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

OFFICE OF PERSONNEL MANAGEMENT

5 CFR Part 890

RIN 3206-AH46

Federal Employees Health Benefits Program: Opportunities to

Enroll and Change Enrollment

AGENCY: Office of Personnel Management.

ACTION: Final rule.

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SUMMARY: The Office of Personnel Management (OPM) is issuing final

regulations to simplify and clarify the existing Federal Employees

Health Benefits (FEHB) Program regulations concerning opportunities to

enroll and change enrollment. These regulations will make it easier for

employing offices to determine whether circumstances permit individuals

to enroll or change enrollment, and will result in a reduced potential

for error and improved customer service.

EFFECTIVE DATE: August 18, 1997.

FOR FURTHER INFORMATION CONTACT:

Barbara Myers (202) 606-0004.

SUPPLEMENTARY INFORMATION: On July 9, 1996, OPM issued proposed

regulations in the Federal Register (61 FR 35973) that would amend Part

890 to (1) organize the opportunities to enroll and change enrollment

into separate sections for each category of enrollee, (2) group

enrollment opportunities within each category by similar

characteristics, such as change in employment status, or loss of health

benefits coverage, (3) standardize timeframes for individuals to enroll

or change enrollment, (4) locate effective date information within the

paragraph that describes the enrollment or change opportunity, (5)

clarify some opportunities by removing certain hard to define

requirements that individuals must meet to become eligible to enroll or

change, and (6) permit insurance carriers to determine incapacity of

self-support for children over age 22 under certain conditions.

OPM received comments from six Government agencies, two insurance

carriers, and one retired employees' association. While all of the

commenters were in favor of the proposed regulations, some had specific

areas of concern that we will address below. We have tried to list

these issues in the same order as the regulations that they pertain to.

Two commenters recommended expanding the definition of

``appropriate request'' to include elections not to enroll, and to add

the term ``processing office.'' We have expanded the definition of

``appropriate request'' to include elections not to enroll. We have

also defined ``election not to enroll'' in the definitions section. We

do not believe that adding the term ``processing office'' to the

definition of ``appropriate request'' is necessary because the term

``employing office'' as defined in Sec. 890.101 means the office with

jurisdiction and responsibility for health benefits actions. This would

include the processing office.

We are removing the definition of ``regular tour of duty'' because

it no longer reflects the definition as set forth in Sec. 610.102 of

this chapter.

Several commenters had concerns with the new paragraph (c) that we

are adding to Sec. 890.103 that will give the employing office

authority to retroactively correct enrollee enrollment code errors.

This paragraph applies only to enrollment code errors made by the

employee and therefore should not be combined with paragraphs (a) and

(b) which concern administrative errors. In the past, agencies had no

authority to correct enrollee enrollment code errors. The intent of the

new paragraph is to give enrollees who discover that they made an

enrollment code error an opportunity to have it corrected; we did not

intend to give them the opportunity to change their election should

they find that they are dissatisfied with their election. An enrollee

who reports an enrollment code error beyond the specified time frame

must wait until the next open season to correct the error. If an error

was made by the employing office, then it would be an administrative

error and would be subject to paragraphs (a) and (b) rather than this

new paragraph (c).

One commenter believes that these regulations should require

employees to furnish evidence of their eligibility to enroll or change

enrollment. Employing offices have always been responsible for

determining eligibility, and they may require whatever evidence they

need to verify that an event actually occurred. In some cases, such as

changes in employment status, the employing office has the information

readily available; in others, such as documentation of a marriage, a

move, or the loss of other group health insurance coverage, they can

require additional evidence. Special regulatory language is not needed.

One commenter expressed concern about the reenrollment of an

employee whose enrollment was terminated after 365 days of leave

without pay status. When this employee returns to pay status, he or she

may reenroll and the enrollment would normally take effect on the first

day of the next pay period. However, if the employee is not in pay

status in the pay period after the one in which he or she submitted the

enrollment request, the enrollment could not take effect. If an

employee's enrollment terminated after 365 days leave without pay, and

the employee is not entitled to any further continuation of coverage

because he or she has not had 4 consecutive months of pay status since

exhausting the 365 days continuation of coverage in leave without pay,

coverage terminates on the last day of his or her last pay period in

pay status. There is no need for special regulatory language as this

principle is reflected in Sec. 890.304(a)(1)(v).

