Civil Service Federal Employees Federal Employees Federal Employees

Retirement Group Life Health Benefits Retirement

System Insurance Program System

United States

Office of Personnel Management

Retirement and Insurance Service

Benefits Administration Letter

Number: 97-205 Date: August 15, 1997 

Subject: Federal Employees Health Benefits (FEHB) Program: Opportunities to Enroll

and Change Enrollment

On July 18, 1997, the Office of Personnel Management published final FEHB regulations in

the Federal Register (62 FR 38433) concerning Opportunities to Enroll and Change

Enrollment. These regulations will take effect on August 18, 1997. A copy of these

regulations is attached. Additional guidance will be forthcoming.

Abby L. Block, Chief

Insurance Policy and 

 Information Division

 

Attachment
Publication date JULY 18, 1997

6325-01

OFFICE OF PERSONNEL MANAGEMENT

RIN 3206-AH46

5 CFR Part 890

Federal Employees Health Benefits Program:

Opportunities to Enroll and Change Enrollment

AGENCY: Office of Personnel Management.

ACTION: Final rule.

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: (Insert 30 days from date of publication in the

Federal Register)

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.
2

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

§ 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

§610.102 of this chapter.

Several commenters had concerns with the new paragraph (c)

that we are adding to §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
3

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 §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.

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
4

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 those 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 realize 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 individual enrolls within 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 commenters 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
5

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 §890.806(j) because it is redundant

with §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 Statesponsored 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: (l) 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 Statesponsored) 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 changes and clarifications where

appropriate.

Regulatory Flexibility Act

I certify that these regulations will not have a significant
6

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.

U.S. OFFICE OF PERSONNEL MANAGEMENT

S))))))))))))))))))))))

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; §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 §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:

§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
 7

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

§§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 §890.303.

* * * * *

3. In §890.103, paragraphs (c) and (d) are redesignated as

(d) and (e), and a new paragraph (c) is added to read as follows:

§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 revised to read as follows:

Subpart C - Enrollment

5. Section 890.301 is revised to read as follows:

§890.301 Opportunities for employees to enroll or change 

enrollment; effective dates.

(a) Initial opportunity to enroll. An employee who becomes

eligible may elect to enroll or not to enroll within 60 days

after becoming eligible.

(b) Effective date--generally. Except as otherwise provided,

an enrollment or change of enrollment takes effect on the first

day of the first 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 employing office advises the

employee of its determination.

(d) Enrollment by proxy. Subject to the discretion of the

employing office, an employee's representative, having written
 8

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.

(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
 9

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 in which the employing office

receives an appropriate request to enroll or change the

enrollment.

(6) A transfer from a post of duty within a State of the

United States or the District of Columbia to a post of duty

outside a State of the United States or the District of Columbia,

or the reverse. An employee 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
 10

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 cancelled the plan in which enrolled.

(iii) If one option of a plan that has two options is

discontinued, an employee who does not change the enrollment is

considered to be enrolled in the remaining option of the plan.

(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
 11

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. 

(l) Salary of temporary employee insufficient to pay

withholdings. If the salary of a temporary employee eligible

under 5 U.S.C. 8906a is not sufficient to pay the withholdings

for the plan in which the employee is enrolled, the employing

office shall notify the employee of the plans available at a cost

that does not exceed the employee's salary. The employee may

enroll in another plan whose cost is no greater than his or her

salary within 60 days after receiving such notification from the

employing office. The change of enrollment takes effect

immediately upon termination of the prior enrollment.

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

§890.302 Coverage of family members.

* * * * *

(f) Determination of incapacity. (1) Except as provided in

paragraph (f)(2) of this section, the employing office shall make

determinations of incapacity.

(2) Either the employing office or the carrier may make a

determination of incapacity if a medical condition, as specified

by OPM, exists that would cause a child to be incapable of selfsupport during adulthood. 

