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United States 

Office of 

Personnel Management 

The Federal Government’s Human Resources Agency

Benefits Administration Letter

Number: 15-208 Date: October 20, 2015

Subject: Federal Employees Health Benefits (FEHB) Program: Self Plus One 

Operational Issues 

I. Background 

The U.S. Office of Personnel Management issued a final rule on September 17, 2015 to 

amend the Federal Employees Health Benefits (FEHB) Program regulations to include 

the new Self Plus One enrollment type. The final rule amends FEHB regulations to 

comply with provisions of the 2013 Bipartisan Budget Act. 

For additional information about the Self Plus One enrollment type, please visit 

www.opm.gov/selfplusone. In addition, the following Benefits Administration Letters 

are available on our website at www.opm.gov/retirement-services/publicationsforms/benefits-administration-letters/: 

 14-203: Self Plus One Enrollment;

 14-213: Self Plus One Enrollment; and

 15-205: Self Plus One Final Rule Published.

This Benefits Administration Letter (BAL) highlights several operational details 

impacted by the final rule, including: 

 Children’s Equity and Changes to Self Plus One;

 Open Season Changes for Those Retiring at the End of 2015;

 Switching a Covered Family Member; and

 Qualifying Life Events (QLEs) That Occur After Open Season 2015, and Prior to

January 1, 2016.

II. Children’s Equity and Changes to Self Plus One

The FEHB rules concerning children's equity when a court order is involved are the same 

for a Self Plus One enrollment as they are for a Self Only and a Self and Family 

enrollment. This means that employees subject to a court or administrative order to 

provide health benefits for their child(ren), must cover their child(ren) under a Self Plus 
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One or Self and Family enrollment. As a result, we have modified the procedure for 

processing health benefits enrollments in children's equity cases with a court order in 

order to address the Self Plus One enrollment type. This modification will require the 

system administrators of the enrollment systems and the agency human resources (HR) 

representatives to take the actions described below: 

a. Actions to be Taken by the System Administrators of the Enrollment 

Systems 

System administrators must ensure that the online enrollment systems do not 

automatically process a decrease in enrollment type from Self and Family to Self Plus 

One or Self Plus One to Self Only in children's equity cases with a court order. Instead, 

system administrators should program the systems to generate a “pop up” that alerts 

enrollees that they must contact their agency HR representative to verify that the family 

member designated in the Self Plus One enrollment is the child under court order. 

b. Actions to be Taken by the Agency HR Representatives 

Agency HR representatives are responsible for responding to inquiries from enrollees 

with court orders who have been referred to them by the system administrator. Agency 

HR representatives should manually process all health benefits enrollments 

involving court orders. Enrollees with court orders can decrease their enrollment from 

Self and Family to Self Plus One if the court order only covers one child, but this change 

must be made with paper (not electronically). In cases where the family member in the 

Self Plus One enrollment is not the family member under court order, the transaction 

must be rejected and notification sent to the enrollee of the rejection. 

III. Open Season Changes for Those Retiring at the End of 2015 

Employees who plan to retire at the end of 2015 should be discouraged from using 

electronic enrollment systems to make any Open Season changes. Instead, agency HR 

representatives should include a paper Standard Form (SF) 2809 in the retirement 

paperwork of individuals retiring during the time period from the end of Open Season 

2015 until the first day of the first pay period of 2016 who wish to make an Open Season 

change. 

In addition, agency HR representatives must check the agency’s electronic enrollment 

systems for future dated changes. A print out indicating future dated changes must be 

included in the retirement paperwork. This will ensure that OPM’s Retirement Services 

has the requisite information to process the requests in a timely fashion and will prevent 

duplication of enrollment actions. 

These actions are particularly relevant for the 2015 Open Season because of the volume 

of changes expected due to the availability of the new Self Plus One enrollment type. 
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However, agency HR representatives should follow these procedures every year for 

individuals retiring at the end of the year.

