under spouse equity, you are only eligible to enroll in the FEHB program. If you are not eligible for coverage under spouse equity and you are otherwise eligible for Temporary Continuation of Coverage (TCC), then you could enroll in TCC under the PSHB program.
- Upon divorce
If you are an enrollee, and your divorce or annulment is final, your ex-spouse cannot remain covered as a family member under your Self Plus One or Self and Family enrollment. You must enter the date of the divorce or annulment and remove your ex-spouse in the PSHB System. We may ask for a copy of the divorce decree as proof. If you need to change your enrollment type, you must use the PSHB System. A change will not automatically be made.
If you were married to an enrollee and your divorce or annulment is final, you may not remain covered as a family member under your former spouse’s enrollment. This is the case even when the court has ordered your former spouse to provide health benefits coverage for you. However, you may be eligible for your own coverage under the spouse equity law or TCC. Former spouses eligible for coverage under the spouse equity law are not eligible to enroll in the PSHB program. However, former spouses eligible for coverage under the spouse equity law may enroll in the FEHB program. (Former spouses seeking but not yet adjudicated as eligible for Spouse Equity may be entitled to TCC under a PSHB plan in the interim).
Former spouses not meeting the spouse equity requirements may be eligible for TCC under the PSHB program provided you otherwise meet the eligibility requirements for TCC. If you are recently divorced or are anticipating a divorce, contact your ex-spouse’s employing or retirement office to get additional information about your coverage choices. You can also visit OPM’s website, www.opm.gov/healthcare-insurance/life-events/memy-family/im-separated-or-im-getting-divorced#url-health. We may request that you verify the eligibility of any or all family members listed as covered under the enrollee’s PSHB enrollment.
- Medicare PDP EGWP
When a Postal Service annuitant who is Medicare Part D-eligible or their covered Medicare-eligible family member opts out of or disenrolls from our PDP EGWP, they will not have our prescription drug coverage under this plan. If you do not maintain creditable coverage, reenrollment in our PDP EGWP may be subject to a late enrollment penalty. Contact us for additional information at 888-338-7737.
- Temporary Continuation of Coverage (TCC)
If you leave Federal service, or if you lose coverage because you no longer qualify as a family member, you may be eligible for TCC. For example, you can receive TCC if you are not able to continue your PSHB enrollment after you retire, if you lose your Federal job, or if you are a covered child and you turn age 26, regardless of marital status, etc.
You may not elect TCC if you are fired from your Federal job due to gross misconduct.
Enrolling in TCC. Get the RI 79-27, which describes TCC, from your employing or retirement office or from www.opm.gov/healthcare-insurance. It explains what you have to do to enroll.