On July 22, 1996, OPM published interim regulations that require

Federal agencies to provide employees entering leave without pay

status, or whose pay is insufficient to cover their FEHB premium

payments, written notice of their opportunity to continue their FEHB

coverage (61 FR 37807). These employees have the option of continuing

or terminating their FEHB coverage. Employees who elect to terminate

their coverage may enroll upon their return to duty in a pay status in

a position which provides eligibility for FEHB coverage. We have added

a provision to paragraph 890.301(h)(1) of these final regulations that

would reflect this enrollment opportunity.

[[Page 38434]]

One commenter expressed concern about our requirement that the

effective date of an open season enrollment must follow a pay period

during any part of which the employee is in pay status. This is not a

new provision and we have made no change to the existing regulation. If

an employee is in leave without pay status when an open season

enrollment would normally take effect, the enrollment could not take

effect until the employee returns to pay status.

One commenter suggested that we define changes in family status in

the definitions section. We are concerned that it would be

unnecessarily restrictive to specify in regulation the situations that

we believe are changes in family status. We believe it is sufficient to

continue to provide this information in our guidance in the FEHB

Handbook for Personnel and Payroll Offices (formerly FPM Supplement

890-1). For the convenience of the reader, we will restate the examples

of changes in family status given in the supplementary information of

the proposed regulations, as follows: (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.

Two commenters suggest that we consider further changing the

regulations to give the employing office discretion in determining

effective dates of enrollment changes in certain situations. We do not

favor making this change. We believe that specifying effective dates of

coverage in regulation is easier to administer and assures that all

enrollees and their family members are treated in a uniform manner. For

example, when an enrollee changes from self only to self and family

coverage because of the birth of a child, the regulations specify that

the effective date of the change is the first day of the pay period in

which the child is born.

One commenter expressed concern about the events based upon a loss

of other FEHB coverage (paragraph 890.301(i)) and our extension of the

enrollment timeframe from 31 to 60 days. We are extending the timeframe

for uniformity and to try to reduce the number of requests for belated

enrollment. We realized that some individuals may enroll after the

expiration of the 31-day temporary extension of coverage, but within

the 60 day timeframe and that this will cause a gap in coverage.

However, as long as the individuals enrolls with the time limit

required by regulation, he or she will not be penalized for purposes of

meeting the requirements for continuing the FEHB enrollment into

retirement (coverage for 5 years of service immediately before

retirement, or, if less than 5 years, for all service since the first

opportunity to enroll).

One commenter asked if OPM could treat employees and former spouses

whose plan is discontinued and who do not select another plan the same

as annuitants and deem them to have enrolled in the Blue Cross and Blue

Shield (BCBS) Service Benefit Plan. The provision for annuitants was

originally written when the Aetna plan left the FEHB Program and there

were many annuitants who did not respond to our request that they

change plans. It was intended to assure that no annuitant would be

without FEHB coverage, especially since those who did not select

another plan were deemed to have cancelled their enrollment and,

generally, annuitants who cancel their enrollment may not reenroll.

This provision is not difficult to administer since annuitants have one

employing office. We do not favor extending this provision to employees

or former spouses since they may make a belated change of enrollment if

their employing office permits, or they can reenroll during the next

open season. We believe that giving agencies the authority to place

employees and former spouses who do not change plans in the BCBS Plan

would be difficult for agencies to administer, since these enrollees

might object to being placed in BCBS without their consent.

Several comments are concerned about our proposal to permit

carriers to determine whether an enrollee's child over age 22 is

incapable of self-support when the child's disability appears on a list

of specific medical conditions provided by OPM. We agree that carriers

and employing offices will need to communicate their determinations to

each other and we plan to issue additional guidance and procedures on

this issue. The purpose of our revision to the current regulation is to

provide uninterrupted coverage when the child's condition is so severe

that there would be no question that the child is incapable of self-

support and that the condition would not abate. In cases where the

child's condition does not appear on the OPM list, the enrollee would

have to contact their employing office and follow the procedures

currently required for approval.

We also are simplifying and clarifying the current regulations

regarding the effective date of cancellation so that all cancellations

take effect on the last day of the pay period in which the appropriate

request cancelling the enrollment is received by the employing office.

Another commenter had several concerns about our section pertaining

to former spouses. Former spouses may change to family status only if

the child to be covered is a child of the former spouse and the

employee or annuitant. In addition, former spouses who establish

eligibility for a former spouse enrollment but postpone enrolling (e.g.

because they are on active military service or are covered by CHAMPUS)

may enroll at a later date. Therefore, there is no need for special

regulatory language for former spouses who are discharged from the

military. Finally, we deleted the first sentence of Sec. 890.806(j)

because it is redundant with Sec. 890.806(a).

