# Federal Employees Health Benefits Program; Miscellaneous Changes > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A94-28929 ## Record - **Collection:** Federal Register - **Document type:** Uncategorized Document - **Published:** November 23, 1994 ## Text OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 890 RIN 3206-AF74 Federal Employees Health Benefits Program; Miscellaneous Changes AGENCY: Office of Personnel Management. ACTION: Final rule. ----------------------------------------------------------------------- SUMMARY: The Office of Personnel Management (OPM) is issuing final regulations which implement a number of miscellaneous changes to the Federal Employees Health Benefits (FEHB) Program. The changes will improve the administration of the FEHB Program and result in better service to enrollees. EFFECTIVE DATE: December 23, 1994. FOR FURTHER INFORMATION CONTACT: Robert G. Iadicicco, (202) 606-0191. SUPPLEMENTARY INFORMATION: On May 10, 1994, OPM issued proposed regulations in the Federal Register (59 FR 24062) to clarify the last day of Open Season; give Federal retirement systems staffs the discretion to allow annuitants to make FEHB coverage changes by other methods, such as telephone requests; allow legally separated employees and annuitants covered as family members under their spouses' FEHB enrollment to enroll in FEHB for self only or self and family coverage; extend to employees whose FEHB enrollment terminated when 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 option of reinstating FEHB coverage upon retirement; permit annuitants, whose entire annuity or compensation has been waived or suspended, to pay FEHB premiums directly to their retirement system or the Office of Workers' Compensation Programs for any period of wavier or suspension which is three months or more; require agencies to counsel employees entering leave without pay (LWOP) 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 final regulations cover all of the changes in the proposed regulations except the requirement that agencies counsel employees entering LWOP or whose pay is insufficient to cover their FEHB premium payments. We will issue separate interim regulations on that change. We received comments from two FEHB plans, two Federal agencies, and one retiree organization. One commenter agreed that the proposed changes will result in better service to enrollees and considered the change to allow annuitants to make FEHB coverage changes by telephone especially significant. The commenter recommended that retirement systems establish a dedicated telephone number, or a system that will record FEHB coverage change requests. OPM is doing this and more. OPM's Office of Retirement Programs (ORP) administers the Civil Service Retirement System and the Federal Employees Retirement System. ORP's Retirement Information Office (RIO) phone system at (202) 606-0500 will have a voice mail box dedicated to recording FEHB coverage change requests. RIO staff will either make the coverage change requested or call the annuitant to obtain additional information required before making the change. In addition, ORP will not limit annuitants to calling RIO to request a coverage change. At first, both RIO and ORP's Insurance Services Branch will be authorized to take the calls and make the changes. Eventually, all staff in ORP will accept requests and process coverage changes. The commenter also recommended that other retirement systems allow their annuitants to make FEHB coverage changes by telephone and follow the OPM ``model'' in order to minimize the confusion that would occur if other retirement systems used a different model. Our intention is to give retirement systems the discretion to accept alternatives to a properly completed health benefits registration form (SF 2809), but not require the retirement systems to do so. Our reasoning is that it is the responsibility of each retirement system to determine how to best serve their annuitants. OPM has determined that our annuitants are best served by allowing them to make FEHB coverage by telephone. Other retirement systems may decide, based on their current capabilities or other factors, not to allow telephone requests. Of course, we are more than willing to share our knowledge and procedures with other retirement systems who want to follow our ``model.'' Three commenters expressed concern that allowing telephone requests increases the possibility of unauthorized coverage changes by someone other than the annuitant, and will result in misunderstandings between the annuitant and OPM. Two commenters suggested that the retirement system send a notice of the coverage change to the annuitant. OPM agrees with this suggestion and is revising the regulations to require the retirement system to promptly give annuitants written notification of the change in coverage. ORP already follows this requirement by automatically generating notices of FEHB changes to provide annuitants with an early opportunity to reverse erroneous or unauthorized changes. One commenter suggested as an alternative to telephone requests we allow annuitants to submit a written request to OPM at a post office box number specifically designated for health benefits requests or to fax their requests. OPM already has a post office box number specifically designated for health benefits requests. In contrast to a telephone call, a post office box does not eliminate the time is takes for the request to be delivered to OPM. The faxing of requests does save time, but most annuitants do not have convenient, inexpensive access to a fax machine. However, under these regulations retirement systems have the authority to accept faxed requests for coverage changes and OPM will do so. One commenter was concerned that telephone requests would not be processed by retirement system staff because of the lack of a written document. The commenter suggested allowing changes by letter because it would provide written documentation of the request. We agree that a retirement system must be confident that telephone requests will be processed and be processed accurately before the retirement system accepts telephone requests. We are confident that ORP will accurately process telephone requests for three reasons. First, ORP staff already have a great deal of experience handling telephone requests for other changes, such as changes of address. Second, ORP staff already have developed procedures to follow when they handle telephone requests for FEHB coverage changes. Third, in the rare case the telephone request is incorrectly processed or not processed at all, the annuitant will soon become aware of the error through the retirement system's notice of the coverage change, or the lack of notice and the health benefits enrollment data included in their next monthly annuity payment