[Federal Register Volume 62, Number 138 (Friday, July 18, 1997)]
[Rules and Regulations]
[Pages 38433-38443]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-18958]
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Rules and Regulations
Federal Register
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Federal Register / Vol. 62, No. 138 / Friday, July 18, 1997 / Rules
and Regulations
[[Page 38433]]
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OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
RIN 3206-AH46
Federal Employees Health Benefits Program: Opportunities to
Enroll and Change Enrollment
AGENCY: Office of Personnel Management.
ACTION: Final rule.
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SUMMARY: The Office of Personnel Management (OPM) is issuing final
regulations to simplify and clarify the existing Federal Employees
Health Benefits (FEHB) Program regulations concerning opportunities to
enroll and change enrollment. These regulations will make it easier for
employing offices to determine whether circumstances permit individuals
to enroll or change enrollment, and will result in a reduced potential
for error and improved customer service.
EFFECTIVE DATE: August 18, 1997.
FOR FURTHER INFORMATION CONTACT:
Barbara Myers (202) 606-0004.
SUPPLEMENTARY INFORMATION: On July 9, 1996, OPM issued proposed
regulations in the Federal Register (61 FR 35973) that would amend Part
890 to (1) organize the opportunities to enroll and change enrollment
into separate sections for each category of enrollee, (2) group
enrollment opportunities within each category by similar
characteristics, such as change in employment status, or loss of health
benefits coverage, (3) standardize timeframes for individuals to enroll
or change enrollment, (4) locate effective date information within the
paragraph that describes the enrollment or change opportunity, (5)
clarify some opportunities by removing certain hard to define
requirements that individuals must meet to become eligible to enroll or
change, and (6) permit insurance carriers to determine incapacity of
self-support for children over age 22 under certain conditions.
OPM received comments from six Government agencies, two insurance
carriers, and one retired employees' association. While all of the
commenters were in favor of the proposed regulations, some had specific
areas of concern that we will address below. We have tried to list
these issues in the same order as the regulations that they pertain to.
Two commenters recommended expanding the definition of
``appropriate request'' to include elections not to enroll, and to add
the term ``processing office.'' We have expanded the definition of
``appropriate request'' to include elections not to enroll. We have
also defined ``election not to enroll'' in the definitions section. We
do not believe that adding the term ``processing office'' to the
definition of ``appropriate request'' is necessary because the term
``employing office'' as defined in Sec. 890.101 means the office with
jurisdiction and responsibility for health benefits actions. This would
include the processing office.
We are removing the definition of ``regular tour of duty'' because
it no longer reflects the definition as set forth in Sec. 610.102 of
this chapter.
Several commenters had concerns with the new paragraph (c) that we
are adding to Sec. 890.103 that will give the employing office
authority to retroactively correct enrollee enrollment code errors.
This paragraph applies only to enrollment code errors made by the
employee and therefore should not be combined with paragraphs (a) and
(b) which concern administrative errors. In the past, agencies had no
authority to correct enrollee enrollment code errors. The intent of the
new paragraph is to give enrollees who discover that they made an
enrollment code error an opportunity to have it corrected; we did not
intend to give them the opportunity to change their election should
they find that they are dissatisfied with their election. An enrollee
who reports an enrollment code error beyond the specified time frame
must wait until the next open season to correct the error. If an error
was made by the employing office, then it would be an administrative
error and would be subject to paragraphs (a) and (b) rather than this
new paragraph (c).
One commenter believes that these regulations should require
employees to furnish evidence of their eligibility to enroll or change
enrollment. Employing offices have always been responsible for
determining eligibility, and they may require whatever evidence they
need to verify that an event actually occurred. In some cases, such as
changes in employment status, the employing office has the information
readily available; in others, such as documentation of a marriage, a
move, or the loss of other group health insurance coverage, they can
require additional evidence. Special regulatory language is not needed.
One commenter expressed concern about the reenrollment of an
employee whose enrollment was terminated after 365 days of leave
without pay status. When this employee returns to pay status, he or she
may reenroll and the enrollment would normally take effect on the first
day of the next pay period. However, if the employee is not in pay
status in the pay period after the one in which he or she submitted the
enrollment request, the enrollment could not take effect. If an
employee's enrollment terminated after 365 days leave without pay, and
the employee is not entitled to any further continuation of coverage
because he or she has not had 4 consecutive months of pay status since
exhausting the 365 days continuation of coverage in leave without pay,
coverage terminates on the last day of his or her last pay period in
pay status. There is no need for special regulatory language as this
principle is reflected in Sec. 890.304(a)(1)(v).
On July 22, 1996, OPM published interim regulations that require
Federal agencies to provide employees entering leave without pay
status, or whose pay is insufficient to cover their FEHB premium
payments, written notice of their opportunity to continue their FEHB
coverage (61 FR 37807). These employees have the option of continuing
or terminating their FEHB coverage. Employees who elect to terminate
their coverage may enroll upon their return to duty in a pay status in
a position which provides eligibility for FEHB coverage. We have added
a provision to paragraph 890.301(h)(1) of these final regulations that
would reflect this enrollment opportunity.
[[Page 38434]]
One commenter expressed concern about our requirement that the
effective date of an open season enrollment must follow a pay period
during any part of which the employee is in pay status. This is not a
new provision and we have made no change to the existing regulation. If
an employee is in leave without pay status when an open season
enrollment would normally take effect, the enrollment could not take
effect until the employee returns to pay status.
One commenter suggested that we define changes in family status in
the definitions section. We are concerned that it would be
unnecessarily restrictive to specify in regulation the situations that
we believe are changes in family status. We believe it is sufficient to
continue to provide this information in our guidance in the FEHB
Handbook for Personnel and Payroll Offices (formerly FPM Supplement
890-1). For the convenience of the reader, we will restate the examples
of changes in family status given in the supplementary information of
the proposed regulations, as follows: (1) Birth or acquisition of a
child; (2) issuance of a court order specifically requiring an employee
to enroll for his or her children or provide health benefits protection
for them; (3) issuance or termination of a court order granting
interlocutory divorce, limited divorce, legal separation, or separate
maintenance to the enrollee or spouse; (4) entry into or discharge from
military service of a spouse or of a child under age 22.
Two commenters suggest that we consider further changing the
regulations to give the employing office discretion in determining
effective dates of enrollment changes in certain situations. We do not
favor making this change. We believe that specifying effective dates of
coverage in regulation is easier to administer and assures that all
enrollees and their family members are treated in a uniform manner. For
example, when an enrollee changes from self only to self and family
coverage because of the birth of a child, the regulations specify that
the effective date of the change is the first day of the pay period in
which the child is born.
One commenter expressed concern about the events based upon a loss
of other FEHB coverage (paragraph 890.301(i)) and our extension of the
enrollment timeframe from 31 to 60 days. We are extending the timeframe
for uniformity and to try to reduce the number of requests for belated
enrollment. We realized that some individuals may enroll after the
expiration of the 31-day temporary extension of coverage, but within
the 60 day timeframe and that this will cause a gap in coverage.
However, as long as the individuals enrolls with the time limit
required by regulation, he or she will not be penalized for purposes of
meeting the requirements for continuing the FEHB enrollment into
retirement (coverage for 5 years of service immediately before
retirement, or, if less than 5 years, for all service since the first
opportunity to enroll).
One commenter asked if OPM could treat employees and former spouses
whose plan is discontinued and who do not select another plan the same
as annuitants and deem them to have enrolled in the Blue Cross and Blue
Shield (BCBS) Service Benefit Plan. The provision for annuitants was
originally written when the Aetna plan left the FEHB Program and there
were many annuitants who did not respond to our request that they
change plans. It was intended to assure that no annuitant would be
without FEHB coverage, especially since those who did not select
another plan were deemed to have cancelled their enrollment and,
generally, annuitants who cancel their enrollment may not reenroll.
