Interim Final Rule: Federal Employees Health Benefits Program
May 16, 1986
TO: STATE AGENCIES ADMINISTERING CHILD SUPPORT ENFORCEMENT PLANS UNDER TITLE IV-D OF THE SOCIAL SECURITY ACT AND OTHER INTERESTED INDIVIDUALS
SUBJECT: Federal Employees Health Benefits Program
ATTACHMENT:Attached are interim regulations issued by the Office of Personnel Management that revise 5 CFR Part 890 to implement changes to the Federal Employees Benefits Improvement Act of 1986 (P. L. 99-251). We wish to point out that regulations at 5 CFR 890.804 (51 FR 15748) permit the enrollment of a dependent child(ren) of a former spouse and a Federal employee if the dependent child(ren) is under the age of 22 and is not covered by any other Federal employee health plan. This provision allows the former spouse of an absent parent who is an employee, former employee, or employee annuitant of the Federal government to obtain health insurance coverage.
EFFECTIVE DATE: April 28, 1986
COMMENT PERIOD: Consideration will be given to written comments received by Reginald M. Jones, Assistant Director for Pay and Benefits Policy, Compensation Group, Office of Personnel Management, P. 0. Box 57, Washington, D.C. 20044, on or before May 28, 1986.
REGULATION REFERENCE: 5 CFR Part 890
RELATED REFERENCE; OCSE-AT-85-16, dated October 21, 1985.
INQUIRIES TO: OCSE Regional Representatives
Office of Child Support
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
Federal Employees Health Benefits Program
AGENCY: Office of Personnel Management
ACTION: Revised interim regulations
SUMMARY: The Office Personnel Management (OPM) is issuing interim regulations to implement Changes to the Federal Employees Health Benefits (FEHB) program made by the Federal Employees Benefits Improvement Act of 1986. These interim regulations are a revision to interim regulations published June 13, 1985, which were issued to implement FEHB program changes made by the Civil Service Retirement Spouse Equity Act of 1984.
DATES: Interim rule effective on April 28, 1986. Comments must be received on or before May 28, 1986.
ADDRESSES: Send comments to Reginald M. Jones, Assistant Director for Pay and Benefits Policy, Compensation Group. Office of Personnel Management, P.O. Box 57, Washington, D.C. 20044, or deliver to OPM, Room 4351, 1900 E Street, NW., Washington, DC.
FOR FURTHER INFORMATION CONTACT: Mary Ann Mercer, (202) 632-0003.
SUPPLEMENTARY INFORMATION: On June 13, 1985, OPM published interim regulations in the Federal Register (50 FR 24757) to implement changes to the FEHB program made by the Civil Service Retirement Spouse Equity Act of 1984, Pub. L. 98-615. Comments were requested from interested parties prior to publishing final regulations. Seven comments were received (four from Federal agencies, two from carriers in the FEHB program, and one from a professional association) and considered.
However, the Federal Employees Benefits Improvement Act of 1986, Pub L. 99-251, was enacted February 27, 1986, which changed several of the provisions of Pub. L. 98-615. Therefore, OPM is issuing revised interim regulations to implement the most recent changes in law and to clarify portions of the regulations published June 13, 1985, in response to the comments received. Another opportunity to comment is provided before final regulations are issued.
A discussion of the regulatory changes made to implement Pub. L. 99-251 and the clarifying changes made to the June 13, 1985 regulations follows:
Eligible Former Spouses
Certain former spouses previously denied health benefits coverage under Pub. L. 98-615 may now receive benefits. Under Pub. L. 98-615, a former spouse who had been awarded a portion of a former employee's retirement benefits was excluded from health benefits coverage if the marriage ended before May 7,1985. Section 201(c) of the Federal Employees Benefits Improvement Act of 1986 permits these former spouses to enroll in the FEHB program if all other requirements for coverage are met. Generally, a former spouse may now apply for health benefits under the program if he or she currently receives, or has future entitlement to receive, a portion of a former employee's retirement benefits or a survivor annuity benefit, regardless of the date of the court order evidencing the dissolution of the marriage [Ãµ 890.803(a)(3)].