One commenter asked why these regulations allow annuitants and

former spouses who cancel their enrollment for the purpose of enrolling

in a Medicare-sponsored Coordinated Care Plan (also referred to as a

Medicare HMO) or Medicaid (or similar State-sponsored program of

medical assistance for the needy) to reenroll in FEHB, but do not

extend this same opportunity to individuals enrolled under the

Temporary Continuation of Coverage (TCC) provisions. FEHB law (5 U.S.C.

8905a) is very specific about the events that qualify individuals to

continue their FEHB coverage under the TCC provisions, as follows: (1)

Employees who lose coverage upon separation from service; (2) children

who cease to meet the requirements for being unmarried dependent

children, and (3) former spouses who lose coverage under a self and

family enrollment because of termination of marriage, and who do not

qualify for coverage under the former spouse provisions of FEHB law.

There is nothing in the TCC provisions of law that would permit us to

allow an individual to cancel their TCC for the purpose of obtaining

MCCP or Medicaid (or similar State-sponsored) coverage and later

reenroll.

We also would like to point out that we plan to revise the Table of

Permissible Changes in Enrollment on the back of the Health Benefits

Registration Form (Standard Form 2809) to incorporate these changes.

In addition, there were several suggestions to correct real or

perceived technical or typographical errors in the proposed

regulations. We have made

[[Page 38435]]

changes and clarifications where appropriate.

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, and

Retirement.

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 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 revised, the definitions for Cancellation, Change of

enrollment, Register, Register to enroll, and Regular tour of duty are

removed, and the definitions for Appropriate request, Cancel, Change

the enrollment, Election not to enroll, 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, change of enrollment, or cancellation.

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).

* * * * *

Election not to enroll means to submit to the employing office an

appropriate request electing not to be enrolled by an employee who is

eligible to enroll.

* * * * *

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 cancelled.

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. The title of Subpart C is received to read as follows:

Subpart C--Enrollment

5. 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 pay of the

first pay 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 employee office advises the employment 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 that begins after the date 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 the Office of Personnel Management 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.

[[Page 38436]]

(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--

(1) A return to pay status following loss of coverage under

either--

(i) Section 890.304(a)(1)(v) due to the expiration of 365 days in

leave without pay (LWOP) status, or

(ii) Section 890.502(b)(5) due to the termination of coverage

during LWOP status.

(2) Reemployment after a break in service of more than 3 days.

(3) Restoration to a civilian position after serving in the

uniformed services under conditions that entitle him or her to benefits

under part 353 of this chapter, or similar authority.

(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 (h)(5) is the first day of the pay

period 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 who enrolls or changes the enrollment under this paragraph

(h)(6) must do so 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 due to the termination of membership in an

employee organization sponsoring or underwriting an FEHB plan.

(4) 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)(4):

(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

canceled 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.

(5) Loss of coverage under the Medicaid program or similar State-

sponsored program of medical assistance for the needy.

(6) 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.

(7) Loss of coverage under a non-Federal health plan.

(j) Move from comprehensive medical plan's area. An employee in a

comprehensive medical plan who moves or becomes employed outside the

geographic area from which the plan accepts enrollments, or if already

outside this area, moves or becomes employed further from this area,

may change the enrollment upon notifying the employing office of the

move or change of place of employment. Similarly, an employee whose

covered family member moves outside the geographic area from which the

plan accepts enrollments, or if already outside this area, moves

further from this area, may change the enrollment upon notifying the

employing office of the family member's move. The change of enrollment

takes effect on the first day of the pay period that begins after the

employing office receives an appropriate request.

(k) 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.

(1) 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

[[Page 38437]]

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.

6. In Sec. 890.302, paragraph (f) is revised to read as follows:

Sec. 890.302 Coverage of family members.

* * * * *

(f) Determiniation 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.

* * * * *

7. 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.

* * * * *

8. In Sec. 890.304, paragraph (a)(2) is amended by removing

``Sec. 890.301(ee)'' and adding in its place ``Sec. 890.301(1)'',

paragraph (b)(1) is amended by removing ``Sec. 890.301(q)'' and adding

in its place ``Sec. 890.306(q)'', and paragraph (d) is revised to read

as follows:

Sec. 890.304 Termination of enrollment.

* * * * *

(d) Cancellation. (1) Except as 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 cancelling the enrollment is received by the employing office.

(2) If an annuitant submits documentation that the cancellation is

for the purpose of enrolling in a prepaid health plan under section

1833 or 1876 of the Social Security Act, the cancellation becomes

effective on the day before the enrollment under the prepaid health

plan takes effect. Such documentation must be submitted to the

employing office within the period beginning 31 days before and ending

31 days after the prepaid health plan enrollment takes effect.