This provision is not difficult to administer since annuitants have one
employing office. We do not favor extending this provision to employees
or former spouses since they may make a belated change of enrollment if
their employing office permits, or they can reenroll during the next
open season. We believe that giving agencies the authority to place
employees and former spouses who do not change plans in the BCBS Plan
would be difficult for agencies to administer, since these enrollees
might object to being placed in BCBS without their consent.
Several comments are concerned about our proposal to permit
carriers to determine whether an enrollee's child over age 22 is
incapable of self-support when the child's disability appears on a list
of specific medical conditions provided by OPM. We agree that carriers
and employing offices will need to communicate their determinations to
each other and we plan to issue additional guidance and procedures on
this issue. The purpose of our revision to the current regulation is to
provide uninterrupted coverage when the child's condition is so severe
that there would be no question that the child is incapable of self-
support and that the condition would not abate. In cases where the
child's condition does not appear on the OPM list, the enrollee would
have to contact their employing office and follow the procedures
currently required for approval.
We also are simplifying and clarifying the current regulations
regarding the effective date of cancellation so that all cancellations
take effect on the last day of the pay period in which the appropriate
request cancelling the enrollment is received by the employing office.
Another commenter had several concerns about our section pertaining
to former spouses. Former spouses may change to family status only if
the child to be covered is a child of the former spouse and the
employee or annuitant. In addition, former spouses who establish
eligibility for a former spouse enrollment but postpone enrolling (e.g.
because they are on active military service or are covered by CHAMPUS)
may enroll at a later date. Therefore, there is no need for special
regulatory language for former spouses who are discharged from the
military. Finally, we deleted the first sentence of Sec. 890.806(j)
because it is redundant with Sec. 890.806(a).
One commenter asked why these regulations allow annuitants and
former spouses who cancel their enrollment for the purpose of enrolling
in a Medicare-sponsored Coordinated Care Plan (also referred to as a
Medicare HMO) or Medicaid (or similar State-sponsored program of
medical assistance for the needy) to reenroll in FEHB, but do not
extend this same opportunity to individuals enrolled under the
Temporary Continuation of Coverage (TCC) provisions. FEHB law (5 U.S.C.
8905a) is very specific about the events that qualify individuals to
continue their FEHB coverage under the TCC provisions, as follows: (1)
Employees who lose coverage upon separation from service; (2) children
who cease to meet the requirements for being unmarried dependent
children, and (3) former spouses who lose coverage under a self and
family enrollment because of termination of marriage, and who do not
qualify for coverage under the former spouse provisions of FEHB law.
There is nothing in the TCC provisions of law that would permit us to
allow an individual to cancel their TCC for the purpose of obtaining
MCCP or Medicaid (or similar State-sponsored) coverage and later
reenroll.
We also would like to point out that we plan to revise the Table of
Permissible Changes in Enrollment on the back of the Health Benefits
Registration Form (Standard Form 2809) to incorporate these changes.
In addition, there were several suggestions to correct real or
perceived technical or typographical errors in the proposed
regulations. We have made
[[Page 38435]]
changes and clarifications where appropriate.
Regulatory Flexibility Act
I certify that these regulations will not have a significant
economic impact on a substantial number of small entities because they
primarily affect Federal employees, annuitants, and former spouses.
List of Subjects in 5 CFR Part 890
Administrative practice and procedure, Government employees, Health
facilities, Health insurance, Health professions, Hostages, Iraq,
Kuwait, Lebanon, Reporting and recordkeeping requirements, and
Retirement.
Office of Personnel Management.
James B. King,
Director.
Accordingly, OPM is amending 5 CFR part 890 as follows:
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
1. The authority citation for part 890 continues to read as
follows:
Authority: 5 U.S.C. 8913; Sec. 890.803 also issued under 50
U.S.C. 403p, 22 U.S.C. 4069c and 4069c-1; subpart L also issued
under sec. 599C of Pub. L. 101-513, 104 Stat. 2064, as amended.
2. In Sec. 890.101, paragraph (a), the definitions for Enrolled and
Enrollee are revised, the definitions for Cancellation, Change of
enrollment, Register, Register to enroll, and Regular tour of duty are
removed, and the definitions for Appropriate request, Cancel, Change
the enrollment, Election not to enroll, and Enroll are added in
alphabetical order to read as follows:
Sec. 890.101 Definitions; time computations.
(a) * * *
Appropriate request means a properly completed health benefits
registration form or an alternative method acceptable to both the
employing office and OPM. Alternative methods must be capable of
transmitting to the health benefits plans the information they require
before accepting an enrollment, change of enrollment, or cancellation.
Electronic signatures, including the use of Personal Identification
Numbers (PIN), have the same validity as a written signature.
* * * * *
Cancel means to submit to the employing office an appropriate
request electing not to be enrolled by an enrollee who is eligible to
continue enrollment.
Change the enrollment means to submit to the employing office an
appropriate request electing a change of enrollment to a different plan
or option, or to a different type of coverage (self only or self and
family).
* * * * *
Election not to enroll means to submit to the employing office an
appropriate request electing not to be enrolled by an employee who is
eligible to enroll.
* * * * *
Enroll means to submit to the employing office an appropriate
request electing to be enrolled in a health benefits plan.
Enrolled means an appropriate request has been accepted by the
employing office and the enrollment in a health benefits plan approved
by OPM under this part has not been terminated or cancelled.
Enrollee means the individual in whose name the enrollment is
carried. The term includes employees, annuitants, former employees,
former spouses, or children who are enrolled after completing an
appropriate request under the provisions of Secs. 890.301, 890.306,
890.601, 890.803, or 890.1103 or have continued an enrollment as an
annuitant or survivor annuitant under 5 U.S.C. 8905(b) or Sec. 890.303.
* * * * *
3. In Sec. 890.103, paragraphs (c) and (d) are redesignated as (d)
and (e), and a new paragraph (c) is added to read as follows:
Sec. 890.103 Correction of errors.
* * * * *
(c) The employing office may make retroactive correction of
enrollee enrollment code errors if the enrollee reports the error by
the end of the pay period following the one in which he or she received
the first written documentation (i.e. pay statement or enrollment
change confirmation) indicating the error.
* * * * *
4. The title of Subpart C is received to read as follows:
Subpart C--Enrollment
5. Section 890.301 is revised to read as follows:
Sec. 890.301 Opportunities for employees to enroll or change
enrollment; effective dates.
(a) Initial opportunity to enroll. An employee who becomes eligible
may elect to enroll or not to enroll within 60 days after becoming
eligible.
(b) Effective date--generally. Except as otherwise provided, an
enrollment or change of enrollment takes effect on the first pay of the
first pay period that begins after the date the employing office
receives an appropriate request to enroll or change the enrollment and
that follows a pay period during any part of which the employee is in
pay status.
(c) Belated enrollment. When an employing office determines that an
employee was unable, for cause beyond his or her control, to enroll or
change the enrollment within the time limits prescribed by this
section, the employee may enroll or change the enrollment within 60
days after the employee office advises the employment of its
determination.
(d) Enrollment by proxy. Subject to the discretion of the employing
office, an employee's representative, having written authorization to
do so, may enroll or change the enrollment for the employee.
(e) Change to self only. (1) An employee may change the enrollment
from self and family to self only at any time.
