[Federal Register Volume 62, Number 229 (Friday, November 28, 1997)]
[Proposed Rules]
[Pages 63282-63284]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-31166]
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Proposed Rules
Federal Register
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This section of the FEDERAL REGISTER contains notices to the public of
the proposed issuance of rules and regulations. The purpose of these
notices is to give interested persons an opportunity to participate in
the rule making prior to the adoption of the final rules.
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Federal Register / Vol. 62, No. 229 / Friday, November 28, 1997 /
Proposed Rules
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OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
RIN 3206-AH61
Federal Employees Health Benefits Program: Disenrollment
AGENCY: Office of Personnel Management.
ACTION: Proposed rule.
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SUMMARY: The Office of Personnel Management (OPM) is proposing
regulations that are consistent with existing administrative procedures
requiring employing offices to provide information about enrollees in
the Federal Employees Health Benefits (FEHB) Program to the carriers of
the FEHB plans in which they are enrolled. Carriers are also required
to use the information provided by employing offices to reconcile their
enrollment records. The proposed regulations would also regularize the
conditions that would allow carriers to disenroll individuals when
their employing office of record does not show them as enrolled in the
carrier's plan and the carrier is otherwise unable to verify the
enrollment. The purpose of these proposed regulations is to facilitate
reconciliation of carrier and employing office enrollment records,
especially in cases where the carrier has not previously received a
notice showing an enrollment no longer is valid.
DATES: Comments must be received on or before December 29, 1997.
ADDRESSES: Send written comments to Frank D. Titus, Assistant Director
for Insurance Programs, Retirement and Insurance Service, Office of
Personnel Management, P.O. Box 57, Washington, DC 20044; or deliver to
OPM, Room 3425, 1900 E Street NW., Washington, DC; or FAX to (202) 606-
0633.
FOR FURTHER INFORMATION CONTACT: Margaret Sears (202) 606-0004.
SUPPLEMENTARY INFORMATION: The proposed regulations are consistent with
existing procedures that require employing offices to report to each
carrier on a quarterly basis the names and certain other data about
employees and other individuals serviced through its payroll office(s)
who are enrolled in the carrier's plan. OPM would specify the format
and the information to be contained in the report, such as the
individual's Social Security Number and the amount of withholdings and
contributions for that individual. Carriers would use the information
to reconcile their enrollment records.
Currently, when the carrier receives a quarterly report, it is
required by contract to compare the enrollees listed with its own
record of enrollees for that payroll office. If the carrier records
show an enrollee that is not listed by the payroll office, the carrier
contacts the payroll office for an explanation. The payroll office
provides documentation to resolve the discrepancy or gives the reason
the employee is no longer in the plan or no longer on the payroll (for
example, the employee canceled the enrollment, separated from Federal
service, retired, changed plans, or transferred to a different agency)
and the effective date of the change.
The proposed regulations would adopt as regulatory requirements the
current administrative quarterly reporting requirement and the
requirement for carriers to use the information to reconcile their
enrollment records. If the payroll office of record with the carrier is
unable to provide information about the enrollment, the proposed
regulations would give the carrier the authority to disenroll the
individual, after giving him or her the opportunity to respond.
Carriers do not currently have the authority to disenroll individuals.
The proposed regulations also provide an administrative procedure
for notifying the enrollee of the disenrollment. Under these procedures
the carrier would be required to notify the enrollee that the employing
agency of record did not show him or her as enrolled. The enrollee
would have 31 days after the date of the notice to provide
documentation showing that he or she was enrolled in the plan. If the
enrollee did not provide such documentation within the required time
frame, the carrier would disenroll him or her without further notice.
Under the proposed regulations the employee or annuitant could ask
his or her employing office or retirement system to reconsider the
carrier's decision to disenroll the enrollee. The employing office
would be required to notify both the enrollee and the carrier of its
determination, fully explaining its findings and conclusions.
