Federal Employees Health Benefits Program: Opportunities to Enroll and Change Enrollment

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