(2) A change of enrollment to self only takes effect on the first
day of the first pay period that begins after the date the employing
office receives an appropriate request to change the enrollment, except
that at the request of the employee and upon a showing satisfactory to
the employing office that there was no family member eligible for
coverage by the family enrollment, the employing office may make the
change effective on the first day of the pay period following the one
in which there was no family member.
(f) Open season. (1) An open season will be held each year from the
Monday of the second full workweek in November through the Monday of
the second full workweek in December.
(2) The Director of the Office of Personnel Management may modify
the dates specified in paragraph (f)(1) of this section or hold
additional open seasons.
(3) During an open season, an eligible employee may enroll and an
enrolled employee may change the enrollment from self only to self and
family, from one plan or option to another, or make any combination of
these changes.
(4)(i) An open season new enrollment takes effect on the first day
of the first pay period that begins in the next following year and
which follows a pay period during any part of which the employee is in
a pay status.
(ii) An open season change of enrollment takes effect on the first
day of the first pay period which begins in January of the next
following year.
(5) When a belated open season enrollment or change of enrollment
is accepted by the employing office under paragraph (c) of this
section, it takes effect as required by paragraph (f)(4) of this
section.
[[Page 38436]]
(g) Change in family status. (1) An eligible employee may enroll
and an enrolled employee may change the enrollment from self only to
self and family, from one plan or option to another, or make any
combination of these changes when the employee's family status changes,
including a change in marital status or any other change in family
status. The employee must enroll or change the enrollment within the
period beginning 31 days before the date of the change in family
status, and ending 60 days after the date of the change in family
status.
(2) An enrollment or change of enrollment made in conjunction with
the birth of a child, or the addition of a child as a new family member
in some other manner, takes effect on the first day of the pay period
in which the child is born or becomes an eligible family member.
(h) Change in employment status. An eligible employee may enroll
and an enrolled employee may change the enrollment from self only to
self and family, from one plan or option to another, or make any
combination of these changes when the employee's employment status
changes. Except as otherwise provided, an employee must enroll or
change the enrollment within 60 days after the change in employment
status. Employment status changes include, but are not limited to--
(1) A return to pay status following loss of coverage under
either--
(i) Section 890.304(a)(1)(v) due to the expiration of 365 days in
leave without pay (LWOP) status, or
(ii) Section 890.502(b)(5) due to the termination of coverage
during LWOP status.
(2) Reemployment after a break in service of more than 3 days.
(3) Restoration to a civilian position after serving in the
uniformed services under conditions that entitle him or her to benefits
under part 353 of this chapter, or similar authority.
(4) A change from a temporary appointment in which the employee is
eligible to enroll under 5 U.S.C. 8906a, which requires payment of the
full premium with no Government contribution, to an appointment that
entitles the employee to receive the Government contribution.
(5) Separation from Federal employment when the employee or the
employee's spouse is pregnant and the employee supplies medical
documentation of the pregnancy. An employee who enrolls or changes the
enrollment under this paragraph (h)(5) must do so during his or her
final pay period. The effective date of an enrollment or a change of
enrollment under this paragraph (h)(5) is the first day of the pay
period which the employing office receives an appropriate request to
enroll or change the enrollment.
(6) A transfer from a post of duty within a State of the United
States or the District of Columbia to a post of duty outside a State of
the United States or the District of Columbia, or the reverse. An
employee who enrolls or changes the enrollment under this paragraph
(h)(6) must do so within the period beginning 31 days before leaving
the old post of duty and ending 60 days after arriving at the new post
of duty.
(7) A change, without a break in service or after a separation of 3
days or less, to part-time career employment as defined in 5 U.S.C.
3401(2) and 5 CFR part 340, subpart B, or a change from such part-time
career employment to full-time employment that entitles the employee to
the full Government contribution.
(i) Loss of coverage under this part or under another group
insurance plan. An eligible employee may enroll and an enrolled
employee may change the enrollment from self only to self and family,
from one plan or option to another, or make any combination of these
changes when the employee or an eligible family member of the employee
loses coverage under this part or another group health benefits plan.
Except as otherwise provided, an employee must enroll or change the
enrollment within the period beginning 31 days before the date of loss
of coverage, and ending 60 days after the date of loss of coverage.
Losses of coverage include, but are not limited to--
(1) Loss of coverage under another FEHB enrollment due to the
termination, cancellation, or a change to self only, of the covering
enrollment.
(2) Loss of coverage under another federally-sponsored health
benefits program.
(3) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan.
(4) Loss of coverage due to the discontinuance of an FEHB plan in
whole or in part. For an employee who loses coverage under this
paragraph (i)(4):
(i) If the discontinuance is at the end of a contract year, the
employee must change the enrollment during the open season, unless OPM
establishes a different time. If the discontinuance is at a time other
than the end of the contract year, OPM must establish a time and
effective date for the employee to change the enrollment.
(ii) If the whole plan is discontinued, an employee who does not
change the enrollment within the time set is considered to have
canceled the plan in which enrolled.
(iii) If one option of a plan that has two options is discontinued,
an employee who does not change the enrollment is considered to be
enrolled in the remaining option of the plan.
(5) Loss of coverage under the Medicaid program or similar State-
sponsored program of medical assistance for the needy.
(6) Loss of coverage under a non-Federal health plan because an
employee moves out of the commuting area to accept another position and
the employee's non-federally employed spouse terminates employment to
accompany the employee. An employee may enroll or change the enrollment
within the period beginning 31 days before the date the employee leaves
employment in the old commuting area and ending 180 days after entry on
duty at place of employment in the new commuting area.
(7) Loss of coverage under a non-Federal health plan.
(j) Move from comprehensive medical plan's area. An employee in a
comprehensive medical plan who moves or becomes employed outside the
geographic area from which the plan accepts enrollments, or if already
outside this area, moves or becomes employed further from this area,
may change the enrollment upon notifying the employing office of the
move or change of place of employment. Similarly, an employee whose
covered family member moves outside the geographic area from which the
plan accepts enrollments, or if already outside this area, moves
further from this area, may change the enrollment upon notifying the
employing office of the family member's move. The change of enrollment
takes effect on the first day of the pay period that begins after the
employing office receives an appropriate request.
(k) On becoming eligible for Medicare. An employee may change the
enrollment from one plan or option to another at any time beginning on
the 30th day before becoming eligible for coverage under title XVIII of
the Social Security Act (Medicare). A change of enrollment based on
becoming eligible for Medicare may be made only once.
(1) Salary of temporary employee insufficient to pay withholdings.
If the salary of a temporary employee eligible under 5 U.S.C. 8906a is
not sufficient to pay the withholdings for the plan in which the
employee is enrolled, the employing office shall notify the
[[Page 38437]]
employee of the plans available at a cost that does not exceed the
employee's salary. The employee may enroll in another plan whose cost
is no greater than his or her salary within 60 days after receiving
such notification from the employing office. The change of enrollment
takes effect immediately upon termination of the prior enrollment.
6. In Sec. 890.302, paragraph (f) is revised to read as follows:
Sec. 890.302 Coverage of family members.
* * * * *
(f) Determiniation of incapacity. (1) Except as provided in
paragraph (f)(2) of this section, the employing office shall make
determinations of incapacity.
(2) Either the employing office or the carrier may make a
determination of incapacity if a medical condition, as specified by
OPM, exists that would cause a child to be incapable of self-support
during adulthood.
* * * * *
7. In Sec. 890.303, paragraph (a)(1) is amended by removing
``registration'' and adding in its place ``enrollment'', and paragraph
(a)(3) is revised to read as follows:
Sec. 890.303 continuation of enrollment.