(3) The enrollee and covered family members are not entitled to the

temporary extension of coverage for conversion or to convert to an

individual contract for health benefits.

* * * * *

9. 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 retirement, 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 cause 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 employing

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 that begins after the date 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 there 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 section 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 or similar State-sponsored 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 that 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 martial 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

[[Page 38438]]

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 section 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 Medicaid or similar State-sponsored program of

medical assistance for the needy. (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 or a similar State-

sponsored program of medical assistance for the needy, and who

involuntarily loses that coverage, 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 or similar State-sponsored coverage. A

reenrollment under this paragraph (i)(1) takes effect on the date

following the date of loss of Medicaid or similar State-sponsored

coverage.

(2) An annuitant who cancelled his or her enrollment because he or

she furnished proof of eligibility for coverage under the Medicaid

program or a similar State-sponsored 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 that 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 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 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 married, and whose survivor

annuity is later restored because the marriage ended, 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.

(6) 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

[[Page 38439]]

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 loses 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 due to the termination of membership in an

employee organization sponsoring or underwriting an FEHB plan;

(4) 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)(4)--

(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.

(iv) 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 procedures that are provided under

Secs. 831.1305(d)(2) and 845.205(d)(2) of this chapter apply to

elections under this paragraph (1)(4)(iv);

(5) Loss of coverage under the Medicaid program or similar State-

sponsored program of medical assistance for the needy.

(6) Loss of coverage under a non-Federal health plan.

(m) Move from comprehensive medical plan's area. An annuitant in a

comprehensive medical plan who moves or becomes employed outside the

geographic area from which the plan accepts enrollments, or, if already

outside this area, moves or becomes employed further from this area,

may change the enrollment upon notifying the employing office of the

move or change of place of employment. Similarly, an annuitant whose

covered family member moves outside the geographic area from which the

plan accepts enrollments, or if already outside this area, moves

further from this area, may change the enrollment upon notifying the

employing office of the family member's move. The change of enrollment

takes effect on the first day of the pay period that begins after the

employing office receives an appropriate request.

(n) 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.

(o) 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.

(p) 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.

(q) Annuity insufficient to pay withholdings. (1) If an annuity is

insufficient 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(d); or

(ii) Enroll in any plan in which the annuitant's share of the

premium is less than the 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 (q)(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.

[[Page 38440]]

(r) 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.

(s) 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]

10. Section 890.602 is amended by removing ``register'' and adding

in its place ``elect to enroll''.

Sec. 890.803 [Amended]

11. 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''.

Sec. 890.805 [Amended]

12. In Sec. 890.805, paragraph (a)(2)(v) is amended by removing

``appointment'' and adding in its place ``apportionment''.

13. 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 date 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.

(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 that begins after the date 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 section

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 cancelled the enrollment under this part

because he or she furnished proof of eligibility for coverage under the

Medicaid program or a similar State-sponsored program of medical

assistance for the needy, and who wishes to reenroll in a plan under

that part for reasons other than an involuntary loss of that 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 cancelled enrollment to

enroll in a Medicare-sponsored Coordinated Care Plan. (1) A former

spouse who had been enrolled for coverage under this part and cancelled

enrollment for the purpose of enrolling in a prepaid health plan under

section 1833 or 1876 of the Social Security Act, or who meets the

eligibility requirements of Sec. 890.803 and the application time

limitation requirements of Sec. 890.805, but postponed enrollment for

this purpose, 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

[[Page 38441]]

section) to assure continuing uninterrupted health plan coverage.

(i) Reenrollment of former spouses who cancelled enrollment because

of eligibility under Medicaid or similar State-sponsored program of

medical assistance for the needy. (1) A former spouse who had been

enrolled for coverage under this part and cancelled the enrollment

because he or she furnished proof of eligibility for coverage under the

Medicaid program or a similar State-sponsored program of medical

assistance for the needy, or who meets the eligibility requirements of

Sec. 890.803 and the application time limitation requirements of

Sec. 890.805, but postponed enrollment for this reason, and who

involuntarily loses that coverage, 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 or similar State-sponsored coverage. A

reenrollment under this paragraph (i)(1) takes effect on the date

following the date of loss of Medicaid or similar State-sponsored

coverage.

(2) A former spouse who cancelled his or her enrollment because he

or she furnished proof of eligibility for coverage under the Medicaid

program or a similar State-sponsored 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 that 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. 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 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, 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 due to the termination of membership in an

employee organization sponsoring or underwriting an FEHB plan;

(4) 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)(4)--

(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 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.