Pub. L 99-251 also permits a former spouse of an employee who died before May 7, 1985, to enroll for health benefits providing the employee was eligible for immediate retirement on or before the date of death and all other requirements for coverage are met.
The interim regulations were unclear about the "employing office" (for handling FEHB enrollments) for a former spouse whose marriage to a former employee was dissolved after the employee's retirement and who has future entitlement to an annuity. In these cases, the former spouse is not an annuitant, yet the marriage dissolved after the employee retired. These revised interim regulations make it clear that the employing office for a former spouse who meets these criteria is the office which has the authority to approve payment of an annuity for the retired employee.
One agency also suggested that OPM amend the regulations to state whether the employing office [Ãµ 890.101(a)(5)] is the operating level personnel office or central payroll records office. 0PM believes that the location of the former spouse enrollment function should be left to the discretion of the individual agencies.
One comment concerned the process for obtaining an application. The commenter found the regulations unclear on what constitutes an application and from whom it is obtained. The commenter also found unclear the responsibilities of the employing office, such as, who provides the schedule of payments to the former spouses the timeframe in which the schedule will be provided, end the timeframe within which the employing office will process the application.
These revised interim regulations clarify the enrollment and payment schedule processes. Section Ãµ 890.808(a) now makes it clear that the application does not have to be a completed Standard Form 2809, Health Benefits Registration Form; it may simply be an informal written notice (letter, statement, etc.) to the employing office of intent to apply for health benefits. This application merely preserves the FEHB enrollment right while the administrative tasks associated with enrollment are being completed. Section Ãµ890.808(b)(2) now states that the employing office is responsible for sending the payment schedule to the former spouse at the time it sends notice of eligibility.
In response to the suggestion that OPM set timeframes for administrative tasks associated with the former spouse's enrollment, we have not imposed timeframes because there is no effective enforcement mechanism. However, the effective date of a former spouse enrollment (the first day of the first pay period beginning more than days after the employing office receives the Standard Form 2899, or an appropriate substitute, and satisfactory proof of eligibility) discussed in the following paragraph encourages timely processing of the enrollment by the employing office. Further, we expect the number of former spouses applying for health benefits after the initial start-up period to be small enough that employing offices will be able to carry out their administrative duties in a timely manner.
Effective Date of Coverage
The effective date of enrollment under the June 13, 1985, interim regulations (i.e., the first day of the first pay period after the date of the agency's receipt of the Standard Form 2899 and satisfactory proof of eligibility] does not allow agencies sufficient time to process the enrollment. We had originally intended that enrollments for former spouses commence at the same time as enrollments of employees. Processing enrollments of former spouses requires more time, however, because the former spouse's entitlement to health coverage must be verified, while employees are automatically entitled to health coverage by virtue of their employment. Since the employing office is unable to process the enrollment until it reviews and approves the Standard Form 2089 completed by the former spouse and the documents submitted along with it as evidence of eligibility, the revised interim regulations set the effective date as the first day of the pay period beginning more than 30 days after the employing office receives the Standard Form 2809 (or an appropriate substitute) and satisfactory proof of eligibility. The 30-day provision should allow employing offices enough time to process the enrollment. In cases in which the former spouse applied for health coverage in writing prior to the effective date of these revised interim regulations, the applicable effective date will be established according to the interim regulations published on June 13, 1985. The 30-day buffer period is applicable only to cases in which the written application is filed on or after the effective date of these revised interim regulations.
Payment of Premiums
The two health carrier respondents suggested that OPM require former spouses to prepay premiums. The carriers are concerned that if premiums are due after the pay period in which the former spouse is covered, as many as four pay periods could elapse before a former spouse's coverage will be terminated for nonpayment of premium. This delay would enable the former spouse to maintain an unpaid enrollment for a considerable amount of time. Further, if the former spouse fails to pay the premium within the time frames established by the regulations, coverage will be terminated retroactive to the end of the last pay period for which payment has been received. Thus, any claims payment made by the carrier during the period of unpaid enrollment must be resolved between the carrier and the former spouse.
We agree that prepayment of premiums would have merit for former spouses who have no employer-employee relationship and who are required, by law, to pay both the enrollee's and the Government's share of premiums. However, the risk to FEHB carriers is inherent in the statutory extension of FEHB coverage to former spouses and we are unable to devise an administratively acceptable system of prepayments that would be effective.
