Waiver of the FEHB 5-Year Rule

Waiver of 5-Year Enrollment Requirement

Public Law 99-251 gave OPM the authority to waive the 5 year service requirement when, in its sole discretion, it determines that it would be against equity and good conscience not to allow a person to be enrolled in the FEHB Program as an annuitant. An employee’s failure to satisfy the 5-year requirement must be due to exceptional circumstances. Employees requesting a waiver must provide OPM with evidence that:

• the employee intended to have FEHB coverage as a retiree;
• the circumstances that prevented the employee from meeting the 5-year requirement were essentially outside of the employee’s control; and
• the employee acted reasonably to protect the right to continue FEHB coverage into retirement. (This includes reading and acting on information provided and requesting information if none is given automatically.)
• Quoted from OPM FEHB Program Handbook

How OPM Applies Its Waiver Authority

OPM’s approval of a waiver request depends on the extent to which the individual could have controlled the events leading to the loss of coverage at retirement. When OPM reviews a waiver request, it considers:

• whether the individual had a compelling reason to believe he/she was covered as a family member of another person enrolled in FEHB during the time in question;
• evidence that an individual’s employing office would not allow him/her to enroll;
• the extent to which an individual could have controlled the events that led up to the loss of the right to continued FEHB coverage;
• whether the individual had acted to gain FEHB coverage at the earliest opportunity after learning of the loss of benefits or possible loss of future rights; and
• whether the individual had substantial FEHB coverage during his/her career even though there was a break in continuity during the last 5 years of service.
• Quoted from OPM FEHB Program Handbook