* * * * *

7. In §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:

§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 §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 §890.304, paragraph (a)(2) is amended by removing

"§890.301(ee)" and adding in its place "§890.301(l)", paragraph

(b)(1) is amended by removing "§890.301(q)" and adding in its

place "§890.306(q)", and paragraph (d) is revised to read as

follows:

§890.304 Termination of enrollment.

* * * * *
 12

(d) Cancellation . (1) Except as provided in §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:

§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 §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.
 13

(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

§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 marital status or any other

change in family status. In the case of an enrolled survivor

annuitant, a change in family status based on additional family

members occurs only if the additional family members are family

members of the deceased employee or annuitant. The annuitant

must change the enrollment within the period beginning 31 days

before the date of the change in family status, and ending 60

days after the date of the change in family status. 

(2) A change of enrollment made in conjunction with the birth

of a child, or the addition of a child as a new family member in

some other manner, takes effect on the first day of the pay

period in which the child is born or becomes an eligible family

member.
 14

(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

§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 §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
 15

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, l976, 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
 16

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 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
 17

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 §§831.1305(d)(2)

and 845.205(d)(2) of this chapter apply to elections under this

paragraph (l)(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
 18

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 §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

§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, l990.

(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.
 19

(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.

10. §890.602 [Amended]

Section 890.602 is amended by removing "register" and adding

in its place "elect to enroll".

11. §890.803 [Amended]

In §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 "sections 831.613(a) and (b) and 842.605(a) and (b) of this

chapter".

12. §890.805 [Amended]

In §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:

§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 §890.803 and the application

time limitation requirements of §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
 20

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

§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 §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
 21

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 §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

§890.803 and the application time limitation requirements of

§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 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 Statesponsored program of medical assistance for the needy, or who

meets the eligibility requirements of §890.803 and the

application time limitation requirements of §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
 22

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 §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 §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.
 23

(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.

(l) 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 §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 section 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:

§890.807 Termination of enrollment.

* * * * *

(c) Failure to make an election under §890.806(l). (1) If the
 24

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

§890.806(l) (electing a plan with a full subscription charge that

is less than the annuity; or paying premiums directly to the

retirement system in accordance with §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 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:

§890.808 Employing office responsibilities.

* * * * *

(e) Withholding from annuity. The retirement system acting as

employing office for a former spouse will establish a method for

withholding the full subscription charge from the former spouse's

annuity check. When the annuity is insufficient to cover the

full subscription charge, the retirement system will follow the

procedures specified in section 890.806(l).

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:

§890.1105 Initial election of temporary continuation of

coverage; application time limitations and effective dates.
 25

* * * * *

(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 §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 §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 §890.1104(c)(1), the date the former

spouse received the notice from the employing office described in

§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
 26

temporary continuation of coverage is the day after other

coverage under this part expires, including the 31-day temporary

extension of coverage under §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:

§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

§890.301(f), an enrollee (except for a former spouse who is

eligible for continued coverage under §890.1103(3)) may change

the enrollment from self only to self and family, from one plan

or option to another, or make any combination of these changes. 

A former spouse who is eligible for continued coverage under

§890.1103(3) may change from one plan or option to another, but

may not change from self only to self and family unless the

individual to be covered under the family enrollment qualifies as

a family member under §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
 27

next following year.

(3) When a belated open season change of enrollment is

accepted by the employing office under paragraph (b) of this

section, it takes effect as required by paragraph (e)(2) of this

section.

(f) Change in family status. (1) Except for a former spouse,

an enrollee may change the enrollment from self only to self and

family, from one plan or option to another, or make any

combination of these changes when the enrollee's family status

changes, including a change in marital status or any other change

in family status. The enrollee must change the enrollment within

the period beginning 31 days before the date of the change in

family status, and ending 60 days after the date of the change in

family status.

(2) A former spouse who is covered under this section may

change the enrollment from self 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 §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

§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 §890.1107. 

Coverage does not extend beyond the expiration of the period

described in §890.1107. The effective date of the reenrollment

is the day following the termination of the coverage described in

§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
 28

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.

Billing Code: 6325-01