Although we have not adopted the suggestion of prepaid premiums, we have revised the regulations to reduce the unpaid enrollment period to 15 days by dropping the 31-day grace period for payment of overdue premiums provided in the June 13, 1985, regulations. If the former spouse does not pay by the due date, the employing office will send the notice immediately to the former spouse that payment must be made within 15 days after the receipt of the notice or coverage will be terminated. This method of payment will prompt the former spouse to timely payments for coverage and significantly reduce the period of risk for the carriers.
These revised interim regulations also give special consideration to the time period for premium payment for overseas personnel. Since correspondence overseas takes longer than the 15-day general provision in the regulations we have extended the 15-day period to 45 days for former spouses overseas to allow sufficient time for them to be notified and remit payment before the agency terminates coverage.
Two comments concerned the treatment of a former spouse annuitant's coverage when the annuity is insufficient to cover the amount of the premium. One commenter suggested that rather than require the former spouse to elect a lower cost enrollment or termination of coverage the regulations should entitle the former spouse annuitant to pay the full premium or premium balance by check. Pub. L. 98-615 does not place a statutory restriction on the way in which a former spouse may make premium payments. Because the former spouse annuity, or portion of the retiree's annuity, may be quite small and because many former spouses will have already established the habit of paying directly to the employing office we have reconsidered our position. These revised regulations now permit the former spouse to make the total premium payment directly to the retirement system when the annuity or portion of the retiree's annuity is
insufficient to cover the full premium amount [Ãµ 890.808(d)]. The former spouse however, must pay the full premium to the retirement system. Dividing payment between an annuity withholding and a direct payment would be confusing (due to annuity fluctuations as a result of COLA increases, changes in deductions, etc.) and administratively impractical.
One agency suggested that former spouses make payments on a monthly cycle because former spouses may find it difficult to track Federal biweekly pay periods. These revised interim regulations grant agencies discretion to base the former spouse premium payment cycle on any regular pay period established for their employees, including a monthly pay period.
One carrier commented that, in the FEHB generally, carriers are unable to reconcile membership or payments received from OPM with any specific member and noted that this problem is exacerbated with former spouse enrollments. We do not believe that former spouse enrollments aggravate the reconciliation process. OPM currently obtains from agency records a supplemental semi-annual headcount report by plan for former spouses which is included along with the regular employee headcount report for carriers' use in reconciling enrollment. We believe that this method works reasonably well. However, OPM will continue to monitor and improve the reconciliation process.
One respondent expressed concern that Ãµ 809.804(c)(2), which denies coverage as a family member if there is evidence calling a child's paternity or maternity into question, would be inappropriately used by agencies. The respondent's concern is that a Federal agency's decision to deny coverage may supersede Judicial and/or administrative findings related to parental rights. It is the intent of the regulations that agency determinations be made in accordance with statutory requirements for coverage in the FEHB program.
One carrier noted a conflict between Ãµ 89O.301(f)(1) of the June 13,1985, interim regulations, which denies a family member an entitlement to convert to an individual contract with the plan when a former spouse changes enrollment to self alone, and Ãµ890.807(b), which entitles family members to convert to a private plan when their enrollment is terminated. OPM agrees that family members should have a right to convert when thee coverage is terminated, regardless of the reasons for termination. These revised regulations treat family members who lose coverage because the former spouse changes to self alone as family members who lose coverage because of any other change in status.
Section 890.301(i) prohibits an enrollment change from self-alone to self and family when selecting a new plan upon termination of enrollment by an employee organization plan. One respondent found an apparent conflict between this provision and the provision at Ãµ 890.301(e)(2), which permits a change to self and family within 60 days after birth or acquisition of a child who meets the requirements of a qualified family member. However, there is no conflict because the prohibition in Ãµ890.301(i] does not apply if anotherevent permits a change to self and family.
