FEHB Coverage Code

1

Enrolled

System-generated after the SF 2809, Health Benefits Election Form, or SF 2810, Notice of Change in Health Benefits Enrollment, is processed. This code cannot be entered on a personnel action. Do not attempt to enter Code 1 even when it is known at the time of the accession that the employee will participate in the FEHB program.

2

Ineligible

Employee is excluded from FEHB and Flexible Spending Account (FSA) coverage by law or regulation but eligible for non‐Federal benefits.

3

Waived

Employee transferred into the Agency or is reemployed without a break in service of more than three days and has waived coverage under prior Federal employment. This code is system–generated after the SF 2809 is processed for employees new to the federal government or employees with a break in service of more than three days who waive FEHB.

4

Eligible Pending

Employee is eligible to participate in FEHB and FSA but has not enrolled. When the SF 2809 enrolling the employee in FEHB is processed, the FEHB Coverage Code changes to 1 except when the SF 2809 and the accession personnel action are processed in the same pay period with the same effective date. In that case, the 4 does not change to 1.

Note: The U.S. Office of Personnel Management (OPM) regulations state that, except for open season, most enrollments and changes of enrollment become effective on the first day of the pay period after the personnel office receives the SF 2809 and that follows a pay period during which the employee is in pay status for any part of period.

FEHB deductions begin during the pay period in which the SF 2809 or SF 2810 is processed and applied to the database.

5

Canceled

Employee transferred into the Agency or is reemployed without a break in service of more than three days and has canceled coverage under prior Federal employment. This code is system-generated after the SF 2809 is processed for employees new to the federal government or employees with a break in service of more than three days who waive FEHB.

6

Court Order - Enrolled

Employee is required by a court or administrative order to provide health benefits coverage for one or more children and is enrolled in an appropriate plan. This code is system-generated after the SF 2809 and Nature of Action Code (NOAC) 916, Court Ordered FEHB Change, with Authority BEG, are processed. NOAC 916 with Authority END is processed when the court-ordered benefits end.

7

Court Order - Eligible Pending Family Coverage

Employee is enrolled in Family coverage and is required by a court or administrative order to provide health benefits coverage for one or more children. NOAC 916 with Authority BEG must be processed to lock the benefits so they cannot change. After the SF 2809 and NOAC 916 are processed/applied, the enrollment code changes to 6.

8

Court Order - Self Only Pending Family Coverage

Employee is enrolled in Self Only coverage and is required by a court or administrative order to provide health benefits coverage for one or more children. The employee has until the end of the pay period following the one in which notice is given to make a change from Self Only to Self and Family coverage.

When the employee does not make a change to Self and Family coverage, the Agency personnel office must enroll the employee in the Basic Option of the Blue Cross/Blue Shield Service Benefit Plan (Enrollment Code 112, Self and Family). The effective date of coverage is the first day of the pay period following the one in which the SF 2809 is completed or the effective date as stated on the court or administrative order. NOAC 916 must be processed to lock the benefits so they cannot change. After the SF 2809 and NOAC 916 are processed/applied, the enrollment code changes to 6.

9

Termination

Employee’s coverage was terminated by the Agency due to a nonpay situation or other reasons. NOAC 915, Health Benefits Coverage, is required to change the code to another value after 60 days from the appointment effective date.