[Federal Register Volume 59, Number 89 (Tuesday, May 10, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11165]
[[Page Unknown]]
[Federal Register: May 10, 1994]
VOL. 59, NO. 89
Tuesday, May 10, 1994
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
RIN 3206-AF74
Federal Employees Health Benefits Program: Miscellaneous Changes
AGENCY: Office of Personnel Management.
ACTION: Proposed rule.
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SUMMARY: These regulations propose a number of changes to the Federal
Employees Health Benefits (FEHB) Program. The changes would improve the
administration of the FEHB Program and result in better service to
enrollees.
DATES: We must receive comments on or before July 11, 1994.
ADDRESSES: Send written comments to Lucretia F. Myers, Assistant
Director for Insurance Programs, Retirement and Insurance Group, Office
of Personnel Management, P.O. Box 707, Washington, DC 20044, or deliver
to OPM, room 3415, 1900 E Street NW., Washington, DC.
FOR FURTHER INFORMATION CONTACT:
Robert G. Iadicicco, (202) 606-0191.
SUPPLEMENTARY INFORMATION: These regulations would enhance the
administration of the Federal Employees Health Benefits (FEHB) Program
and improve service to enrollees by:
1. Clarifying that the last day of Open Season will be the Monday
of the second full workweek in December, instead of the Friday of the
first full workweek in December. This clarification is necessary
because the second full workweek in November includes the Veterans Day
holiday.
2. Giving retirement system staff the discretion to allow retirees
to make FEHB coverage changes by other methods, such as telephone
requests. Current policy requires retirees to fill out registration
forms to make coverage changes. Allowing retirees to request FEHB
coverage changes by telephone would result in the coverage changes
taking effect sooner by eliminating the time spent requesting,
completing, and returning a form. Retirees must still provide proof,
satisfactory to the retirement system staff, that they meet the
requirements to make the coverage change.
The ability to use methods other than a registration form to make
FEHB coverage changes is limited to retirees because of two significant
distinctions between retirees and employees. The first distinction is
that the vast majority of retirees cannot quickly obtain and then
submit registration forms because of the limited number of retirement
system worksites. For example, retirees in the Civil Service Retirement
System or the Federal Employees Retirement System who do not live near
worksites in either Washington, DC or Boyers, Pennsylvania must wait
for the registration form to be mailed to them and then wait for the
completed form to be returned to the retirement system staff before the
change in coverage can become effective. In comparison, most employees
can easily obtain and submit registration forms to the office
responsible for their health benefits actions because the office is
located near the employee's worksite.
The second distinction is that employees must complete and sign
registration forms to document their FEHB coverage during the course of
their Federal employment. Retirement systems staff use the completed
registration forms to determine whether the employee was covered by an
FEHB plan during his or her last 5 years of employment. The employee
must meet the 5 year requirement to continue his or her FEHB coverage
into retirement. In contrast, once the retirement system staff
determines a retiree meets the 5 year requirement and can continue his
or her FEHB coverage into retirement there is no longer a need to
document the retiree's FEHB coverage through signed registration forms.
3. Allowing a legally separated employee or annuitant covered as a
family member under his or her spouse's FEHB enrollment to enroll in
FEHB for self only or self and family coverage.
Current policy allows dual enrollment only to ensure all family
members have FEHB coverage. For example, if two employees who are
married to each other both have children from prior marriages who do
not live with them, then both employees need to enroll for self and
family coverage to provide FEHB coverage for all their children.
Under this regulation most couples who are legally separated will
decide not to have two self and family enrollments because one self and
family enrollment covers both spouses and all of their eligible
children and is less expensive. However, in a limited number of cases,
circumstances will lead the covered spouse to enroll for FEHB coverage
in his or here own right. One example is when separation resulted in
the covered spouse moving out of the service area of a comprehensive
medical plan and the spouse carrying the enrollment refused to switch
to a different plan. The covered spouse would find it very difficult to
obtain covered health care. Another example is when the spouse finds it
very difficult to obtain reimbursement for medical payments under a
fee-for-service plan, because reimbursements are sent to the spouse
carrying the enrollment.
The proposed regulations would not allow dual coverage. Each
enrollee would have to notify the insurance carrier of the names of
family members covered under his or her enrollment that are not covered
under the other enrollment.
4. Extending to certain employees the option of reinstating FEHB
coverage upon retirement. This option would be available to employees
whose employing office terminated their FEHB enrollment because they
entered on duty in a uniformed service, and who retire on an immediate
annuity from their Federal civilian position while on such duty. The
individual must make the request for reinstatement to the retirement
system within 60 days after his or her retirement. If the individual
does not exercise this option, the retirement system will automatically
reinstate the FEHB enrollment on the day the person separates from the
uniformed service. In either case, reinstatement will only take place
if the Federal retiree meets the 5-year requirement for continuing FEHB
coverage into retirement. Currently, retirement systems can reinstate
the FEHB enrollment only on the day the person separates from the
uniformed service.
