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: 97-210 Date: October 7, 1997 

Subject: Federal Employees Health Benefits (FEHB) Program: Implementing New

Regulations on Opportunities to Enroll and Change Enrollment

Background On July 18, 1997, the Office of Personnel Management (OPM)

published final Federal Employees Health Benefits (FEHB)

Program regulations in the Federal Register (62 FR 38433)

concerning Opportunities to Enroll and Change Enrollment. 

These regulations took effect on August 18, 1997. A copy of

these regulations is provided in Benefits Administration Letter

97-205, dated August 15, 1997.

The purpose of this letter is to note some of the major changes

made by the regulations and explain how to implement them.

Please note that this letter does not provide guidance on every

change made by the regulations as most of the changes are selfexplanatory. We have addressed only those that we expect will

generate the greatest number of questions from your employees.

 

General Changes Following are some of the general changes made to the

regulations:

1. The opportunities to enroll and change enrollment are grouped

into separate sections for employees, annuitants, former

spouses who qualify for FEHB under the Spouse Equity

provisions of FEHB law, and individuals who qualify for

Temporary Continuation of Coverage (TCC). The employing

office must refer to the appropriate section when determining

if an individual is eligible to enroll or change enrollment.

2. The opportunities within each section are grouped by similar

characteristics, such as change in employment status or loss of

other group health insurance coverage.
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3. Whenever the effective date of an enrollment or change differs

from the general rule for effective dates stated in each section,

it is included in the same paragraph as the regulation. 

4. The enrollment timeframes have been standardized as much as

possible. Any unusual timeframes are noted within the

specific regulation. 

NOTE: For most of the enrollment opportunities, individuals

now have up to 60 days after the occurrence of the event to make

an election. Please caution your employees that an individual

who takes the full 60 days to enroll will be without Federal

Employees Health Benefits (FEHB) coverage until the

effective date of the enrollment. This may be of serious

concern to those who are enrolling because of a loss of other

group health insurance coverage.

Although taking all of the time allowed by regulation may cause 

a gap in coverage, OPM will not count this when determining

eligibility to continue FEHB after retirement (covered for 5 years

immediately before retirement or, if less than five years, for all

service since the first opportunity to enroll). 

 

Expanded

Opportunities

This section discusses two major changes to the regulations that

expand the opportunities to enroll or change enrollment. We

expect these will generate the greatest number of questions from

your employees. The two major changes are:

1. An employee may enroll or change enrollment if a spouse

loses non-Federal health insurance coverage for any reason. 

Employing offices still need to verify that the spouse lost other

group health insurance coverage, but the reason does not

matter. Thus, if the employee's spouse lost coverage because

of resignation from employment, or cancellation of coverage,

the employee is eligible to enroll or change.

2. An employee who has a change in family status without a

change in marital status may enroll. Employing offices still

need to determine if the individual to be covered is an eligible

family member. Such situations include but are not limited to:

birth or acquisition of a child;

issuance of a court order specifically requiring an

employee to enroll for his or her children or provide

health benefits protection for them;
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issuance or termination of a court order granting

interlocutory divorce, limited divorce, legal separation, or

separate maintenance to the enrollee or spouse;

entry into or discharge from military service of a spouse

or of a child under age 22. 

NOTE: When an employee enrolls because of the birth or

acquisition of a child, the enrollment takes effect on the first day

of the pay period in which the child is born or becomes an

eligible family member, regardless of whether the enrollee was

in pay status the previous pay period. This is the only situation

in which an employee who enrolls does not have to be in pay

status before the enrollment takes effect.

 

Procedures We recognize that our reordering of the enrollment opportunities

in the regulations may cause some confusion in documenting

enrollments and changes on Standard Form (SF) 2809. 

However, until we complete our revision of the form to more

accurately follow the regulations, agencies should continue to use

the current form. 

When selecting an event number from the chart on SF 2809,

employing offices should use the event that is most similar to the

regulation that permits the enrollment or change. The new

regulation number should be entered in the "Remarks" section.

Following are two examples of how to document SF 2809:

1. If an employee enrolls based on a spouse's loss of non-Federal

coverage, employing offices should continue to use event #20. 

The regulation number that should be entered in "Remarks" is

"5 CFR, 890.301(i)(7)."

2. If an employee enrolls based upon loss of Federal Employees

Health Benefits (FEHB) coverage due to cancellation of the

covering enrollment, employing offices should continue to use

event #17. The regulation number that should be entered in

"Remarks" is "5 CFR, 890.301(i)(1)."

 

Enrollment Code

Errors

Employing offices now have the authority to retroactively correct

enrollment code errors made by the enrollee. This gives

enrollees who discover that they made an enrollment code error

an opportunity to have it corrected. An enrollee who reports an

error beyond the specified time frame (see section 890.103(c))

must wait until the next open season.

 
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E. Questions If you have any questions about this regulatory change, please 

contact our information staff at (202) 606-0191, or email

fehb@OPM.gov.

 

 Abby L. Block, Chief

 Insurance Policy and

 Information Division