We expect that few individuals would reach the end of this process
without their actual enrollment status becoming clear. However, in the
event that an individual was disenrolled under the proposed regulations
and it is later discovered that another provision of the regulations
should have been applied to the individual's circumstances, the
disenrollment under this regulation would become void and the
enrollment would be reinstated retroactively to the date of the
disenrollment. For example, if it later became clear that the
individual's enrollment should have continued because he or she retired
under circumstances allowing continued enrollment, the disenrollment
would become void.
The proposed regulations would allow a carrier to end a self only
enrollment upon receipt of reliable information that the enrollee had
died. A carrier may learn of the death of an enrollee when it processes
the claim for hospital or physician costs incurred at the time of
death. It may also learn of an enrollee's death when correspondence is
returned by the Postal Service with the notation that the addressee is
deceased. These would be considered reliable sources. Since proof of
death is not required, the carrier would send notification of its
action to the enrollee so that the enrollee, if still living, could so
inform the carrier. The discovery that the report of death was in error
would void the disenrollment.
The proposed regulations would allow a carrier to disenroll a child
survivor annuitant when the child becomes age 22, unless the carrier
has information indicating that the child is eligible for continued
coverage because the child is incapable of self support due to a
physical or mental disability. The proposed regulations include an
administrative procedure under which the child can ask the retirement
system to reconsider the carrier's decision to disenroll the child. The
carrier is also required to provide the child with notice of his or her
conversion right and possible eligibility for temporary continuation of
coverage.
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Finally, the proposed regulations allow the carrier to disenroll a
former employee who notifies the carrier that he or she has separated
from Federal employment under circumstances that do not entitle him or
her to an immediate annuity. The carrier would be required to send the
individual a written notice prescribed or approved by OPM.
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 administrative procedures for Federal agencies and
health benefit carriers that participate in the FEHB Program.
Executive Order 12866, Regulatory Review
This rule has been reviewed by the Office of Management and Budget
in accordance with Executive Order 12866.
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, Retirement.
Office of Personnel Management.
Janice R. Lachance,
Acting Director.
Accordingly, OPM proposes to amend 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. 890.102(f) also issued under sec.
153 of Pub. L. 104-134; 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 subpart A, Sec. 890.110 is added to read as follows:
Sec. 890.110 Enrollment reconciliation.
(a) Each employing office must report to each carrier on a
quarterly basis the names of the individuals who are enrolled in the
carrier's plan in a format and containing such information as required
by OPM.
(b) The carrier must compare the data provided with its own
enrollment records. When the carrier finds in its aggregate enrollment
records individuals whose names do not appear in the report from the
employing office of record, the carrier must request the employing
office to provide the documentation necessary to resolve the
discrepancy.
3. In subpart C, Sec. 890.308 is added to read as follows:
Sec. 890.308 Disenrollment.
(a)(1) Except as otherwise provided in this section, a carrier that
cannot reconcile its record of an individual's enrollment with agency
enrollment records must provide written notice to the individual that
the employing office of record does not show him or her as enrolled in
the carrier's plan and that he or she will be disenrolled 31 days after
the date of the notice unless the enrollee provides appropriate
documentation to resolve the discrepancy. Appropriate documentation
includes, but is not limited to, a copy of the Standard Form 2809
(basic enrollment document), the Standard Form 2810 transferring the
enrollment into the gaining employing office (or the equivalent
electronic submission), copies of earnings and leave statements or
annuity statements showing withholdings for the health benefits plan,
or a document or other credible information from the enrollee's
employing office stating that the employee is entitled to continued
enrollment in the plan and that the premiums are being paid.
(2) If the carrier does not receive documentation required under
paragraph (a)(1) of this section within the specified time frame, the
carrier must disenroll the individual, without further notice.