5. Permitting retirees, whose entire annuity or compensation has
been waived or suspended, to pay FEHB premiums directly to the
retirement system or the Office of Workers' Compensation Programs
(OWCP) for any period of waiver or suspension which is 3 months or
more. Currently, a retiree's FEHB coverage terminates when the period
of the waiver or suspension exceeds 3 months. The retirement system or
OWCP automatically reinstates FEHB coverage on a prospective basis when
annuity or compensation payments resume. The proposed rule provides
better service to retirees by allowing them to continue their FEHB
coverage when their annuity or compensation is waived or suspended for
more than 3 months.
6. Establishing a requirement that agencies counsel employees
entering leave without pay status, or whose pay is insufficient to
cover their FEHB premium payments, of the options of continuing or
terminating their FEHB coverage, and if continuing, of paying premiums
directly on a current basis or incurring a debt to be withheld from
future salary. These regulations are intended to ensure employees are
fully aware of these alternatives. Furthermore, because the regulations
establish a procedure under which the employee voluntarily arranges to
have the debt recovered from salary in a specified amount after
returning to duty or after salary increases to cover the amount of the
health benefits contributions, the involuntary offset provisions of 5
U.S.C. 5514 and subpart K of 5 CFR part 550 do not apply.
7. Deleting the sentence in section 890.701 that lists the States
determined to be ``medically underserved areas'' effective January 1,
1988, because the list is out of date. Since 1988, the list of States
determined to be ``medically underserved areas'' for each contract year
have been published on an annual basis in a notice in the Federal
Register.
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, Reporting and
recordkeeping requirements, Retirement.
U.S. Office of Personnel Management.
Lorraine A. Green,
Deputy 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 is revised 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, the definition of Register is revised to read
as follows:
Sec. 890.101 Definitions; time computations.
* * * * *
Register means to file with the employing office a properly
completed health benefits registration form, either electing to be
enrolled in a health benefits plan or electing not to be enrolled.
Retirement systems may accept alternative means, such as telephone
requests, in substitution of a properly completed health benefits
registration form. Register to enroll means to register an election to
be enrolled. Enrolled means a valid registration form has been accepted
by the employing office, or an alternative method has been accepted by
the retirement system, and the enrollment in a health benefits plan
approved by OPM under this part has not been terminated or cancelled.
Sec. 890.301 [Amended]
3. In Sec. 890.301, paragraph (c) is amended by removing
``Sec. 890.304(a)(4)'' and adding in its place ``Sec. 890.304(a)(5)'';
paragraph (d)(1) introductory text is amended by removing ``through the
Friday of the first full work-week in December'' and adding in its
place ``through the Monday of the second full workweek in December''.
4. In Sec. 890.302, paragraph (a)(2) is revised, and paragraph
(a)(3)(i) is amended by adding the words ``or legally separated'' after
the word ``divorced'', to read as follows:
Sec. 890.302 Coverage of family members.
(a) * * *
(2) Dual enrollment--spouse. (i) To protect the interests of the
children, an employee or annuitant may enroll in his or her own right
in a self and family enrollment even though is or her spouse also has a
self and family enrollment. Generally, such dual enrollments are
permitted only where two employees or annuitants are married, each with
children from prior marriages who do not live with them, or are legally
separated, with each spouse retaining custody of his or her own
children by a prior marriage. To ensure that no person receives
benefits under more than one enrollment, each enrollee must tell the
insurance carrier which family members are covered under his or her
enrollment. These individuals are not covered under the other
enrollment.
(ii) To protect the interests of legally separated Federal
employees, annuitants and their children, a legally separated employee
or annuitant may enroll in his or her own right in a self only or self
and family enrollment even though his or her spouse also has a self and
family enrollment. To ensure that no person receives benefits under
more than one enrollment, each enrollee must tell the insurance carrier
which family members are covered under his or her enrollment. These
individuals are not covered under the other enrollment.
* * * * *
5. In Sec. 890.305, paragraph (b) is revised to read as follows:
Sec. 890.305 Reinstatement of enrollment after military service.
* * * * *
(b) An employee whose employing office terminates his or her
enrollment because his or her order to enter on duty in a uniformed
service is for a period longer than 30 days, and who retires on an
immediate annuity from his or her Federal civilian position while on
such duty, may reinstate his or her enrollment by asking to do so
within 60 days after retirement. In the absence of such a request, the
retirement system automatically reinstates the enrollment on the day
the person separates from the uniformed service. For the retirement
system to reinstate the enrollment, the individual must have been
covered under this part since his or her first opportunity or for the 5
years of civilian service (excluding the period of uniformed service)
immediately preceding the civilian retirement, whichever is shorter.