statement. Two commenters stated that it is extremely important for the retirement system to obtain all the pertinent information from the annuitant and accurately communicate the information to the FEHB plans. One of the commenters stressed that accurate communication of dependent information is especially important. The other commenter recommended that the retirement system staff person complete a SF 2809 while taking the request. We agree that when taking a telephone request the retirement system staff needs to collect and communicate to the FEHB plans the same information they provide for all other coverage changes. Therefore, we are revising the proposed regulations by specifying that alternative methods of making FEHB coverage changes, such as telephone requests, must transmit to the health benefit plans the information they require before accepting an enrollment. Because OPM uses a more advanced method to transmit information to the plans, there is no need for OPM staff to prepare a SF 2809 when taking a telephone request. However, for retirement systems who use the SF 2809 to transmit information to the plans, filling out the SF 2809 when taking the telephone request is a practice that should be strongly considered. One commenter stated that allowing OPM retirement system staff to make coverage changes based on telephone requests may cause problems in tracking coverage changes. We are confident tracking problems will not occur because ORP has had for many years an on-line tracking system to record all coverage changes. The tracking system creates an FEHB change history file for each annuitant. One commenter responded to our statement in the supplementary information section of the proposed regulations that most employees work near the office responsible for their FEHB actions by noting a significant percentage of their agency's employees work at remote sites. The commenter believes that there are other agencies with similar workforces and requested OPM to make this logistical situation an important consideration in its future policy and program planning. OPM has always been aware that certain agencies, because of their mission, have a significant percentage of employees at remote locations. We are also keenly aware of the need to increase the efficiency of Federal personnel operations through automation. Consequently, we are considering a regulatory change that would allow agencies to automate their FEHB enrollment processing and invite all interested agencies to contact us. One commenter concurred with the change allowing a legally separated employee or annuitant covered as a family member under his or her spouses' FEHB enrollment to enroll in FEHB for self only or self and family coverage. The commenter also asked whether this change means an employee with a self and family enrollment can drop the coverage of their separated spouse, if the spouse is ineligible to enroll or decides not to enroll for FEHB coverage. An employee may switch to self only coverage at any time and in that way drop the coverage of their separated spouse. However, unless a separated spouse has his or her own enrollment, he or she remains covered under the employee's self and family enrollment. We received three comments discussing the fact that while the regulations would allow the dual enrollment of legally separated employees or annuitants, they did not allow a person to be covered and receive benefits under more than one enrollment. The regulations require each enrollee 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. One commenter wanted to know the employing office's responsibility for ensuring that the employee notifies the insurance carrier of covered family members. An employing office, when it becomes aware or strongly suspects that both members of a legally separated couple are enrolled or enrolling in the FEHB Program and at least one has a self and family enrollment, is responsible for informing the employee that he or she must notify the insurance carrier of the family members covered under the enrollment that are not covered under the other enrollment. One commenter strongly recommended that employing offices should include the carrier code and the family members covered under the enrollments of both legally separated spouses in the remarks section of the SF 2809. The commenter believes this will assist the FEHB carriers to contact other carriers when necessary. We think this is a good idea and recommend offices that send the SF 2809 to carriers follow this practice whenever possible and offices that do not send the SF 2809 find another method to send carriers this information. One commenter was concerned about the employing office's responsibility in cases where a person is covered and receives benefits under more than one enrollment because the employee did not notify the carrier. Carriers will contact employing offices directly to resolve any dual coverage cases they discover. Employing offices are responsible for assisting carriers in resolving these cases. Employing offices are also responsible for informing carriers when they become aware a person is being covered and receiving benefits under more than one enrollment. 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 is amending 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 methods, such as telephone requests, in substitution of a properly completed health benefits registration form. Alternative methods must transmit to the health benefits plans the information they require before accepting an enrollment. In addition, for enrollments and cancellations to be valid, the signature of the requesting individual must be on the request, or on a form from the retirement system to the requesting individual giving notice of the enrollment or cancellation. For changes of enrollment, the signature of the requesting individual is not required but the retirement system must promptly give to the requesting individual written notice of the change of enrollment. 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) 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 his 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 waiver or suspension 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 pay 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 OPM. (f) If suspension of annuity or compensation is because of reemployment, the reemploying office must make the withholding currently and enrollment continues during reemployment. Sec. 890.701 [Amended] 7. Section 890.701 is amended by removing the last sentence of the definition of Medically underserved area. Sec. 890.808 [Amended] 8. 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. 94-28929 Filed 11-22-94; 8:45 am] BILLING CODE 6325-01-M --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A94-28929. Public record. Not legal advice.