Another commenter questioned what responsibilities agencies have to authenticate a former spouses's initial claim of eligibility or continued eligibility for health benefits. The former spouse bears the burden of providing acceptable proof (as determined by the agency) of initial eligibility. It is in the former spouse's best interest to provide any documents the agency may require as proof because failure to provide the required documents may result in delays in coverage. Once coverage is obtained, a number of circumstances will cause the former spouse to lose entitlement, such as, remarriage prior to age 55 and issuance of a revised court order terminating benefits. At the time the former spouse enrolls for health benefits, he or she is required to certify in writing that he or she will notify the employing office within 31 days of an event that terminates eligibility. Should the former spouse fail to notify the employing office of an ineligibility to continue enrollment, any claims payment made during the period of ineligibility will be resolved between the carrier and the former spouse.
Two agencies suggested that the former spouse's enrollment transfer along with the employee's when the employee transfers to a new agency, separates, or retires, rather than remain with the agency which employed the. employee at the time of divorce. The agencies expressed concern that the 31-day conversion period available to the former spouse could expire before the employing office is notified of the employee's separation, transfer, or retirement from another agency. (A former spouse's enrollment would not be terminated solely by virtue of a transfer or retirement because the former spouse's future title to all or a portion of annuity would still exist. It would be terminated, however, if an employee separates with no future entitlement to annuity or a separated employee dies before becoming eligible for a deferred annuity.)
The law requires that the former spouse's enrollment be processed and maintained by the office which employed the employee at the time of divorce until the former spouse begins receiving annuity payments. However, there are circumstances under which the former spouse, through no fault of his or her own, may belatedly become aware of an event that terminates his or her FEHB enrollment. In these cases, the former spouse should not lose the right to convert. Accordingly, these revised interim regulations provide a temporary extension of coverage through 31 days after the employing office's notice to the former spouse that coverage is terminated where the former spouse could not have known that (a) the employee on whose service the former spouse's health benefits entitlement was based separated from service with no future entitlement to annuity; or (b) the separated employee on whose service the former spouse's health benefits entitlement was based died before becoming eligible for a deferred annuity. In these cases, the former spouse must pay the full premium during the extended period, exclusive of the 31-day period following the notice.
One respondent suggested a separate enrollment form for former spouses. A special enrollment form for former spouses has not been prescribed because the number of former spouses seeking health benefits coverage is not expected to be large enough to warrant procuring, stocking, and maintaining currency of a separate form. We believe the Standard Form 2809, with the "Remarks" section cross-referenced to the employee, former employee, or annuitant, is acceptable.
Waiver of Proposed Rulemaking
Pursuant to section 553(b)(3)(B) of title 5 of the U.S. Code, I find that good cause exists for waiving the general notice of proposed rulemaking. The notice is being waived because certain entitlements are conveyed immediately by the authorizing statute. Regulatory guidance is needed immediately for effective implementation.
E.O. 12291, Federal Regulation
I have determined that this is not a major rule as defined under section 1(b) of E.O. 12291, Federal Regulation.
Regulatory Flexibility Act
I certify that these regulations will not have a significant economic impact on a substantial number of small entities because the regulations merely implement the amendments to the Federal Employees Health Benefits Act under the Civil Service Retirement
Spouse Equity Act of 1984, Pub. L. 98-615 and the Federal Employees Benefits Improvement Act of 1986, Pub. L. 99-251.
List of Subjects in 5 CFR Part 890
Administrative practice and procedure, Claims, Government
employees, Health Insurance, Retirement.
U.S. Office of Personnel Management.
PART 890-FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
1. The authority citation for Part 890 is revised to read as set forth below and the authority citations following all the sections in Part 890 are removed:
Authority: 5 U.S.C. 8913; sec 890.102 also issued under 5 U.S.C. 1104 and sec. 3(5) of Pub. L. 95-454, 92 Stat. 1112; sec. 890.301 also issued under 5 U.S.C 8905(b); sec. 890.302 also issued under 5 U.S.C. 8901(5) and 5 U.S.C 8901(9); sec. 890.701 also issued under 5 U.S.C. 8902(m)(2); Subpart H also issued under Title I of Pub. L. 98-615, 98 Stat. 3195, and Title II of Pub. L. 99-251.
2. Section 890.101 is amended by revising paragraphs (a)(5) and (a)(9) to read as follows:
Ãµ890.101 Definitions; time computations.