6. Section 890.307 is revised to read as follows:
Sec. 890.307 Waiver or suspension of annuity or compensation.
(a) Except as provided in paragraphs (b) and (f) of this section,
when annuity or compensation is entirely waived or suspended, the
annuitant's enrollment continues for not more than 3 months (not more
than 12 weeks for annuitants whose compensation under subchapter I of
chapter 81 of title 5, United States Code, is paid each 4 weeks). If
the waiver or suspension continues beyond this period, the employing
office will notify the annuitant in writing that the employing office
will terminate the enrollment effective at the end of the period,
subject to the temporary extension of coverage for conversion, unless
the annuitant elects to make payment of the premium directly to the
employing office during the period of waiver. If the annuitant elects
to have the enrollment terminated, the employing office automatically
reinstates the enrollment on a prospective basis when the annuitant
again receives payment of annuity or compensation. The employing office
will make the withholding for the period of suspension or waiver during
which enrollment was continued (i.e., 3 months or less).
(b) If the annuitant elects to pay premiums directly, he or she
must send to the employing office his or her share of the subscription
charge for the enrollment for every pay period during which the
enrollment continues, exclusive of the 31-day temporary extension of
coverage for conversion provided in Sec. 890.401. The annuitant must
pay after each pay period he or she is covered in accordance with a
schedule established by the employing office. If the employing office
does not receive payment by the date due, the employing office will
notify the annuitant by certified mail return receipt requested that
coverage will continue only if payment is made within 15 days after
receipt of the notice. The employing office will terminate the
enrollment of an annuitant who fails to pay within the specified time
frame. The employing office will automatically reinstate the enrollment
on a prospective basis when payment of annuity or compensation resumes.
(c) If the annuitant is prevented by circumstances beyond his or
her control from paying within 15 days after receipt of the notice, he
or she may request reinstatement of coverage by writing to the
employing office. The annuitant must file the request within 30
calendar days from the date of termination, and must include supporting
documentation. The employing office will determine if the annuitant is
eligible for reinstatement of coverage; and, when the determination is
affirmative, reinstate the coverage of the annuitant retroactive to the
date of termination. If the determination is negative, the annuitant
may request a review of the decision as provided in Sec. 890.104.
(d) Termination of enrollment for failure to pay premiums within
the time frame established in accordance with paragraph (b) of this
section is retroactive to the end of the last period for which the
employing office timely received payment.
(e) The employing office will submit all direct premium payments
along with its regular health benefits premiums to OPM in accordance
with procedures established by that office.
(f) If suspension of annuity or compensation is because of
reemployment, the reemploying office must make the withholding
currently and enrollment continues during reemployment.
7. In Sec. 890.502, the heading, paragraphs (a), (b), (c), and (d)
are revised; paragraphs (e), (f), and (g) are removed; and paragraph
(h) is redesignated as paragraph (e), to read as follows:
Sec. 890.502 Employee withholdings and contributions and direct
payment of premiums.
(a) Employee and annuitant withholdings and contributions. (1)
Except as provided in paragraph (a)(2) of this section, an employee or
annuitant is responsible for payment of the employee share of the cost
of enrollment for every pay period during which the enrollment
continues. An employee or annuitant incurs an indebtedness due the
United States in the amount of the proper employee withholding required
for each pay period that health benefits withholdings or direct premium
payments are not made but during which the enrollment continues.
(2) An individual is not required to pay withholdings for the
period between the end of the pay period in which he or she separates
from service and the commencing date of an immediate annuity, if later.
(3) Temporary employees who are eligible to enroll under 5 U.S.C.
8906a must pay the full subscription charges including both the
employee share and the Government contribution. Employees with
provisional appointments under Sec. 316.403 are not considered eligible
for coverage under 5 U.S.C. 8906a for the purpose of this paragraph.
(4) The employing office must determine the withholding for
employees whose annual pay is paid during a period shorter than 52
workweeks on an annual basis and prorate the withholding over the
number of installments of pay regularly paid during the year.
(5) The employing office must make the withholding required from
enrolled survivor annuitants in the following order. First, withhold
from the annuity of a surviving spouse, if any. If that annuity is less
than the withholding required, the employing office must make the
withholding to the extent necessary from the annuity of the children,
if any, in the following order. First, withhold from the annuity of the
youngest child, and if necessary, then from the annuity of the next
older child, in succession, until the withholding is satisfied.
(6) Surviving spouses in receipt of a basic employee death benefit
under 5 U.S.C. 8442(b)(1)(A) and annuitants whose health benefits
premiums exceed the amount of their annuities may pay their portion of
the health benefits premium directly to the retirement system acting as
their employing office in accordance with procedures set out in
paragraph (d) of this section.