(a) * * *
(3) For the purpose of this part, an employee is considered to have
enrolled at his or her first opportunity if the employee enrolled
during the first of the periods set forth in Sec. 890.301 in which he
or she was eligible to enroll or was covered at that time by the
enrollment of another employee or annuitant, or whose enrollment was
effective not later than December 31, 1964.
* * * * *
8. In Sec. 890.304, paragraph (a)(2) is amended by removing
``Sec. 890.301(ee)'' and adding in its place ``Sec. 890.301(1)'',
paragraph (b)(1) is amended by removing ``Sec. 890.301(q)'' and adding
in its place ``Sec. 890.306(q)'', and paragraph (d) is revised to read
as follows:
Sec. 890.304 Termination of enrollment.
* * * * *
(d) Cancellation. (1) Except as provided in Sec. 890.807(e), an
enrollee may cancel his or her enrollment at any time by filing an
appropriate request with the employing office. The cancellation takes
effect on the last day of the pay period in which the appropriate
request cancelling the enrollment is received by the employing office.
(2) If an annuitant submits documentation that the cancellation is
for the purpose of enrolling in a prepaid health plan under section
1833 or 1876 of the Social Security Act, the cancellation becomes
effective on the day before the enrollment under the prepaid health
plan takes effect. Such documentation must be submitted to the
employing office within the period beginning 31 days before and ending
31 days after the prepaid health plan enrollment takes effect.
(3) The enrollee and covered family members are not entitled to the
temporary extension of coverage for conversion or to convert to an
individual contract for health benefits.
* * * * *
9. Section 890.306 is revised to read as follows:
Sec. 890.306 Opportunities for annuitants to change enrollment or to
reenroll; effective dates.
(a) Requirements to continue coverage. (1) To be eligible to
continue coverage in a plan under this part, a former employee in
receipt of an annuity must meet the statutory requirements under 5
U.S.C. 8905(b) of having retired on an immediate annuity and having
been covered by a plan under this part for the 5 years of service
immediately before retirement, or if less than 5 years, for all service
since his or her first opportunity to enroll, unless OPM waives the
requirement under Sec. 890.108.
(2) To be eligible to continue coverage in a plan under this part,
a survivor annuitant must be covered as a family member when the
employee or annuitant dies.
(b) Effective date--generally. Except as otherwise provided, an
annuitant's change of enrollment takes effect on the first day of the
first pay period that begins after the date the employing office
receives an appropriate request to change the enrollment.
(c) Belated enrollment. When an employing office determines that an
annuitant was unable, for cause beyond his or her control, to continue
coverage by enrolling in his or her own name or change the enrollment
within the time limits prescribed by this section, the annuitant may do
so within 60 days after the employing office advises the annuitant of
its determination.
(d) Enrollment by proxy. Subject to the discretion of the employing
office, an annuitant's representative, having written authorization to
do so, may continue the annuitant's coverage by enrolling in the
annuitant's own name, or change the enrollment for the annuitant.
(e) Change to self only. (1) An annuitant may change the enrollment
from self and family to self only at any time.
(2) A change of enrollment to self only takes effect on the first
day of the first pay period that begins after the date the employing
office receives an appropriate request to change the enrollment, except
that at the request of the annuitant and upon a showing satisfactory to
the employing office that there was no family member eligible for
coverage under the family enrollment, the employing office may make the
change effective on the first day of the pay period following the one
in which there was no family member.
(f) Open season. (1) During an open season as provided by
Sec. 890.301(f)--
(i) An enrolled annuitant may change the enrollment from self only
to self and family, from one plan or option to another, or make any
combination of these changes.
(ii) An annuitant who cancelled the enrollment under this part for
the purpose of enrolling in a prepaid health plan under section 1833 or
1876 of the Social Security Act, and who subsequently voluntarily
disenrolls from the prepaid health plan, may reenroll.
(iii) An annuitant who cancelled the enrollment under this part
because he or she furnished proof of eligibility for coverage under the
Medicaid program or similar State-sponsored program of medical
assistance for the needy, and who wishes to reenroll in a plan under
this part for reasons other than an involuntary loss of that coverage,
may do so.
(2) An open season reenrollment or change of enrollment takes
effect on the first day of the first pay period that begins in January
of the next following year.
(3) When a belated open season reenrollment or change of enrollment
is accepted by the employing office under paragraph (c) of this
section, it takes effect as required by paragraph (f)(2) of this
section.
(g) Change in family status. (1) An enrolled former employee in
receipt of an annuity may change the enrollment from self only to self
and family, from one plan or option to another, or make any combination
of these changes when the annuitant's family status changes, including
a change in martial status or any other change in family status. In the
case of an enrolled survivor annuitant, a change in family status based
on additional family members occurs only if the additional family
members are family members of the deceased employee or annuitant. The
annuitant must change the enrollment within the period beginning 31
days before the date of the change in family status, and
[[Page 38438]]
ending 60 days after the date of the change in family status.
(2) A change of enrollment made in conjunction with the birth of a
child, or the addition of a child as a new family member in some other
manner, takes effect on the first day of the pay period in which the
child is born or becomes an eligible family member.
(h) Reenrollment of annuitants who cancelled enrollment to enroll
in a Medicare-sponsored Coordinated Care Plan. (1) An annuitant who had
been enrolled (or was otherwise eligible to enroll) for coverage under
this part and cancelled the enrollment for the purpose of enrolling in
a prepaid health plan under section 1833 or 1876 of the Social Security
Act (as provided by Sec. 890.304(d)), and who is subsequently
involuntarily disenrolled from the prepaid health plan, may immediately
reenroll in any available plan under this part at any time beginning 31
days before and ending 60 days after the disenrollment. A reenrollment
under this paragraph (h) takes effect on the date following the
effective date of the disenrollment as shown on the documentation from
the prepaid health plan.
(2) An annuitant who voluntarily disenrolls from the prepaid health
plan must do so in conjunction with reenrolling in a plan under this
part during the next available open season (as provided by paragraph
(f) of this section) to assure continuing uninterrupted health plan
coverage.
(i) Reenrollment of annuitants who cancelled enrollment because of
eligibility under Medicaid or similar State-sponsored program of
medical assistance for the needy. (1) An annuitant who had been
enrolled (or was otherwise eligible to enroll) for coverage under this
part and cancelled the enrollment because he or she furnished proof of
eligibility for coverage under the Medicaid program or a similar State-
sponsored program of medical assistance for the needy, and who
involuntarily loses that coverage, may reenroll in any available plan
under this part at any time beginning 31 days before and ending 60 days
after the loss of Medicaid or similar State-sponsored coverage. A
reenrollment under this paragraph (i)(1) takes effect on the date
following the date of loss of Medicaid or similar State-sponsored
coverage.
(2) An annuitant who cancelled his or her enrollment because he or
she furnished proof of eligibility for coverage under the Medicaid
program or a similar State-sponsored program of medical assistance for
the needy, and who wishes to reenroll in a plan under this part for
reasons other than an involuntary loss of that coverage, may do so
during the next available open season as provided by paragraph (f) of
this section.
(j) Annuitants who apply for postponed minimum retirement age plus
10 years of service (MRA plus 10) annuity. (1) A former employee who
meets the requirements for an immediate annuity under 5 U.S.C. 8412(g)
and for continuation of coverage under 5 U.S.C. 8905(b) at the time of
separation, and whose enrollment is terminated under
Sec. 890.304(a)(1)(ii) may enroll in a health benefits plan under this
part within 60 days after OPM mails the former employee a notice of
eligibility. If such former employee dies before the end of this 60-day
election period, a survivor who is entitled to a survivor annuity may
enroll in a health benefits plan under this part within 60 days after
OPM mails the survivor a notice of eligibility.