(a) * * *
(5) "Employing office" means the office of an agency to which jurisdiction and responsibility for health benefits actions for an employee, an annuitant, or an eligible former spouse of an employee or annuitant, have been delegated.
(i) For an enrolled annuitant (including survivor annuitant and former spouse annuitant) who is not also an eligible employee, "employing office" is the office which has the authority to approve payment of annuity or worker's compensation for the annuitant concerned.
(ii) For a former spouse of an annuitant whose marriage dissolved after the employee's retirement and who had entitlement to receive future annuity payments under section 8341(h) or 8345(i) of title 5, United States Code, "employing office" is the office which has the authority to approve payment of annuity for the annuitant or former spouse concerned.
(iii) For a former spouse of a current employee, and a former spouse of an annuitant or separated employee having title to a deferred annuity whose marriage dissolved during the employee's Federal service, "employing office" is the agency that employed the employee or annuitant at the time the marriage was dissolved.
* * * * *
(9) "Pay period" means the biweekly pay period established pursuant to section 5504 of title 5, United States Code, for the employees to whom that section applies and the regular pay period for employees not covered by that section. "Pay period" as it relates to a former spouse who is not actively receiving an annuity means any regular pay period for employees of the agency to which jurisdiction and responsibility for health benefits actions for the former spouse have been delegated as provided by paragraph (a)(5) of this section. "Pay period" for annuitants means the period for which a single installment of annuity is customarily paid.
* * * * *
3. Section 890.104 is amended by revising paragraph (a) to read as follows:
Ãµ890.104 Initial decision and reconsideration.
(a) Who may file. An employee, annuitant, or former spouse may request OPM to reconsider an initial decision of an employing office (including OPM) that denies coverage or change of enrollment.
* * * * *
4. Section 890.301 is amended by revising paragraphs (d)(2), (e), (f), (h), (i), (k), (n), and (u) to read as follows:
Ãµ890.301 Opportunities to register to enroll and change enrollment.
* * * * *
(d) * * *
(2) An enrolled employee, annuitant, or former spouse may register to another plan, another option, or from self alone to self and family, or may make any combination of these changes.
(e) Change in family status. (1) Other than a former spouse, an enrolled employee or annuitant may register to change enrollment from self alone to self and family, or from one plan or option to another, or both; and an employee, if not registered to be enrolled, may register to be enrolled, at any time during the period beginning 31 days before a change in marital status and ending 60 days after the change in marital status. Other than a former spouse, an enrolled employee or annuitant may change enrollment from self alone to self and family within 60 days after any other change in family status.
(2) An enrolled former spouse may register to change enrollment from self alone to self and family, or from one plan or option to another, or both, within 60 days after the birth or acquisition of a child who is a qualified family member under Ãµ 890.804(a) of this part.
(f) Change to self alone. (1) An employee, annuitant, or former spouse may register at any time to change enrollment from self and family to self alone.
(2) Other than a former spouse, an employee or annuitant who is covered by the enrollment of another under this part may elect self alone coverage within 31 days after a change in the covering enrollment has been filed under authority of this paragraph.
* * * * *
(h) Move from area served by comprehensive medical plan. If a comprehensive medical plan limits full service to a geographic area, an employee, annuitant, or former spouse enrolled in that plan who moves outside the full service area or, if already living outside the full service area, moves further from the full service area, may register at any time after the move, to be enrolled in another health benefits plan.
(i) Termination by employee organization plan. An employee, annuitant, or former spouse who is enrolled in a health benefits plan sponsored or underwritten by an employee organization and whose membership in the employee organization is terminated, may register to be enrolled In another plan under the following conditions:
(1) Health benefits enrollment is terminated by the plan; and,
(2) Registration to enroll in another plan is submitted within 31 days after termination of enrollment in the employee organization plan, the employee, annuitant, or former spouse may not change enrollment from self alone to self and family under this paragraph.
* * * * *
(k) Termination of plan in which enrolled. If a plan is discontinued in whole or part, each employee, annuitant, and former spouse whose enrollment is thereby terminated may enroll in another plan. If the discontinuance is at the end of a contract period which is immediately preceded by an open season, the time for enrollment is the open season. Otherwise, OPM will establish a time and effective date for enrollment. Persons who fail to change enrollment within the time set are considered to have canceled the plan in which enrolled, except that if one option of a plan is discontinued, enrolled employees, annuitants, and former spouses who do not chance plans will be considered enrolled in the remaining option of the plan.