IV. Switching a Covered Family Member 

Under a Self Plus One enrollment, an enrollee may “switch” the designated family 

member based on certain QLEs experienced outside of Open Season. Switching a family 

member means that the enrollment type remains Self Plus One, but the designated family 

member changes. Effective dates for switching a covered family member will be 

prospective. BAL #15-205 (Self Plus One Final Rule Published) also discussed 

opportunities for switching a covered family member. 

An enrollee may not switch the designated family member if the QLE experienced is not 

consistent with that change. Please see the examples below: 

1. Situation when the enrollee may switch a covered family member 

An enrollee has a spouse and one eligible child. The enrollee’s spouse has 

coverage through his employer, so the enrollee enrolls in a Self Plus One 

enrollment and designates the eligible child as the covered family member. When 

the covered child turns age 26 and is no longer eligible to be covered under an 

FEHB enrollment as an eligible family member, the enrollee has the following 

options: 

a. The enrollee may remain in the Self Plus One enrollment and choose to 

switch the spouse for the child (who is no longer eligible) during the 31

days before until the 60 days following the QLE. In this circumstance, 

code 1C would be the applicable QLE code on the SF 2809 (for those 

participating in premium conversion) and would include the name of the 

newly designated eligible family member (the spouse). When the carrier 

receives this information, the carrier may request documentation to prove 

the eligibility of the newly designated family member, just as it currently 

does when a new family member is added to a Self and Family enrollment. 

b. The enrollee may choose to decrease the enrollment to Self Only during 

the 31 days before until the 60 days following the QLE. In this 

circumstance, code 1C would be the applicable QLE code on the SF 2809 

as well. 

It is important to emphasize that the window to report a QLE in all these situations is 

during the 31 days before until the 60 days following the QLE. If the enrollee does not 

report the QLE during this time period, he/she will need to wait until the next Open 

Season, or until another QLE occurs, to make the change. Retroactive switching of a 

covered family member is not allowed. 

2. Situation when the enrollee may NOT switch a covered family member 
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An enrollee has a Self Plus One enrollment and covers her spouse. The enrollee 

then adopts a child. This QLE is consistent with increasing enrollment to Self and 

Family but not with switching the covered family member from the spouse to the 

newly eligible child. 

V. QLEs That Occur After the 2015 Open Season and Prior to January 1, 2016 

Self Plus One enrollments will not be available for any coverage effective dates prior to 

January 1, 2016. If an enrollee experiences a QLE that necessitates a decrease or 

increase in coverage to Self Plus One after the 2015 Open Season (which ends on 

December 14, 2015) and prior to January 1, 2016, and the first day of the next pay period 

is prior to January 1, 2016, the Self Plus One enrollment option will not be available 

during that pay period. For instance: 

 For an enrollee on a bi-weekly pay cycle, the pay period following the 2015 Open 

Season runs from December 13-26, 2015. A change to Self Plus One cannot 

become effective on the first day of the next pay period because December 27, 

2015 is prior to January 1, 2016. 

 For an enrollee on a monthly pay cycle, the pay period following the 2015 Open 

Season begins on January 1, 2016. A change to Self Plus One can become 

effective on the first day of this pay period because it is after December 31, 2015. 

Agency HR representatives cannot process an enrollment change to Self Plus One for 

enrollees whose coverage effective dates are prior to January 1, 2016. Instead, these 

enrollees should be counseled to select a Self and Family enrollment due to the QLE and 

then decrease the enrollment to Self Plus One during the Limited Enrollment Period, 

which will run from February 1-29, 2016. Only decreases in enrollment type from Self 

and Family to Self Plus One will be allowed during the Limited Enrollment Period. For 

enrollees whose coverage effective date falls on or after January 1, 2016, HR 

representatives should process enrollment changes to Self Plus One. 

If you have additional questions, please contact the Self Plus One inbox at 

selfplusone@opm.gov. 

Sincerely, 

 John O’Brien 

Director 

Healthcare and Insurance