(2) The former employee's enrollment takes effect on the first day
of the month following the month in which OPM receives the appropriate
request or on the commencing date of annuity, whichever is later. A
survivor's enrollment takes effect on the first day of the month
following the month in which OPM receives the appropriate request.
(k) Restoration of annuity or compensation payments. (1) A
disability annuitant who was enrolled in a health benefits plan under
this part immediately before his or her disability annuity was
terminated because of restoration to earning capacity or recovery from
disability, and whose disability annuity is restored under 5 U.S.C.
8337(e) after December 31, 1983, or 8455(b), may enroll in a health
benefits plan under this part within 60 days after OPM mails a notice
of insurance eligibility. The enrollment takes effect on the first day
of the month after the date OPM receives the appropriate request.
(2) An annuitant who was enrolled in a health benefits plan under
this part immediately before his or her compensation was terminated
because OWCP determined that he or she had recovered from the job-
related injury or disease, and whose compensation is restored due to a
recurrence of disability, may enroll in a health benefits plan under
this part within 60 days after OWCP mails a notice of insurance
eligibility. The enrollment takes effect on the first day of the pay
period after the date OWCP receives the appropriate request.
(3) A surviving spouse who was covered by a health benefits
enrollment under this part immediately before his or her survivor
annuity was terminated because of remarriage, and whose survivor
annuity is later restored, may enroll in a health benefits plan under
this part within 60 days after OPM mails a notice of eligibility. The
enrollment takes effect on either--
(i) The first day of the month after the date OPM receives the
appropriate request; or
(ii) The date of restoration of the survivor annuity or October 1,
1976, whichever is later.
(4) A surviving child who was covered by a health benefits
enrollment under this part immediately before his or her survivor
annuity was terminated because he or she ceased being a student, and
whose survivor annuity is later restored, may enroll in a health
benefits plan under this part within 60 days after OPM mails a notice
of eligibility. The enrollment takes effect on the first day of the
month after the date OPM receives the appropriate request or the date
of restoration of the survivor annuity, whichever is later.
(5) A surviving child who was covered by a health benefits
enrollment under this part immediately before his or her survivor
annuity was terminated because he or she married, and whose survivor
annuity is later restored because the marriage ended, may enroll in a
health benefits plan under this part within 60 days after OPM mails a
notice of eligibility. The enrollment takes effect on the first day of
the month after the date OPM receives the appropriate request or the
date of restoration of the survivor annuity, whichever is later.
(6) A surviving spouse who received a basic employee death benefit
under 5 U.S.C. 8442(b)(1)(A) and who was covered by a health benefits
enrollment under this part immediately before remarriage prior to age
55, may enroll in a health benefits plan under this part upon
termination of the remarriage. The survivor must provide OPM with a
certified copy of the notice of death or the court order terminating
the marriage. The surviving spouse must enroll within 60 days after OPM
mails a notice of eligibility. The enrollment takes effect on the first
day of the month after the date OPM receives the appropriate request
and the notice of death or court order terminating the remarriage.
(l) Loss of coverage under this part or under another group
insurance plan. An annuitant who meets the requirements of paragraph
(a) of this section, and who is not enrolled but is covered by another
enrollment under this part may continue coverage by enrolling in his or
her own name when the annuitant loses
[[Page 38439]]
coverage under the other enrollment under this part. An enrolled
annuitant may change the enrollment from self only to self and family,
from one plan or option to another, or make any combination of these
changes when the annuitant or an eligible family member of the
annuitant loses coverage under this part or under another group health
benefits plan. Except as otherwise provided, an annuitant must enroll
or change the enrollment within the period beginning 31 days before the
date of loss of coverage and ending 60 days after the date of loss of
coverage. Losses of coverage include, but are not limited to--
(1) Loss of coverage under another FEHB enrollment due to the
termination, cancellation, or a change to self only, of the covering
enrollment;
(2) Loss of coverage under another federally-sponsored health
benefits program;
(3) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan;
(4) Loss of coverage due to the discontinuance of an FEHB plan in
whole or in part. For an annuitant who loses coverage under this
paragraph (l)(4)--
(i) If the discontinuance is at the end of a contract year, the
annuitant must change the enrollment during the open season, unless OPM
establishes a different time. If the discontinuance is at a time other
than the end of the contract year, OPM must establish a time and
effective date for the annuitant to change the enrollment;
(ii) If a plan has only one option and is discontinued, an
annuitant who does not change the enrollment is deemed to have enrolled
in the standard option of the Blue Cross and Blue Shield Service
Benefit Plan.
(iii) If a plan has two options, and one option of the plan is
discontinued, an annuitant who does not change the enrollment is
considered to be enrolled in the remaining option of the plan.
(iv) If a plan has two options and both options are discontinued,
an annuitant who does not change the enrollment is deemed to have
enrolled in the corresponding option of the Blue Cross and Blue Shield
Service Benefit Plan. If the annuitant is enrolled in a high option and
his or her annuity is insufficient to pay the withholding for the high
option, the annuitant is deemed to have enrolled in the standard option
of the Blue Cross and Blue Shield Service Benefit Plan. The exemptions
from debt collection procedures that are provided under
Secs. 831.1305(d)(2) and 845.205(d)(2) of this chapter apply to
elections under this paragraph (1)(4)(iv);
(5) Loss of coverage under the Medicaid program or similar State-
sponsored program of medical assistance for the needy.
(6) Loss of coverage under a non-Federal health plan.
(m) Move from comprehensive medical plan's area. An annuitant in a
comprehensive medical plan who moves or becomes employed outside the
geographic area from which the plan accepts enrollments, or, if already
outside this area, moves or becomes employed further from this area,
may change the enrollment upon notifying the employing office of the
move or change of place of employment. Similarly, an annuitant whose
covered family member moves outside the geographic area from which the
plan accepts enrollments, or if already outside this area, moves
further from this area, may change the enrollment upon notifying the
employing office of the family member's move. The change of enrollment
takes effect on the first day of the pay period that begins after the
employing office receives an appropriate request.
(n) Overseas post of duty. An annuitant may change the enrollment
from self only to self and family, from one plan or option to another,
or make any combination of these changes within 60 days after the
retirement or death of the employee on whose service title to annuity
is based, if the employee was stationed at a post of duty outside a
State of the United States or the District of Columbia at the time of
retirement or death.
(o) On return from a uniformed service. An enrolled annuitant who
enters on duty in a uniformed service for 31 days or more may change
the enrollment within 60 days after separation from the uniformed
service.
(p) On becoming eligible for Medicare. An annuitant may change the
enrollment from one plan or option to another at any time beginning on
the 30th day before becoming eligible for coverage under title XVIII of
the Social Security Act (Medicare). A change of enrollment based on
becoming eligible for Medicare may be made only once.
(q) Annuity insufficient to pay withholdings. (1) If an annuity is
insufficient to pay the withholdings for the plan that the annuitant is
enrolled in, the retirement system must provide the annuitant with
information regarding the available plans and written notification of
the opportunity to either--
(i) Pay the premium directly to the retirement system in accordance
with Sec. 890.502(d); or
(ii) Enroll in any plan in which the annuitant's share of the
premium is less than the amount of annuity. If the annuitant elects to
change to a lower cost enrollment, the change takes effect immediately
upon loss of coverage under the prior enrollment.
