§ 894.101 Definitions. This part is written as if the reader were an applicant or *enrollee*. Accordingly, the terms “you,” “your,” etc., refer, as appropriate, to the applicant or *enrollee*. *Acquiring an eligible child* means one of the following: ( 1 ) Birth of a child;
( 2 ) Adoption of a child;
( 3 ) Acquisition of a foster child as described in § 890.101(a)(8) of this chapter;
( 4 ) Acquisition of a stepchild who lives with the *enrollee* in a regular parent-child relationship;
( 5 ) Establishment of a recognized natural child;
( 6 ) Residence change of the *enrollee's* stepchild or recognized natural child who moves in with the *enrollee*; and
( 7 ) An otherwise eligible child becoming unmarried due to divorce or annulment of marriage, or death.
*Administrator* means the entity with which the Office of Personnel Management contracts to manage the enrollment and premium payment process for the Federal Employees Dental and Vision Insurance Program (FEDVIP).
*Annuitant* means an individual defined at 5 U.S.C. 8901(3). Generally, the term means a former *employee* or *employee* of the United States Postal Service who is entitled to an immediate annuity or a disability annuity under a retirement system established for *employees.* The term also generally includes those receiving a survivor annuity due to the death of an *employee* or *employee* of the United States Postal Service or annuitant (survivor annuitants) and those receiving compensation from the Office of Workers' Compensation Programs (compensationers). The term does not include former *employees* who retire with a deferred annuity under 5 U.S.C. 8413, or former spouses of annuitants.
*Carrier* means a company with which the Office of Personnel Management contracts to provide dental and/or vision benefits.
*Child* means: ( 1 ) Except as discussed in paragraph (4) of this definition, a child is one of the following: ( i ) A child born within marriage;
( ii ) An adopted child;
( iii ) A stepchild or foster child who lives with the *enrollee* in a regular parent-child relationship; or
( iv ) A recognized natural child.
( 2 ) This definition does not include a grandchild (unless the grandchild meets all the requirements of a foster child as stated in § 890.101(a)(8) of this chapter).
( 3 ) The child must be unmarried and under age 22. A child age 22 or over is eligible if the child is incapable of self-support because of a physical or mental disability that existed before the child reached age 22.
( 4 ) With respect to a *TEl, child* means a *TEI child.*
*Compensation* has the same meaning as found under subchapter I of chapter 81 of title 5, United States Code, which is payable because of an on-the-job injury or disease.
*Compensationer* means an individual who is receiving compensation and who the Department of Labor determines is unable to return to duty.
*Covered position* means a position in which an *employee* is not excluded from FEDVIP eligibility by law or regulation.
*Days* means calendar days.
*Dependent* means an unmarried child who is living with or receiving regular and substantial support from the *enrollee*.
*Employee* means an individual defined in 5 U.S.C. 8901. For the purposes of this subpart, the term *employee* additionally means an employee of the United States Postal Service and an *employee* of the District of Columbia courts.
*Enrollee* means the individual in whose name the FEDVIP enrollment is carried. There is one FEDVIP enrollment for each *enrollee* in a dental plan, and/or in a vision plan and that enrollment may include *family members* who may be covered by the enrollment. The term *enrollee* includes individuals eligible to enroll based upon a status described at subpart C of this part, who enroll and are covered. With respect to the Federal workforce, an *enrollee* generally means an *employee* or *annuitant.* With respect to the United States Postal Service, an *enrollee* generally means an *employee* or *annuitant* of the United States Postal Service. With respect to a *TEI,* an *enrollee* generally means the *sponsor* who is a *TEI* with respect to a FEDVIP plan; but if the *sponsor* is not a *TEI,* or for FEDVIP dental benefits if the *sponsor* defined at § 894.804 is not enrolled and meets a condition at § 894.309(a)(3)(iii), then enrollee means the *TEI certifying family member.* A *TEI former spouse* may be an enrollee only for a self-only FEDVIP vision plan. An *enrollee* may enroll and elect a FEDVIP dental and/or vision plan, option, and type of enrollment, except as provided at § 894.309.