(b) Procedures when employee enters LWOP status or pay is
insufficient to cover premium. (1) The employing office must counsel
employees concerning the health benefits options available to them when
the premium payments cannot be made either because the employees will
be entering leave-without-pay status or because the employees' pay is
insufficient to cover the premiums.
(2) Employees must elect in writing either to continue health
benefits coverage or terminate it. If they elect to continue coverage,
they must--
(i) Agree to pay the premium directly to the agency on a current
basis, or
(ii) Agree to have the accrued premiums deducted from salary in a
specified amount upon returning to employment, or upon pay becoming
sufficient to cover the premiums.
(3) If an employee does not return to work or the employing office
cannot recover the debt in full from salary, it may recover the debt
from whatever other sources it normally has available for recovery of a
debt to the United States.
(c) Procedures when an agency under withholds. (1) An agency that
withholds less than or none of the proper health benefits contributions
from an individual's pay, annuity, or compensation must submit an
amount equal to the sum of the uncollected deductions and any
applicable agency contributions required under section 8906 of title 5,
United States Code, to OPM for deposit in the Employees Health Benefits
Fund.
(2) The agency must make the deposit to OPM described in paragraph
(c)(1) of this section as soon as possible, but no later than 60
calendar days after the date the employing office determines the amount
of the underdeduction that has occurred, regardless of whether or when
the agency recovers the underdeduction. A subsequent agency
determination whether to waive collection of the overpayment of pay
caused by failure to properly withhold employee health benefits
contributions shall be made in accordance with 5 U.S.C. 5584 as
implemented by 4 CFR chapter I, subchapter G, unless the agency
involved is excluded from application of 5 U.S.C. 5584, in which case
any applicable authority to waive the collection may be used.
(d) Direct premium payments for annuitants. (1) If an annuity,
excluding an annuity under Subchapter III of Chapter 84 (Thrift Savings
Plan), is too low to cover the health benefits premium due or if a
surviving spouse receives a basic employee death benefit, the
retirement system will provide information to the annuitant regarding
the available plans and notify him or her in writing of the opportunity
to either: register to be enrolled in any plan in which the enrollee's
share of the premium is not in excess of the annuity; or make payment
of the premium directly to the retirement system.
(2) The retirement system must establish a method for accepting
direct payment for health benefits premiums from surviving spouses who
have received or are currently receiving basic employee death benefits
as well as from annuitants whose annuities are too low to cover their
health premiums. The annuitant must continue to make direct payment of
the health benefits premium even if the annuity increases to the extent
that it covers the premium.
(3) The surviving spouse or annuitant must pay to the retirement
system his or her share of the premium for the enrollment for every pay
period during which the enrollment continues, exclusive of the 31-day
temporary extension of coverage for conversion provided in
Sec. 890.401. The surviving spouse or annuitant must pay after each pay
period in which he or she is covered in accordance with a schedule
established by the retirement system. If the retirement system does not
receive payment by the date due, the retirement system will notify the
surviving spouse or annuitant by certified mail return receipt
requested that coverage will continue only if payment is made within 15
days after receipt of the notice. The retirement system will terminate
the enrollment of a surviving spouse or annuitant who fails to pay
within the specified time frame. A surviving spouse or annuitant whose
enrollment is terminated because of nonpayment of premium may not
reenroll or reinstate coverage, except as provided in paragraph (d)(4)
of this section.
(4) If the surviving spouse or annuitant is prevented by
circumstances beyond his or her control from paying within 15 days
after receipt of the notice, he or she may request reinstatement of
coverage by writing to the retirement system. The surviving spouse or
annuitant must file the request within 30 calendar days from the date
of termination, and must include supporting documentation. The
retirement system will determine if the surviving spouse or annuitant
is eligible for reinstatement of coverage; and, when the determination
is affirmative, reinstate the coverage of the surviving spouse or
annuitant retroactive to the date of termination. If the determination
is negative, the individual may request a review of the decision as
provided in Sec. 890.104.
(5) Termination of enrollment for failure to pay premiums within
the time frame established in accordance with paragraph (d)(3) of this
section is retroactive to the end of the last pay period for which
payment has been timely received.
(6) The retirement system will submit all direct premium payments
along with its regular health benefits premiums to OPM in accordance
with procedures established by that office.
* * * * *
Sec. 890.701 [Amended]
8. Section 890.701 is amended by removing the last sentence of the
definition of Medically underserved area.
Sec. 890.808 [Amended]
9. In Sec. 890.808, paragraph (a) is amended by removing
``Sec. 890.805(d)'' and adding in its place ``Sec. 890.805(b)'' and by
removing ``Sec. 890.805(e)'' and adding in its place
``Sec. 890.805(c)''.
[FR Doc. 94-11165 Filed 5-9-94; 8:45 am]
BILLING CODE 6325-01-M
