[Federal Register Volume 61, Number 132 (Tuesday, July 9, 1996)]
[Proposed Rules]
[Pages 35973-35982]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-17248]
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Proposed Rules
Federal Register
________________________________________________________________________
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. 61, No. 132 / Tuesday, July 9, 1996 /
Proposed Rules
[[Page 35973]]
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: Proposed rule.
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SUMMARY: The Office of Personnel Management (OPM) is issuing proposed
regulations to simplify and clarify the existing Federal Employees
Health Benefits (FEHB) Program regulations concerning opportunities to
enroll and change enrollment. The proposed regulations would make it
easier for employing offices to determine whether circumstances permit
individuals to enroll or change enrollment, and would result in a
reduced potential for error and improved customer service.
DATE: We must receive comments on or before September 9, 1996.
ADDRESSES: Send written comments to Lucretia F. Myers, 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 3451, 1900 E Street NW., Washington, DC.
FOR FURTHER INFORMATION CONTACT:
Barbara Myers (202) 606-0004.
SUPPLEMENTARY INFORMATION: The events that permit individuals to enroll
for FEHB coverage or change enrollment are specified in regulation.
When the FEHB Program first began over thirty years ago, there were few
events that permitted individuals to enroll or change their enrollment.
Since then, additional events have been added to accommodate changes to
FEHB law, establishment of other Federal programs that affected Federal
employees and retirees, and changes in the personal circumstances of
employees and annuitants.
Among the changes to FEHB law have been (1) extending FEHB coverage
to certain former spouses and temporary employees, (2) providing
temporary continuation of coverage (TCC) for enrollees and family
members who lose coverage under certain conditions, and (3) prorating
of premiums for part-time employees. Some other Federal programs that
have been established since the FEHB Program began that affect Federal
employees and retirees are Medicare and the Federal Employees
Retirement System (FERS). Also, to adapt to changes in the personal
circumstances of employees and annuitants, FEHB regulations now permit
enrollment upon loss of non-Federal coverage under certain conditions.
The inquiries we receive from the White House, Members of Congress,
Federal agencies, employees, and other individuals indicate that it is
becoming increasingly difficult for employing offices to locate and
interpret the appropriate regulation when an individual request to
enroll or change his or her enrollment. In addition, when an employing
office denies a request because they do not believe the circumstances
comply with the regulations, the individual usually asks for
reconsideration of that decision.
OPM has issued final regulations (59 FR 66434, December 27, 1994)
that delegate to Federal agencies the authority to reconsider disputes
over coverage and enrollment and to make retroactive as well as
prospective corrections of administrative errors. Our proposed
regulations would also give agencies the authority to correct enrollee
errors under certain circumstances. We believe that these proposed
regulations would help to reduce both the number of agency denial of
enrollee requests and the volume of reconsideration requests.
More specifically, we believe these proposed regulations would
improve administration of the FEHB Program by:
1. Organizing the opportunities to enroll and change enrollment
into separate sections for employees, annuitants, former spouses, and
those on Temporary Continuation of Coverage. This would reduce the time
it takes for the employing office to locate the regulation applicable
to the individual that is being assisted.
2. Grouping several of the enrollment opportunities within each
section by similar characteristics, such as opportunities based on a
change in employment status, or a loss of health benefits coverage.
This further organization of the events would make it easier for the
reader to locate the event that is needed.
3. Standardizing as much as possible the timeframes for individuals
to enroll or change enrollment. In some cases the existing timeframe
will increase from 31 to 60 days after the event. In other situations
the timeframe will be extended to include a period before the event as
well as after. This standardization would reduce the number of belated
enrollment requests the employing offices receive, and help to assure
continuous coverage for employees and family members whose eligibility
to enroll in FEHB or change enrollment is based on a loss of other
coverage.
4. Locating effective date information within the paragraph that
describes the enrollment or change opportunity. Current regulations
provide information on enrollment opportunities in one section and
their corresponding effective dates in another. This revision would
improve processing by making it easier for the reader to determine the
appropriate effective date for a specific enrollment or change
opportunity.
5. Clarifying some of the opportunities by removing certain hard to
define requirements that individuals must meet to become eligible to
enroll or change enrollment. This increased flexibility would make it
easier for employees to provide FEHB coverage for their eligible
children. It would also make it easier for agencies to make enrollment
decisions, and reduce the number of agency denials of requests to
enroll or change enrollment. Several examples of the clarified
opportunities include:
a. Under current regulations (paragraph 890.301(y)), an employee
may enroll, and an employee or annuitant may change enrollment when the
employee or a family member involuntarily loses coverage under a non-
Federal health plan. This requirement has generated numerous questions,
denials, and reconsideration request about whether the loss of non-
Federal coverage in a specific situation is voluntary or involuntary.