(5) Loss of coverage under the Medicaid program or similar State-

sponsored program of Medical assistance for the needy.

(6) Loss of coverage under a non-Federal health plan.

(k) Move from comprehensive medical plan's area. A former spouse in

a comprehensive medical plan who moves or becomes employed outside the

geographic area from which the plan accepts enrollments, or, if already

outside this area, moves or becomes employed further from this area,

may change the enrollment upon notifying the employing office of the

move or change of place of employment. Similarly, a former spouse whose

covered family member moves outside the geographic area from which the

plan accepts enrollments, or if already outside this area, moves

further from this area, may change the enrollment upon notifying the

employing office of the family member's move. The change of enrollment

takes effect on the first day of the pay period that begins after the

employing office receives an appropriate request.

(1) 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.

(m) 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 (m)(3) will

be subject to the provisions of Sec. 890.807(c).

14. Section 890.807 is amended by revising the heading for

paragraph (c), and revising paragraphs (c) (1) and (e) to read as

follows:

Sec. 890.807 Termination of enrollment.

* * * * *

(c) Failure to make an election under Sec. 890.806(1). (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(1)

(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.

* * * * *

(e) Cancellation. (1) A former spouse 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 cancelling the enrollment

is received by the employing office.

(2) If a former spouse submits documentation that the cancellation

is for the purpose of enrolling in a prepaid health plan under section

1833 or 1876

[[Page 38442]]

of the Social Security Act, the cancellation becomes effective on the

day before the enrollment under the prepaid health plan takes effect.

Such documentation must be submitted to the employing office within the

period beginning 31 days before and ending 31 days after the prepaid

health plan enrollment takes effect.

(3) The former spouse and family members, if any, are not entitled

to the temporary extension of coverage for conversion or to convert to

an individual contract for health benefits.

(4) Except for a former spouse who provides documentation that he

or she is canceling for the purpose of enrolling in a prepaid health

plan under section 1833 or 1876 of the Social Security Act, or for

coverage under the Medicaid program or a similar State-sponsored

program of medical assistance for the needy, a former spouse who

cancels his or her enrollment may not later reenroll.

15. 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 Sec. 890.806(1).

16. Section 890.1105 is amended by revising the section heading, by

revising paragraphs (b), (c), (d), and (f), and by adding a new

paragraph (g) to read as follows:

Sec. 890.1105 Initial election of temporary continuation of coverage;

application time limitations and effective dates.

* * * * *

(b) Former employees. A former employee's election under this

subpart must be submitted to the employing office within 60 days after

the later of--

(1) The date of separation; or

(2) The date the former employee received the notice from the

employing office.

(c) Children. A child's election under this subpart must be

submitted to the employing office within 60 days after the later of--

(1) The date of the qualifying event; or

(2) If the employee notified the employing office within the 60-day

time period specified under Sec. 890.1104(b)(1) of this part, the date

the child received the notice from the employing office. If the

employee did not notify the employing office within the specified time

period, the child's opportunity to elect continued coverage ends 60

days after the qualifying event.

(d) Former spouses. (1) 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, annuitant, or former spouse notified the

employing office 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 employing office described in

Sec. 890.1104(c)(2). If the employee, annuitant, or former spouse did

not notify the employing office 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.

17. 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 date 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 that begins after the date 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 day of the pay period following the one

in which there was no family member.

(e) Open season. (1) During an 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(a)(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(a)(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

[[Page 38443]]

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 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 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 due to the termination of membership in an

employee organization sponsoring or underwriting an FEHB plan.

(4) 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)(4)--

(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.

(5) Loss of coverage under the Medicaid program or similar State-

sponsored program of medical assistance for the needy.

(6) Loss of coverage under a non-Federal health plan.

(i) Move from comprehensive medical plan's area. An enrollee in a

comprehensive medical plan who moves or becomes employed outside the

geographic area from which the plan accepts enrollments, or, if already

outside this area, moves or becomes employed further from this area,

may change the enrollment upon notifying the employing office of the

move or change of place of employment. Similarly, an enrollee whose

covered family member moves outside the geographic area from which the

plan accepts enrollments, or if already outside this area, moves

further from this area, may change the enrollment upon notifying the

employing office of the family member's move. The change of enrollment

takes effect on the first day of the pay period that begins after the

employing office receives an appropriate request.

(j) 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. 97-18958 Filed 7-17-97; 8:45 am]

BILLING CODE 6325-01-M