*Enrollment reconsideration* means the *Administrator's* review of its initial enrollment decision to determine if it followed the law and regulations correctly in making the initial decision concerning FEDVIP eligibility.
*Family member* means a spouse (including a spouse under a valid common law marriage) and/or unmarried dependent child(ren) under age 22 or beyond age 22, if incapable of self-support because of mental or physical disability which existed before reaching age 22, as defined at 5 U.S.C. 8901(5). With respect to a *TEI,* the term *family member* means a *TEI family member.*
*OPM* means the Office of Personnel Management.
*OWCP* means the Office of Workers' Compensation Programs, U.S. Department of Labor.
*Premium conversion* means the payment of FEDVIP premiums by an *employee* or United States Postal Service employee using pre-tax dollars. See § 892.102 of this chapter for a discussion of how *premium conversion* works.
*QLE* means a qualifying life event.
*Recognized natural child* means a biological child born outside of marriage. A recognized natural child is an eligible family member if the child lives with the *enrollee* or receives financial support from the *enrollee*.
*Regular parent-child relationship* means that the *enrollee* is exercising parental authority, responsibility, and control over the child; is caring for, supporting the child; and is making the decisions about the child's education and medical care.
*Sponsor* generally means the individual who is eligible for medical or dental benefits under 10 U.S.C. chapter 55 based on his or her direct affiliation with the uniformed services (including members of the National Guard and Reserves), in accordance with § 894.804.
*Stepchild* means your spouse's child born within or outside marriage or their adopted child. The child of your spouse shall continue to be considered your stepchild after your divorce from your spouse or the death of your spouse so long as the child continues to live with you in a regular parent-child relationship.
*TEI* means*TRICARE-eligible individual for FEDVIP dental benefits (TEI-D)* or a *TRICARE-eligible individual for FEDVIP vision benefits (TEI-V).*
*TEI certifying family member* means, where the *sponsor* is not an *enrollee* under § 894.309, the *TEI family member* who may accept responsibility to self-certify as an *enrollee* in accordance with § 894.809.
*TEI child* means an individual who is a *TEI* and who meets the definition of dependent in 10 U.S.C. 1072(2)(D) or (I) with respect to a *sponsor.*
*TEI family member* means a TEI who is a dependent with respect to a sponsor, as defined in 10 U.S.C. 1072(2)(A) (spouse), 10 U.S.C. 1072(2)(B) (unremarried widow), 10 U.S.C. 1072(2)(C) (unremarried widower), 10 U.S.C. 1072(2)(D) (child), or 10 U.S.C 1072(2)(I) (unmarried person).
*TEI former spouse* means a *TEI* who is an unremarried former spouse as defined in 10 U.S.C. 1072(2)(F), (G), or (H) and is entitled to medical care under 10 U.S.C. 1086(c) or (d).
*TRICARE-eligible individual (TEI)* means a *TRICARE-eligible individual for FEDVIP dental benefits (TEI-D)* or a *TRICARE-eligible individual for FEDVIP vision benefits (TEI-V),* as the case may be.
*TRICARE-eligible individual for FEDVIP dental benefits* (*TEI-D*) means an individual who is eligible for FEDVIP dental coverage based on the individual's eligibility to enroll or be covered under the TRICARE Retiree Dental Program, 10 U.S.C. 1076c(b) in accordance with § 894.802.
*TRICARE-eligible individual for FEDVIP vision benefits* (*TEI-V*) means an individual who is eligible for FEDVIP vision coverage based on the individual's enrollment in a specified TRICARE health plan in accordance with § 894.803.
*Type of enrollment* means one of the following: ( 1 ) Self only;
( 2 ) Self plus one; or
( 3 ) Self and family.
[73 FR 50184, Aug. 26, 2008, as amended at 78 FR 64879, Oct. 30, 2013; 81 FR 86906, Dec. 2, 2016; 83 FR 32193, July 12, 2018; 83 FR 58177, Nov. 19, 2018; 84 FR 1599, Feb. 5, 2019; 84 FR 26544, June 7, 2019; 88 FR 47745, 47749, July 25, 2023]