* * * * *
(n) On becoming eligible for coverage under Title XVIII of the Social Security Act. An enrolled employee, annuitant, or former spouse with a high option enrollment may register, at any time after the 31st day before he or she is eligible for coverage under Title XVIII of the Social Security Act (Medicare), to change enrollment to the low option of any available plan under this part.
* * * * *
(u) Child's coverage ends. An employee, annuitant, or former spouse may register to change enrollment from self alone to self and family within 31 days after an eligible child loses coverage under another enrollment under this part.
* * * * *
5. Section 890.302 is amended by revising paragraphs (d) and (e) to read as follows:
Ãµ890.302 Coverage of family members.
* * * * *
(d) Child incapable of self-support. When an employee, annuitant, or former spouse enrolls for a family with includes a child who has become 22 years of age and is capable of self support the employing office will require such enrollee to submit a physician's certificate verifying the child's disability. The certificate must-
(1) State that the child is incapable of self-support because of a physical or mental disability that existed before the child became 22 years of age and that can be expected to continue for more than 1 year;
(2) Include a statement of the name of the child, the nature of the disability, the period of time it has existed, and its probable future course and duration; and,
(3) Be signed by the physician and show the physician's office address. The employing office will require the employee, annuitant, or former spouse to submit the certificate on or before the date the child becomes 22 years of age. However, the employing office may accept otherwise satisfactory evidence of incapacity not timely filed
(e) Renewal of certificates of incapacity. The employing office will require the employee, annuitant, or former spouse who has submitted a certificate of incapacity to renew that certificate on the expiration of the minimum period of disability certified.
* * * * *
6. Subpart H is revised to read as follows:
Subpart H-Benefits for Former Spouses
890.803 Who may enroll.
890.805 Application time limitations.
890.806 Effective dates of coverage
890.807 Termination of enrollment.
890.808 Employing office responsibilities.
Subpart H-Benefits for Former Spouses
Ãµ 890.801 Introduction.
This subpart sets forth policies and procedures for obtaining health benefits coverage that are unique to former spouses of Federal employees and retirees.
In this subpart, "Qualifying court order" means qualifying court order as described In Ãµ 831.1704 of this title.
Ãµ 890.803 Who may enroll.
(a) Except as specified in paragraph (b) of this section, a former spouse is eligible to enroll in a health benefits plan under this part provided that-
(1) The former spouse whose marriage to an employee or employee annuitant is dissolved has not remarried if under age 55; and
(2) The former spouse was enrolled in a health benefits plan under this part as a family member at any time during the 18 months preceding the date of the dissolution of marriage; and
(3) (i) the former spouse currently receives, or has future title to receive (A) a portion of annuity payable to the employee upon retirement based on a qualifying court order for purposes of 5 U.S.C. 8345(j); (B) survivor annuity benefits based on a qualifying court order for purposes of 5 U.S.C. 8341(h); or (C) a survivor annuity elected by the employee under 5 U.S.C. 8339(j)(3) (or benefits similar to those under this paragraph under another retirement system for Government employees); or
(ii) The former spouse was married to an employee who retired before May 7, 1985 and (A) the employee annuitant elects to provide a survivor annuity to the former spouse under procedures prescribed in Ãµ 831.621 of this title; or (B) the former spouse satisfies all of the conditions for a survivor annuity in Ãµ 831.622 of this title; or
(iii) The former spouse was married to an employee who died before May 7, 1985, and the employee was eligible for an immediate annuity on or before the date of death, and the former spouse satisfies all of the conditions for a survivor annuity in Ãµ 831.622 of this title.
(b) A former spouse or an employee who separates from Federal service before becoming eligible for immediate annuity is eligible to enroll only if the former spouse's marriage to the employee dissolved before the employee left Federal service.
(c) If a former spouse cannot apply for benefits on his or her own behalf because of a mental or physical disability, application may be filed by a court-appointed guardian.
Ãµ 890.804 Coverage.