(2) If the annuitant is enrolled in the high option of a plan that
has two options, and does not change the enrollment to a plan in which
the annuitant's share of the premium is less than the amount of annuity
or does not elect to pay premiums directly, the annuitant is deemed to
have enrolled in the standard option of the same plan, unless the
annuity is insufficient to pay the withholdings for the standard
option.
(3) An annuitant whose enrollment was terminated because the amount
of annuity was insufficient to cover the enrollee's share of the
premium may apply to be reinstated in any available plan or option.
(4) An annuitant who can show evidence that he or she previously
changed to a lower cost option, plan, or to a self-only enrollment
prior to May 29, 1990, because the annuity was insufficient to cover
the withholdings for the plan in which he or she was enrolled, may
apply to change the enrollment to any available plan or option in which
the enrollee's share of the total premium exceeds his or her monthly
annuity.
(5) The effective date of the reinstatement of enrollment of an
annuitant whose enrollment was terminated, or the change of enrollment
of an annuitant who previously changed enrollment because his or her
annuity was insufficient to cover the annuitant's share of the total
premium, and who elects to pay premiums directly to the retirement
system in accordance with Sec. 890.502(f) is either--
(i) The first day of the first pay period that begins after the
appropriate request is received by the retirement system; or,
(ii) The later of the date the enrollment was terminated or
changed, or May 29, 1990.
(6) Retroactive reinstatement or change of enrollment is contingent
upon payment of appropriate contributions retroactive to the effective
date of the reinstatement or the change of enrollment. For the purpose
of this paragraph (q)(6), a previous cancellation of enrollment because
of insufficient annuity to cover the full amount of the withholdings is
deemed to be a termination of enrollment.
[[Page 38440]]
(r) Sole survivor. When an employee or annuitant enrolled for self
and family dies, leaving a survivor annuitant who is entitled to
continue the enrollment, and it is apparent from available records that
the survivor annuitant is the sole survivor entitled to continue the
enrollment, the office of the retirement system which is acting as
employing office must change the enrollment from self and family to
self only, effective on the commencing date of the survivor annuity. On
request of the survivor annuitant made within 31 days after the first
installment of annuity is paid, the office of the retirement system
which is acting as employing office must rescind the action retroactive
to the effective date of the change to self only, with corresponding
adjustment in withholdings and contributions.
(s) Election between survivor annuities. A surviving spouse,
irrespective of whether his or her survivor annuity continued or was
terminated upon remarriage, who was covered by an enrollment under this
part immediately before the remarriage, may elect to continue an
enrollment under this part acquired as a dependent by virtue of the
remarriage or to enroll in his or her own right (by virtue of
entitlement to the original survivor annuity) in any plan or option
under this part within 60 days after the termination of the remarriage
and entitlement to a survivor annuity.
Sec. 890.602 [Amended]
10. Section 890.602 is amended by removing ``register'' and adding
in its place ``elect to enroll''.
Sec. 890.803 [Amended]
11. In Sec. 890.803, paragraph (a)(3)(i) is amended by removing
``5'' CFR 831.606 (a) and (b) and 842.605 (a) and (b)'' and adding in
its place Secs. 831.613 (a) and (b) and 842.605 (a) and (b) of this
chapter''.
Sec. 890.805 [Amended]
12. In Sec. 890.805, paragraph (a)(2)(v) is amended by removing
``appointment'' and adding in its place ``apportionment''.
13. Section 890.806 is revised to read as follows:
Sec. 890.806 Opportunities for former spouses to enroll and change
enrollment; effective dates of enrollment.
(a) Initial opportunity to enroll. A former spouse who has met the
eligibility requirements of Sec. 890.803 and the application time
limitation requirements of Sec. 890.805 may enroll at any time after
the employing office establishes that these requirements have been met.
(b) Effective date--generally. (1) Except as otherwise provided, an
enrollment takes effect on the first day of the first pay period that
begins after the date the employing office receives an appropriate
request and satisfactory proof of eligibility as required by paragraph
(a) of this section. If a former spouse requests immediate coverage,
and the employing office receives an appropriate request and
satisfactory proof of eligibility within 60 days after the date of
divorce, the enrollment may be made effective on the same day that
temporary continuation of coverage under subpart K of this part would
otherwise take effect.
(2) A change of enrollment takes effect on the first day of the
first pay period that begins after the date the employing office
receives the appropriate request.
(c) Belated enrollment. When an employing office determines that a
former spouse was unable, for cause beyond his or her control, to
enroll or change the enrollment within the time limits prescribed by
this section, the former spouse may do so within 60 days after the
employing office advises the former spouse of its determination.
(d) Enrollment by proxy. Subject to the discretion of the employing
office, a former spouse's representative, having written authorization
to do so, may enroll or change the enrollment for the former spouse.
(e) Change to self only. (1) A former spouse may change the
enrollment from self and family to self only at any time.
(2) A change of enrollment to self only takes effect on the first
day of the first pay period that begins after the date the employing
office receives an appropriate request to change the enrollment, except
that at the request of the former spouse and upon a showing
satisfactory to the employing office that there was no family member
eligible for coverage under the family enrollment, the employing office
may make the change take effect on the first day of the pay period
following the one in which there was no family member.
(f) Open season. (1) During an open season as provided by
Sec. 890.301(f)--
(i) An enrolled former spouse may change the enrollment from self
only to self and family provided the family member(s) is eligible for
coverage under Sec. 890.804, from one plan or option to another, or
make any combination of these changes.
(ii) A former spouse who cancelled the enrollment under this part
for the purpose of enrolling in a prepaid health plan under section
1833 or 1876 of the Social Security Act, and who subsequently
voluntarily disenrolls from the prepaid health plan, may reenroll.
(iii) A former spouse who cancelled the enrollment under this part
because he or she furnished proof of eligibility for coverage under the
Medicaid program or a similar State-sponsored program of medical
assistance for the needy, and who wishes to reenroll in a plan under
that part for reasons other than an involuntary loss of that coverage,
may do so.
(2) An open season reenrollment or change of enrollment takes
effect on the first day of the first pay period that begins in January
of the next following year.
(3) When a belated open season reenrollment or change of enrollment
is accepted by the employing office under paragraph (c) of this
section, it takes effect as required by paragraph (f)(2) of this
section.
(g) Change in family status. (1) An enrolled former spouse may
change the enrollment from self only to self and family, from one plan
or option to another, or make any combination of these changes within
the period beginning 31 days before and ending 60 days after the birth
or acquisition of a child who meets the eligibility requirements of
Sec. 890.804.
(2) A change in enrollment under paragraph (g)(1) of this section
takes effect on the first day of the pay period in which the child is
born or becomes an eligible family member.
(h) Reenrollment of former spouses who cancelled enrollment to
enroll in a Medicare-sponsored Coordinated Care Plan. (1) A former
spouse who had been enrolled for coverage under this part and cancelled
enrollment for the purpose of enrolling in a prepaid health plan under
section 1833 or 1876 of the Social Security Act, or who meets the
eligibility requirements of Sec. 890.803 and the application time
limitation requirements of Sec. 890.805, but postponed enrollment for
this purpose, and who is subsequently involuntarily disenrolled from
the prepaid health plan, may immediately reenroll in any available plan
under this part at any time beginning 31 days before and ending 60 days
after the disenrollment. A reenrollment under this paragraph (h) takes
effect on the date following the effective date of the disenrollment as
shown on the documentation from the prepaid health plan.
(2) A former spouse who voluntarily disenrolls from the prepaid
health plan must do so in conjunction with reenrolling in a plan under
this part during the next available open season (as provided by
paragraph (f) of this
[[Page 38441]]
section) to assure continuing uninterrupted health plan coverage.