To make it
[[Page 35974]]
easier for families to continue their health insurance protection upon
loss of non-Federal coverage, we are no longer requiring agencies to
determine what constitutes an involuntary loss of non-Federal coverage.
We also are extending to enrollees covered under the former spouse and
TCC provisions the opportunity to change from a self-only to self and
family enrollment when an eligible family member loses non-Federal
coverage.
b. Current regulations (paragraph 890.301(e)) permit an employee to
enroll upon a change in marital status, but not upon any other change
in family status. We recognize that in some situations an employee may
have a change in family status without a change in marital status. Such
situations may include (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. Therefore, we are
expanding this regulation to also permit an employee to enroll upon any
other change in family status.
Under current regulations, a new enrollment takes effect at the
beginning of the pay period after the enrollment request is received by
the employing office and that follows a pay period during any part of
which the employee is in pay status. We recognize that in some
situations, the birth or acquisition of a child may occur while an
employee is in a leave without pay status. Therefore, in this situation
only, we are allowing the enrollment to take effect on the first day of
the pay period in which the child is born or becomes an eligible family
member, regardless of whether the enrollee was in a pay status the
previous pay period.
c. Under current regulations (paragraph 890.301(g)(4)), an
employee, annuitant, or former spouse who qualifies for FEHB coverage
under section 890.803, who loses coverage because of cancellation of
the covering enrollment must enroll in the same plan and option as that
from which coverage was lost. We recognize that there may be situations
in which the individual enrolled for self and family cancels the
enrollment but the family member who loses coverage does not want to
enroll in the same plan; or the enrollee of a prepaid plan cancels the
enrollment but the family member who loses coverage lives in a
different geographic location. As part of our effort to accommodate the
complex family situations that can occur, we are eliminating this
requirement and permitting enrollment in any plan or option when
coverage is lost because the covering enrollment has been cancelled.
d. Current regulations (paragraph 890.301(t)) permit an employee to
enroll if his or her coverage under the Medicaid program (State program
of medical assistance for the needy) should terminate. They also permit
an employee who is enrolled for self only to change to a self and
family enrollment if a family member loses Medicaid coverage. Under our
proposed regulations, an employee who is not enrolled may enroll if a
family member should lose Medicaid coverage. Enrollees covered under
the former spouse and TCC provisions may change from self only to self
and family if an eligible family member loses Medicaid coverage. We
also are extending to annuitants and former spouses who cancel their
enrollment because they qualify for Medicaid coverage the opportunity
to reenroll in the FEHB Program upon loss of the Medicaid coverage.
e. Under current regulations (paragraph 890.301(h)), an enrollee in
a comprehensive medical plan who loses coverage or access to health
services because of a change of address or place of employment may
change enrollment. The enrollee must provide the employing office with
written notification of his or her move or employment change or
``satisfactory'' evidence of a family member's move. To accommodate
alternative and more automated systems of processing enrollment
changes, and to make it easier for agencies to process enrollment
changes under this event, we are removing the written notification
requirement and no longer requiring agencies to determine what
constitutes ``satisfactory'' evidence.
As part of our continuing effort to improve service to FEHB
enrollees, we are revising paragraph 890.302(f) concerning
determinations of incapacity for children over age 22. Under FEHB law,
a child's coverage ends at age 22 unless the child is determined
incapable of self-support because of a physical or mental disability
that existed before age 22. Since current regulations require the
employing office (the retirement system is the employing office for
annuitants) to make determinations of incapacity, enrollees who contact
their insurance carrier to request continued coverage for a disabled
child are referred back to the employing office. There are certain
medical conditions that would cause children to be incapable of self-
support during adulthood, and if a child has one of these conditions,
we believe that carriers should be able to extend coverage without
going back to the employing agency. Therefore, we are revising the
regulations to permit either the employing office or the carrier to
make determinations of incapacity in such cases. We will provide an up-
to-date list of these medical conditions in a Benefits Administration
Letter and an FEHBP Letter to All Carriers; if we need to add or delete
a condition in the future, we will notify employing offices and
carriers promptly by means of these publications. If a child has a
medical condition that is not on the list, the employing office will
continue to make the determination.
We also will be adding the term ``appropriate request'' to our
definitions. This new definition will allow for alternative and more
automated methods of processing enrollments. These methods, which
include Employee Express, should result in faster enrollment processing
and improved customer service.