(a) Type of enrollment. A former spouse who meets the requirements of Ãµ 890.803 may elect coverage for self alone or for self and family. A family enrollment covers only the former spouse and any unmarried dependent natural or adopted child of both the former spouse and the employee, former employee, or employee annuitant, provided such child is not otherwise covered by a health plan under this part. An unmarried dependent child must be under age 22 or incapable of self-support because of a mental or physical disability existing before age 22. No person maybe covered by two enrollments.
(b) Proof of dependency. (1) A child is considered to be dependent on the former spouse or the employee, former employee, or employee annuitant if he or she is-
(i) A legitimate child;
(ii) An adopted child;
(iii) A recognized natural child who lives with the former spouse or the employee, former employee, or employee annuitant in a regular parent-child relationship.
(iv) A recognized natural child for whom a judicial determination of support has been obtained; or
(v) A recognized natural child to whose support the former spouse, or the employee, former employee, or employee annuitant makes regular and substantial contributions in accordance with Ãµ 890.302(b)(2).
(c) Exclusions from coverage.
Coverage as a family member may be denied-
(1) If evidence shows that the former spouse, employee, former employee, or annuitant did not recognize the child as his or her own, despite a willingness to support the child; or
(2) If evidence calls the child's paternity or maternity into doubt, despite the former spouse's employee's, former employee's, or employee annuitant's recognition and support of the child.
(d) Child incapable of self-support. When a former spouse enrolls for a family enrollment which includes a child who has become 22 years of age and is incapable of self-support, the employing office shall determine such child's eligibility in accordance with Ãµ 890.302(d), (e), and (f).
(e) Meaning of unmarried child. A child, under age 22 or incapable of self-support, who has never married or whose marriage has been annulled, or a child who is divorced or widowed is considered to be unmarried.
Ãµ 890.805 Application time limitations.
Former spouses must apply for health benefits coverage by the latest of-
(a) February 27, 1987;
(b)(1) Within 60 days after the dissolution of the marriage to the Federal employee; or (2) if the marriage dissolved after retirement, within 60 days after the dissolution of the marriage or within days after the employee elects to provide a survivor annuity for the former spouse under 5 U.S.C. 8330(j)(3); or
(c)(1) Within 60 days after the employee annuitant elects to provide a former spot annuity under Ãµ 831.621; or (2) within 60 days after the date of the OPM notice of entitlement to a former spouse annuity under Ãµ 831.822.
Ãµ 890.806 Effective dates of coverage.
(a) Generally. (1) The effective date of enrollment is the first day of the pay period beginning more than 30 days after the date the employing office receives the properly completed Standard Form 2809 or an appropriate substitute (i.e.., a signed statement with sufficient information to execute enrollment) and satisfactory proof of eligibility.
(2) The effective date of a change of enrollment is the first day of the pay period after the date the employing office receives the properly completed Standard Form 2809.
(b) Change required because of insufficient annuity. When a former spouse annuitant changes to a lower cost enrollment as provided by
Ãµ 89O.301(g), the change is effective immediately upon loss of coverage under the prior enrollment.
Ãµ 890.807 Termination of enrollment.
(a)(1) A former spouse's enrollment terminates, subject to the temporary extension of coverage for conversion, at midnight of the last day of the pay period in which the earliest of the following events occurs:
(i) Court order ceases to provide entitlement to survivor annuity or portion of retirement annuity under a retirement system for Government employees.
(ii) Former spouse remarries before age 55.
(iii) Former spouse dies.
(iv) Employee or annuitant on whose service the benefits are based dies and no survivor annuity is payable.
(v) Separated employee on whose service the benefits are based dies before the requirements for deferred annuity have been met.
(vi) Employee on whose service benefits are based leaves Federal
service before establishing title to an immediate annuity or a deferred annuity.
(vii) Refund of retirement money is paid to the separated employee on whose service the health benefits are based.
(2) OPM may authorize a longer time frame for the temporary extension of coverage for conversion than the 31 days provided in Ãµ 890.401(a) if in OPM's judgment the former spouse could not have known that (1) the employee on whose service benefits are based left Federal service before establishing title to an immediate or deferred, annuity; or (2) the separated employee on whose service the benefits are based died before the requirements for deferred annuity had been met. In such cases, the right of conversion may be exercised up to 31 days after the employing office's notice of termination. The former spouse must pay the fun premium (employee's and Government's share) during the extended period, exclusive of the 31 day period following the notice.