(i) Reenrollment of former spouses who cancelled enrollment because
of eligibility under Medicaid or similar State-sponsored program of
medical assistance for the needy. (1) A former spouse who had been
enrolled for coverage under this part and cancelled the enrollment
because he or she furnished proof of eligibility for coverage under the
Medicaid program or a similar State-sponsored program of medical
assistance for the needy, or who meets the eligibility requirements of
Sec. 890.803 and the application time limitation requirements of
Sec. 890.805, but postponed enrollment for this reason, and who
involuntarily loses that coverage, may reenroll in any available plan
under this part at any time beginning 31 days before and ending 60 days
after the loss of Medicaid or similar State-sponsored coverage. A
reenrollment under this paragraph (i)(1) takes effect on the date
following the date of loss of Medicaid or similar State-sponsored
coverage.
(2) A former spouse who cancelled his or her enrollment because he
or she furnished proof of eligibility for coverage under the Medicaid
program or a similar State-sponsored program of medical assistance for
the needy, and who wishes to reenroll in a plan under this part for
reasons other than an involuntary loss of that coverage, may do so
during the next available open season as provided by paragraph (f) of
this section.
(j) Loss of coverage under this part or under another group
insurance plan. An enrolled former spouse may change the enrollment
from self only to self and family, from one plan or option to another
or make any combination of these changes when the former spouse or a
child who meets the eligibility requirements under Sec. 890.804 loses
coverage under another enrollment under this part or under another
group health benefits plan. Except as otherwise provided, the former
spouse must change the enrollment within the period beginning 31 days
before the date of loss of coverage and ending 60 days after the date
of loss of coverage, provided he or she continues to meet the
eligibility requirements under Sec. 890.803. Losses of coverage include
but are not limited to--
(1) Loss of coverage under another FEHB enrollment due to the
termination, cancellation, or a change to self only, of the covering
enrollment;
(2) Loss of coverage under another federally-sponsored health
benefits program;
(3) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan;
(4) Loss of coverage due to the discontinuance of an FEHB plan in
whole or in part. For a former spouse who loses coverage under this
paragraph (j)(4)--
(i) If the discontinuance is at the end of a contract year, the
former spouse must change the enrollment during the open season, unless
OPM establishes a different time. If the discontinuance is at a time
other than the end of the contract year, OPM must establish a time and
effective date for the former spouse to change the enrollment;
(ii) If the whole plan is discontinued, a former spouse who does
not change the enrollment within the time set is considered to have
cancelled the plan in which enrolled.
(iii) If one option of a plan that has two options is discontinued,
a former spouse who does not change the enrollment is considered to be
enrolled in the remaining option of the plan.
(5) Loss of coverage under the Medicaid program or similar State-
sponsored program of Medical assistance for the needy.
(6) Loss of coverage under a non-Federal health plan.
(k) Move from comprehensive medical plan's area. A former spouse in
a comprehensive medical plan who moves or becomes employed outside the
geographic area from which the plan accepts enrollments, or, if already
outside this area, moves or becomes employed further from this area,
may change the enrollment upon notifying the employing office of the
move or change of place of employment. Similarly, a former spouse whose
covered family member moves outside the geographic area from which the
plan accepts enrollments, or if already outside this area, moves
further from this area, may change the enrollment upon notifying the
employing office of the family member's move. The change of enrollment
takes effect on the first day of the pay period that begins after the
employing office receives an appropriate request.
(1) On becoming eligible for Medicare. A former spouse may change
the enrollment from one plan or option to another at any time beginning
on the 30th day before becoming eligible for coverage under title XVIII
of the Social Security Act (Medicare). A change of enrollment based on
becoming eligible for Medicare may be made only once.
(m) Annuity insufficient to pay withholdings. (1) If the annuity of
a former spouse is insufficient to pay the full subscription charge for
the plan in which he or she is enrolled, the retirement system must
provide the former spouse with information regarding the available
plans and written notification of the opportunity to either--
(i) Pay the premium directly to the retirement system in accordance
with Sec. 890.808(d); or
(ii) Enroll in any plan with a full premium that is less than the
amount of annuity. If the former spouse elects to change to a lower
cost enrollment, the change takes effect immediately upon loss of
coverage under the prior enrollment.
(2) If the former spouse is enrolled in the high option of a plan
that has two options, and does not elect a plan with a full premium
that is less than the annuity or does not elect to pay premiums
directly, he or she is deemed to have enrolled in the standard option
of the same plan unless the annuity is insufficient to pay the full
subscription charge for the standard option.
(3) A former spouse who is enrolled in a plan with only one option,
who fails to make the election required by this paragraph (m)(3) will
be subject to the provisions of Sec. 890.807(c).
14. Section 890.807 is amended by revising the heading for
paragraph (c), and revising paragraphs (c) (1) and (e) to read as
follows:
Sec. 890.807 Termination of enrollment.
* * * * *
(c) Failure to make an election under Sec. 890.806(1). (1) If the
annuity is insufficient to pay the full subscription charge due for the
plan in which the former spouse is enrolled, the former spouse may
elect one of the two opportunities offered under Sec. 890.806(1)
(electing a plan with a full subscription charge that is less than the
annuity; or paying premiums directly to the retirement system in
accordance with Sec. 890.808(d)). Except as provided in paragraph
(c)(3) of this section the enrollment of a former spouse who fails to
make an election within the specified time frame will be terminated.
* * * * *
(e) Cancellation. (1) A former spouse may cancel his or her
enrollment at any time by filing an appropriate request with the
employing office. The cancellation takes effect on the last day of the
pay period in which the appropriate request cancelling the enrollment
is received by the employing office.
(2) If a former spouse submits documentation that the cancellation
is for the purpose of enrolling in a prepaid health plan under section
1833 or 1876
[[Page 38442]]
of the Social Security Act, the cancellation becomes effective on the
day before the enrollment under the prepaid health plan takes effect.
Such documentation must be submitted to the employing office within the
period beginning 31 days before and ending 31 days after the prepaid
health plan enrollment takes effect.
(3) The former spouse and family members, if any, are not entitled
to the temporary extension of coverage for conversion or to convert to
an individual contract for health benefits.
(4) Except for a former spouse who provides documentation that he
or she is canceling for the purpose of enrolling in a prepaid health
plan under section 1833 or 1876 of the Social Security Act, or for
coverage under the Medicaid program or a similar State-sponsored
program of medical assistance for the needy, a former spouse who
cancels his or her enrollment may not later reenroll.
15. In section 890.808, paragraph (e) is revised to read as
follows:
Sec. 890.808 Employing office responsibilities.
* * * * *
(e) Withholding from annuity. The retirement system acting as
employing office for a former spouse will establish a method for
withholding the full subscription charge from the former spouse's
annuity check. When the annuity is insufficient to cover the full
subscription charge, the retirement system will follow the procedures
specified in Sec. 890.806(1).
16. Section 890.1105 is amended by revising the section heading, by
revising paragraphs (b), (c), (d), and (f), and by adding a new
paragraph (g) to read as follows:
Sec. 890.1105 Initial election of temporary continuation of coverage;
application time limitations and effective dates.
* * * * *
(b) Former employees. A former employee's election under this
subpart must be submitted to the employing office within 60 days after
the later of--
(1) The date of separation; or
(2) The date the former employee received the notice from the
employing office.
(c) Children. A child's election under this subpart must be
submitted to the employing office within 60 days after the later of--
(1) The date of the qualifying event; or
(2) If the employee notified the employing office within the 60-day
time period specified under Sec. 890.1104(b)(1) of this part, the date
the child received the notice from the employing office. If the
employee did not notify the employing office within the specified time
period, the child's opportunity to elect continued coverage ends 60
days after the qualifying event.
