Where a person's FEHB coverage begins later than HI, it does not terminate or preclude
HI. Such a situation would rarely occur except where a retiree with RFEHB coverage,
who has qualified for HI under the transitional “deemed insured” provision, converts RFEHB to FEHB coverage. As explained in A. above, the annuitant's
FEHB can begin no earlier than 7/74; if HI began before the first month of FEHB coverage
it will not be affected. Under B. above, FEHB coverage precludes HI entitlement only
where it exists as of the first month in which all requirements of HI 00801.047 are met; FEHB coverage beginning after these requirements for HI are met does not preclude or terminate entitlement to HI
under the deemed insured provision.
Example 1:
Individual was entitled to HI under the deemed insured provision beginning 4/68, the
month attained age 65. HI will not be affected when converts RFEHB to FEHB coverage.
Example 2:
Individual first files for HI under the deemed insured provision on 12/15/ 74 at age
73. (person could have filed and been entitled to HI at any time since 1966.) Person
retired before 7/60, has no QC's (and needs none for HI). Though previously enrolled
under an RFEHB plan, applied for and was awarded FEHB coverage beginning 7/74. Since
HI application is effective 12 months prior to the month of filing, i.e., 12/73, person
may be entitled to HI effective 12/73. The fact that one had FEHB in 8/74 does not
preclude entitlement to HI. However, if one first filed for HI in 8/75 or later and
had FEHB coverage for the first month for which this HI application is effective (8/74),
the FEHBA preclusion applies and the application must be disallowed.