(3) The enrollee may request his or her employing office to
reconsider the carrier's decision to disenroll the individual. The
request for reconsideration must be made in writing and must include
the enrollee's name, address, Social Security Number or other personal
identification number, name of carrier, reason(s) for the request, and,
if applicable, retirement claim number.
(4) A request for reconsideration of the carrier's decision must be
filed within 60 calendar days after the date of the carrier's
disenrollment notice. The time limit on filing may be extended when the
individual shows that he or she was not notified of the time limit and
was not otherwise aware of it, or that he or she was prevented by
circumstances beyond his or her control from making the request within
the time limit.
(5) After reconsideration, the employing office must issue a
written notice of its final decision to the individual and the carrier.
The notice must fully set forth the findings and conclusions on which
the decision was based.
(6) If, at any time after the disenrollment has occurred, the
employing office or OPM determines that another provision of this part
applies to the individual's enrollment or the carrier discovers or
receives appropriate documentation showing that another section of this
part applies to the individual's enrollment, the disenrollment under
paragraph (a)(2) of this section is void and coverage is reinstated
retroactively.
(b) When a carrier receives, from any reliable source, information
of the death of an enrollee with a self only enrollment, the carrier
may take action to disenroll the individual on the date set forth in
Sec. 890.304(a)(1)(iv) or Sec. 890.304(b)(4) of this part, as
appropriate. The carrier must attempt to notify the affected individual
or a family member of the disenrollment. If, at any time after the
disenrollment has occurred, the employing office or OPM determines that
another provision of this part applies to the individual's enrollment
or the carrier discovers or receives appropriate documentation showing
that another section of this part applies to the individual's
enrollment, the disenrollment under this paragraph (b) is void and
coverage is reinstated retroactively.
(c)(1) When a child survivor annuitant covered under a self only
enrollment reaches age 22, the carrier may take action to disenroll the
individual effective with the date set forth in Sec. 890.304(c)(1)
unless records with the carrier indicate that the child is incapable of
self support due to a physical or mental disability. The carrier must
provide the enrollee with a written notice of disenrollment prescribed
or approved by OPM.
(2) The child survivor enrollee may request the retirement system
to reconsider the carrier's decision to disenroll the individual. The
request for reconsideration must be made in writing and include the
enrollee's name, address, Social Security Number or other identifier,
name of carrier, reason(s) for the request, and the survivor annuity
claim number.
(3) A request for reconsideration of the carrier's decision must be
filed with the retirement system within 30 calendar days from the date
of the carrier's disenrollment notice. The time limit on filing may be
extended when the individual shows that he or she was not notified of
the time limit and was not otherwise aware of it, or that he or she was
prevented by circumstances beyond his or her control from making the
request within the time limit.
(4) After reconsideration, the retirement system must issue a
written
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notice of its final decision to the individual and provide a copy to
the carrier. The notice must fully set forth the findings and
conclusions on which the decision was based.
(5) If, at any time after the disenrollment has occurred, the
employing office or OPM determines that another provision of this part
applies to the individual's enrollment or the carrier discovers or
receives appropriate documentation showing that another section of this
part applies to the individual's enrollment, the disenrollment under
paragraph (c)(1) of this section is void and coverage is reinstated
retroactively.
(d) When an enrollee notifies the carrier that he or she has
separated from Federal employment and is no longer eligible for
enrollment, the carrier must disenroll the individual, subject to the
31-day temporary extension of coverage and conversion right under
Sec. 890.401, on the last day of the pay period in which the separation
occurred, if known, otherwise the carrier must disenroll the employee
on the date the employee provides as the date of separation. The
carrier must notify the enrollee of his or her right to convert to a
nongroup contract with the carrier and possible eligibility to enroll
under the temporary continuation of coverage provisions as set forth in
subpart K of this part based on the termination of enrollment as
provided under Sec. 890.304(a)(1)(i).
[FR Doc. 97-31166 Filed 11-26-97; 8:45 am]
BILLING CODE 6325-01-P