(d) Former spouses. (1) A former spouse's election must be received
by the employing office within 60 days after the later of--
(i) The date of the qualifying event; or
(ii) The date coverage under subpart H of this part was lost
because of remarriage or loss of qualifying court order, if the loss of
coverage under subpart H occurred before the expiration of the 36-month
period specified in Sec. 890.1107(c); or
(iii) If the employee, annuitant, or former spouse notified the
employing office of the termination of the marriage within the time
period specified in Sec. 890.1104(c)(1), the date the former spouse
received the notice from the employing office described in
Sec. 890.1104(c)(2). If the employee, annuitant, or former spouse did
not notify the employing office within the specified time period, the
former spouse's opportunity to elect continued coverage ends 60 days
after the qualifying event.
(2) The effective date of former spouse coverage is the later of--
(i) The date determined under paragraph (g) of this section; or
(ii) The date of the divorce or annulment.
* * * * *
(f) Belated elections. Except as provided in paragraphs (c)(2) and
(d)(1)(iii) of this section, when an employing office determines that
an eligible individual was unable, for cause beyond his or her control,
to elect temporary continuation of coverage within the time limits
prescribed by this section, that office must accept the election within
60 days after it advises the individual of that determination.
(g) Effective date of coverage. Except as provided in paragraph
(d)(2)(ii) of this section, the effective date of temporary
continuation of coverage is the day after other coverage under this
part expires, including the 31-day temporary extension of coverage
under Sec. 890.401. If an individual elects temporary continuation of
coverage after the 31-day temporary extension of coverage expires, but
before the expiration of the applicable election period specified in
this section, coverage is restored retroactively, with appropriate
contributions and claims, to the same extent and effect as though no
break in coverage occurred.
17. Section 890.1108 is revised to read as follows:
Sec. 890.1108 Opportunities to change enrollment; effective dates.
(a) Effective date--generally. Except as otherwise provided, a
change of enrollment takes effect on the first day of the first pay
period that begins after the date the employing office receives an
appropriate request to change the enrollment.
(b) Belated change of enrollment. When an employing office
determines that an enrollee was unable, for cause beyond his or her
control, to change the enrollment within the time limits prescribed by
this section, the enrollee may do so within 60 days after the employing
office advises the enrollee of its determination.
(c) Change of enrollment by proxy. Subject to the discretion of the
employing office, an enrollee's representative, having written
authorization to do so, may change the enrollment for the enrollee.
(d) Change to self only. (1) An enrollee may change the enrollment
from self and family to self only at any time.
(2) A change of enrollment to self only takes effect on the first
day of the first pay period that begins after the date the employing
office receives an appropriate request to change the enrollment, except
that at the request of the enrollee and upon a showing satisfactory to
the employing office that there was no family member eligible for
coverage under the family enrollment, the employing office may make the
change effective on the first day of the pay period following the one
in which there was no family member.
(e) Open season. (1) During an open season as provided by
Sec. 890.301(f), an enrollee (except for a former spouse who is
eligible for continued coverage under Sec. 890.1103(a)(3)) may change
the enrollment from self only to self and family, from one plan or
option to another, or make any combination of these changes. A former
spouse who is eligible for continued coverage under Sec. 890.1103(a)(3)
may change from one plan or option to another, but may not change from
self only to self and family unless the individual to be covered under
the family enrollment qualifies as a family member under
Sec. 890.1106(a)(2).
(2) An open season change of enrollment takes effect on the first
day of the first pay period that begins in January of the next
following year.
(3) When a belated open season change of enrollment is accepted by
the employing office under paragraph (b) of this section, it takes
effect as required by paragraph (e)(2) of this section.
(f) Change in family status. (1) Except for a former spouse, an
enrollee may
[[Page 38443]]
change the enrollment from self only to self and family, from one plan
or option to another, or make any combination of these changes when the
enrollee's family status changes, including a change in marital status
or any other change in family status. The enrollee must change the
enrollment within the period beginning 31 days before the date of the
change in family status, and ending 60 days after the date of the
change in family status.
(2) A former spouse who is covered under this section may change
the enrollment from self only to self and family, from one plan or
option to another, or make any combination of these changes within the
period beginning 31 days before and ending 60 days after the birth or
acquisition of a child who qualifies as a covered family member under
Sec. 890.1106(a)(2).
(3) A change of enrollment made in conjunction with the birth of a
child, or the addition of a child as a new family member in some other
manner, takes effect on the first day of the pay period in which the
child is born or becomes an eligible family member.
(g) Reenrollment of individuals who lose other coverage under this
part. An individual whose continued coverage under this section
terminates because of the provisions of Sec. 890.1110(a)(3)
(termination due to other coverage under another provision of this
part) may reenroll if the coverage that terminated the enrollment under
this part ends, but not later than the expiration of the period
described in Sec. 890.1107. Coverage does not extend beyond the
expiration of the period described in Sec. 890.1107. The effective date
of the reenrollment is the day following the termination of the
coverage described in Sec. 890.1110(a)(3).
(h) Loss of coverage under this part or under another group
insurance plan. An enrollee may change the enrollment from self only to
self and family, from one plan or option to another, or make any
combination of these changes when the enrollee loses coverage under
this part or a qualified family member of the enrollee loses coverage
under this part or under another group health benefits plan. Except as
otherwise provided, an enrollee must change the enrollment within the
period beginning 31 days before the date of loss of coverage and ending
60 days after the date of loss of coverage. Losses of coverage include,
but are not limited to--
(1) Loss of coverage under another FEHB enrollment due to the
termination, cancellation, or change to self only, of the covering
enrollment.
(2) Loss of coverage under another federally-sponsored health
benefits program.
(3) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan.
(4) Loss of coverage due to the discontinuance of an FEHB plan, in
whole or in part. For an enrollee who loses coverage under this
paragraph (h)(4)--
(i) If the discontinuance is at the end of a contract year, the
enrollee must change the enrollment during the open season, unless OPM
establishes a different time. If the discontinuance is at a time other
than the end of the contract year, OPM must establish a time and
effective date for the enrollee to change the enrollment.
(ii) If the whole plan is discontinued, an enrollee who does not
change the enrollment within the time set is considered to have
cancelled the plan in which enrolled.
(iii) If a plan has two options, and one option of the plan is
discontinued, an enrollee who does not change the enrollment is
considered to be enrolled in the remaining option of the plan.
(5) Loss of coverage under the Medicaid program or similar State-
sponsored program of medical assistance for the needy.
(6) Loss of coverage under a non-Federal health plan.
(i) Move from comprehensive medical plan's area. An enrollee in a
comprehensive medical plan who moves or becomes employed outside the
geographic area from which the plan accepts enrollments, or, if already
outside this area, moves or becomes employed further from this area,
may change the enrollment upon notifying the employing office of the
move or change of place of employment. Similarly, an enrollee whose
covered family member moves outside the geographic area from which the
plan accepts enrollments, or if already outside this area, moves
further from this area, may change the enrollment upon notifying the
employing office of the family member's move. The change of enrollment
takes effect on the first day of the pay period that begins after the
employing office receives an appropriate request.
(j) On becoming eligible for Medicare. An enrollee may change the
enrollment from one plan or option to another at any time beginning on
the 30th day before becoming eligible for coverage under title XVIII of
the Social Security Act (Medicare). A change of enrollment based on
becoming eligible for Medicare may be made only once.
[FR Doc. 97-18958 Filed 7-17-97; 8:45 am]
BILLING CODE 6325-01-M