Finally, we will be making a conforming change to paragraph
890.803(a)(3)(i) to correct a reference to Sec. 831.606, which has been
redesignated as Sec. 831.613.
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, Retirement.
U.S. Office of Personnel Management.
James B. King,
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. 890.803 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
[[Page 35975]]
revised, the definitions for Cancellation, Change of enrollment,
Register, and Register to enroll are removed, and the definitions for
Appropriate request, Cancel, Change the enrollment, 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. In addition, for an enrollment or
cancellation to be valid, the signature of the requesting individual
must be on the request, or on a form from the employing office that
notifies the requesting individual of the enrollment or cancellation
and requests his or her confirmation. For changes of enrollments, the
signature of the requesting individual is not required but the
employing office must promptly give the requesting individual notice of
the change of enrollment. For purposes of Sec. 890.301, 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).
* * * * *
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 canceled.
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. 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 day of the
first day 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 employing office advises the employee 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 after 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 OPM 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.
(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--
[[Page 35976]]
(1) A return to pay status following loss of coverage under
Sec. 890.304(a)(1)(v) due to the expiration of 365 days in leave
without pay (LWOP) status.
(2) Reemployment after a break in service of more than 3 days.
(3) Restoration to a civilian position under part 353 of this
chapter or other similar authority after being ordered to duty in a
uniformed service for 31 days or more.
(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 is the first day of the pay period in
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 enrolling under this paragraph (h)(6) must enroll or change
the enrollment 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 or loss of access to health services because
the employee or a covered family member in a comprehensive medical plan
moves or becomes employed outside the enrollment or service area, or,
if already outside the enrollment or service area, moves or becomes
employed further from the enrollment or service area. The employee may
change the enrollment upon notifying the employing office of the move
or change of place of employment. The change of enrollment takes effect
on the first day of the pay period that begins after the employing
office receives an appropriate request.
(4) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan.
(5) 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)(5):
(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
cancelled 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.
(6) Loss of coverage under the Medicaid program (State program of
medical assistance for the needy).
(7) 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.
(8) Loss of coverage under a non-Federal health plan.
(j) 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.
(k) 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 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.
5. In Sec. 890.302, paragraph (f) is revised to read as follows:
Sec. 890.302 Coverage of family members.
* * * * *
(f) Determination 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.
* * * * *
6. 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.
* * * * *
(7) In Sec. 890.304, paragraph (a)(2) is amended by removing
``Sec. 890.301(ee)'' and adding in its place ``Sec. 890.301 (k)'',
paragraph (b)(1) is amended by
[[Page 35977]]
removing ``Sec. 890.301 (q)'' and adding in its place ``Sec. 890.306
(o)'', and the first two sentences of paragraph (d) are revised to read
as follows:
Sec. 890.304 Termination of enrollment.
* * * * *
(d) Cancellation. Except an 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 canceling the enrollment is received by the employing office,
except that the cancellation of an enrollee having a monthly or 4-
weekly pay period takes effect at the end of the pay period in which
the appropriate request is received if the request is received between
the first and fifteenth day of the pay period.* * *
* * * * *
8. 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 retirements, 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 clause 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
empoloying 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 after 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
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 sections 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 (State 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 Medicaid 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 marital 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 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 sections 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 the Medicaid program. (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 (State program of
medical assistance for the needy), and who involuntarily loses coverage
under Medicaid, 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 coverage. A reenrollment under this paragraph (i) takes effect
on the date following the date of loss of Medicaid coverage.
(2) An annuitant who cancelled his or her enrollment because he or
she furnished proof of eligibility for Medicaid coverage, and who
wishes to reenroll in a plan under this part for
[[Page 35978]]
reasons other than an involuntary loss of Medicaid 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 the 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 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 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 losses 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 or loss of access to health services because
the annuitant or a covered family member in a comprehensive medical
plan moves or becomes employed outside the enrollment or service area,
or, if already outside the enrollment or service area, moves or becomes
employed further from the enrollment or service area. The annuitant may
change the enrollment upon notifying the employing office of the move
or change of place of employment. The change of enrollment takes effect
on the first day of the pay period that begins after the employing
office receives an appropriate request.
(4) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan;
(5) 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)(5)--
(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.
(iii) 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
[[Page 35979]]
procedures that are provided under sections 831.1305(d)(2) and
845.205(d)(2) of this chapter apply to elections under this paragraph;
(6) Loss of coverage under the Medicaid program (State program of
medical assistance for the needy).
(7) Loss of coverage under a non-Federal health plan.
(m) 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.
(n) 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.