(3) Termination of enrollment for failure to pay premiums within the time frame establishment in accordance with Ãµ 890.808(d)(1) is retroactive to the end of the last pay period for which payment has been timely received.
(4) A former spouse whose enrollment is terminated under this paragraph may not re-enroll.
(b) Coverage of members of the family. The coverage of a member of the family of a former spouse terminates, subject to the temporary extension of coverage for conversion, at midnight of the earlier of the following dates:
(1) The day on which the individual ceases to be an eligible family member.
(2) The day the former spouse ceases to be enrolled, unless the family member is entitled as a survivor annuitant to continued enrollment or is entitled to continued coverage under the enrollment of another.
(c) Cancellation. A former spouse may cancel enrollment at any time by filing with the employing office a properly completed health benefits form. If a former spouse cancels enrollment, the cancellation becomes effective on the last day of the pay period after the pay period in which the health benefits form cancelling the enrollment is received by the employing office. 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. A former spouse who cancels his or her enrollment may not later re-enroll.
Ãµ 890.808 Employing office responsibilities.
(a) Application for benefits. The former spouses's application for health benefits may be in the form of a Standard Form 2809, letter, or written statement to the employing office.
(b) Administration of the enrollment process. (1) The employing office will set up a method for accepting applications for enrollment, informing the former spouse what documents to submit and where to submit them for an eligibility determination, and collecting premium payments. The method will include procedures for verifying the eligibility requirements under Ãµ 890.803(a) (1) and (2). The employing office must obtain OPM documentation that the former spouse meets the additional requirement under Ãµ 890.803(a)(3)(i), (ii) or (iii).
(2) The employing office will send the former spouse notice, in writing, of its decision when an employing office informs a former spouse of his or her eligibility to enroll, it will identify the documents on which it based its decision and will include a premium payment schedule and statement of the requirements for continued enrollment under Ãµ 890.803. If the former spouse does not qualify for health benefits coverage, the employing office must give the former spouse a reconsideration right under Ãµ 890.1O4.
(3) The employing office will maintain a health benefits file for the former spouse as a file separate from the personnel records of the employee or former employee.
(4) The former spouse will be required to certify that he or she meets the requirements listed in Ãµ 890.803 and that he or she will notify the employing office within 31 days of an event that results in failure to meet one or more of the requirements.
(c) Qualifying court order. Subject to a 31-day extension period for conversion, the duration of health benefits coverage will coincide with any period specified in the qualifying court order providing for an annuity. A court order not meeting the requirements under
Ãµ 831.1704 will not be used to establish or continue entitlement to a former spouse's health benefits coverage.
(d) Premium payments. (1) The former spouse must remit to the employing office the full subscription charge for the enrollment for every pay period during which the enrollment continues, exclusive of the 31-day temporary extension of coverage for conversion provided in ÃµÃµ 890.401 and 890.807(a)(2). Payment must be made in accordance with a schedule established by the employing office [see Ãµ 890.101(a)(9)]. If the employing office does not receive payment by the date due, the employing office will notify the former spouse by certified mail return receipt requested that continuation of coverage rests upon payment being made within 15 days (45 days for former spouses residing overseas) after receipt of the notice. The enrollment of an individual who fails to remit payment within the specified time frame will be terminated.
(2) The employing office will submit all premium payments collected from former spouses along with Its regular health benefits payments to OPM. The full subscription charge for former spouses will be classified as "withholdings" and included in the "Withholdings" section of the Standard Form 2812, Journal Voucher and Report of Withholdings and Contributions For Health Benefits, Group Life Insurance, and Civil Service Retirement.
(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 amount of health benefits premium due, the retirement system will notify the former spouse of the opportunity to register to be enrolled in another plan as provided by Ãµ 890.3O1(q) or to make direct payment of the full premium directly to the retirement system.
[FR Doc. 86-9420 Filed 4-25-86;8:45 am]
BILLING CODE 6325-01-M