(o) 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.
(p) Annuity insufficient to pay withholdings. (1) If an annuity is
sufficient 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(f); or
(ii) Enroll in any plan in which the annuitant's share of the
premium is less than that 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 (p)(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.
(q) 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.
(r) 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]
9. Section 890.602 is amended by removing ``register'' and adding
in its place ``elect to enroll''.
Sec. 890.803 [Amended]
10. 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''.
11. 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 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.
[[Page 35980]]
(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 after 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 sections
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 canceled the enrollment under this part
because he or she furnished proof of eligibility for coverage under the
Medicaid program (State 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 Medicaid 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 canceled enrollment to
enroll in a Medicare-sponsored Coordinated Care Plan. (1) A former
spouse who had been enrolled for coverage under this part and canceled
enrollment for the purpose of enrolling in a prepaid health plan under
sections 1833 or 1876 of the Social Security Act, 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 section to assure continuing uninterrupted health
plan coverage.
(i) Reenrollment of former spouses who canceled enrollment because
of eligibility under the Medicaid program. (1) A former spouse who had
been enrolled (or was otherwise eligible to enroll) for coverage under
this part and canceled the enrollment because he or she furnished proof
of eligibility for coverage under the Medicaid program (State program
of medical assistance for the needy), and who involuntarily loses
coverage under Medicaid, 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 coverage. A reenrollment under this paragraph (i)
takes effect on the date following the date of loss of Medicaid
coverage.
(2) A former spouse who canceled his or her enrollment because he
or she furnished proof of eligibility for Medicaid coverage, and who
wishes to reenroll in a plan under this part for reasons other than an
involuntary loss of Medicaid 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. A former spouse who has established eligibility for
health benefits under Sec. 890.803 and met the application time
limitations of Sec. 890.805, and who is not enrolled as a former spouse
but is covered by another enrollment under this part or under another
group health benefits plan, may enroll upon loss of the other coverage.
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
enroll or change the enrollment within the period beginning 31 days
before and ending 60 days after the 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 or access to health services because the
former spouse or a covered family member in a comprehensive medical
plan moves or becomes employed outside the enrollment or service area,
or, if already outside the enrollment or service area, moves or becomes
employed further from the enrollment or service area. The former spouse
may change the enrollment upon notifying the employing office of the
move or change of place of employment. The change of enrollment takes
effect on the first day of the pay period that begins after the
employing office receives an appropriate request.
(4) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan;
(5) 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)(5)--
(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
[[Page 35981]]
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.
(6) Loss of coverage under the Medicaid program (State program of
Medical assistance for the needy).
(7) Loss of coverage under a non-Federal health plan.
(k) 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.
(1) 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 will be
subject to the provisions of section 890.807(c).
(12) Section 890.807 is amended by revising the heading for
paragraph (c) and revising paragraph (c)(1) to read as follows:
Sec. 890.807 Termination of enrollment.
* * * * *
(c) Failure to make an election under Sec. 890.806(l). (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(l)
(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.
* * * * *
13. 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 section 890.806(l).
14. Section 890.1105 is amended by revising the section heading and
adding headings for paragraphs (b), (c), (d), and (f), by revising
paragraphs (d) and (f), and by adding a new paragraph (g) to read as
follows:
Sec. 890.11.05 Initial election of temporary continuation of coverage;
application time limitations and effective dates.
* * * * *
(b) Former employees. * * *
(c) Children. * * *
(d) Former spouses. (a) 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 or former spouse notified the agency 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 agency described in Sec. 890.1104(c)(2). If neither the
employee nor the former spouse notified the agency 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.
15. 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 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 after 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
[[Page 35982]]
day of the pay period following the one in which there was no family
member.
(e) Open season. (1) During the 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(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(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 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 alone 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 or loss of access to health services because
the enrollee or a covered family member in a comprehensive medical plan
moves or becomes employed outside the enrollment or service area, or,
if already outside the enrollment or service area, moves or becomes
employed further from the enrollment or service area. The enrollee may
change the enrollment upon notifying the employing office of the move
or change of place of employment. The change of enrollment takes effect
on the first day of the pay period that begins after the employing
office receives an appropriate request.
(4) Loss of coverage due to the termination of membership in an
employee organization sponsoring or underwriting an FEHB plan.
(5) 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)(5)--
(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.
(6) Loss of coverage under the Medicaid Program (State program of
medical assistance for the needy).
(7) Loss of coverage under a non-Federal health plan.
(i) 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. 96-17248 Filed 7-8-96; 8:45 am]
BILLING CODE 6325-01-M
