Office of Personnel Management

Retirement and Insurance Group

1920 1954 1959 

 

1986 

Benefits Administration Letter

Number: 95-406 Date: September 25,1995 

SUBJECT: FEHB Open Season: Conducting the 1995 Open Season

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GENERAL

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 Changes in Based on the responses we received to the survey in last 

 FEHB Guides year's FEHB Guides, we made several changes to the

Guide itself: a) a definitions section was added, b) more

information about enrollment was provided, and c) we made

it easier to find prepaid plans in the comparison chart

section by listing them by name instead of location.

In the new definition of "Plan Pays" we added an alert which

directs readers to check fee-for-service plan brochures for

details about benefits. Some fee-for-service plans made

substantive changes in their coinsurance and copayments

this year.

We included the complete results of our recent survey of

members about their plans. (Last year, we published the

results separately during Open Season.)

We reduced the quantity of the RI 70-8 (the Guide for

certain temporary employees) agencies will receive this

year. For 1996 your shipment will be reduced to 60% of

eligible employees.

To make it easier for people to access the FEHB Guide,

we're putting it on our electronic bulletin board, OPM

Mainstreet.

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Benefits Administration Letter 95-406

 Counseling Agencies are responsible for counseling employees who

 Employees ask for help on health benefits matters. Counseling should

be limited to answering questions about the FEHB Program

and the application of the FEHB law and regulations to

particular circumstances.

! Since the amount of enrollment information in the

FEHB Guides may not be sufficient for the purposes

of particular employees, the personnel office should

refer employees to their plan brochure if the

requested information is available there.

! Counselors also should try to answer any specific

question on benefits by referring to the applicable

brochure. If the question cannot be answered from

the brochure, the agency should tell the employee to

contact the health plan. Employees should not,

however, be referred to a plan if the question

concerns any subject other than benefits or a

conversion contract.

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 Plan In BAL 95-404, OPM notified agency headquarters

 Terminations Insurance Officers of the names of the plans that are

dropping out of the FEHB Program or dropping an

enrollment area with a separate enrollment code at the end

of 1995. Agencies must notify affected employees of the

termination of their health plans' FEHB participation.

! We strongly recommend that agencies distribute the

lists of terminating plans and terminating enrollment

areas to all enrollees, so they can check to see

whether their plan will be participating in the FEHB

Program and their enrollment code is valid in 1996.
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Benefits Administration Letter 95-406

Employees whose plan will not participate in the Program or

whose plan is dropping an enrollment area that has a

separate enrollment code after December 31, 1995, must

enroll in a different plan to continue FEHB coverage next

year. You should monitor employees who are enrolled in

these terminating plans/codes and follow up with those who

have not submitted a change of enrollment before the end of

open season.

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 Annuitant Some annuitants may contact their former employing

 Inquiries offices asking for SF 2809 (Health Benefits Registration

Form).

! CSRS and FERS - OPM does not use SF 2809 to register

open season changes for Civil Service Retirement System

and Federal Employees Retirement System annuitants. 

These annuitants must use the individualized OPM 2809-

EZ1 preprinted with their name, address, and claim number. 

The 2809-EZ1 is included in the open season package sent

to each enrolled CSRS and FERS annuitant before open

season begins. If an annuitant loses or does not receive the

package or form, he/she can get one from OPM by calling

202-606-0500, or by writing to:

Office of Personnel Management

Open Season Task Force

P.O. Box 809

Washington, DC 20044-0809

The hearing-impaired who have access to a TDD machine

may call OPM's Retirement Information Office TDD number: 

202-606-0551.

When communicating with OPM, annuitants always should

provide their CSA/CSF or FERS claim number and/or their
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Social Security number.

Benefits Administration Letter 95-406

! Other retirement systems - These annuitants should be

told to contact their retirement system for the proper

registration form.

! OWCP - Former employees receiving benefits from the

Office of Workers' Compensation Programs should contact

the OWCP office that maintains their FEHB records.

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CARRIER ACCESS

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 Health Fairs We strongly encourage agencies to hold health fairs or to

permit representatives of FEHB carriers to address groups

of employees on their plan's benefits, methods of obtaining

services, and similar matters.

Carrier representatives must confine their presentations to

benefit provisions and claims procedures of the FEHB plan

they represent. Questions not pertaining to benefits or

claims should be referred to the agency's insurance official.

! The purpose of the fair is to inform, not to promote. 

You should explicitly discourage carriers from

distributing trinkets, holding raffles, or engaging in

similar activities that divert attention from the primary

goal.

! Since the plans' marketing material may not be

available until the beginning of open season, you

should not hold any health fairs prior to the start of

open season.
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Benefits Administration Letter 95-406

 Other Companies Agencies are frequently contacted by companies wishing to

sell dental insurance or other types of "supplemental"

policies to Federal employees. These companies may send

marketing material to agencies, asking the agencies to

distribute it; they may ask to be invited to the agency's

health fairs; they may even show up at health fairs uninvited.

We strongly discourage agencies from assisting in the

marketing efforts of these private companies, including

companies FEHB carriers may have contracted with. To

ensure the integrity of the FEHB Program, agencies should

limit access to their premises to those health plans actually

participating in the FEHB Program, i.e., those plans listed in

the FEHB Guide.

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OPEN SEASON CHANGES

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 Permissible The following changes in registration may be made

 Actions during open season:

 1. An eligible employee who is not enrolled may register

to enroll.

 2. An enrollee may change from one plan or option to

another, from self only to self and family, or make any

combination of these changes.

New enrollments and enrollment changes for permissible

reasons other than the open season can be made, as usual,

between November 13 and December 11, 1995. However,

these changes should not be mistakenly identified as open

season changes.
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Benefits Administration Letter 95-406

Whether an employee is enrolling or changing enrollment

based on open season or some other qualifying event, it is

important that the correct event number be noted on the SF

2809, so that the correct effective date will be assigned.

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 Timely The employing office must receive an open season

 Registration change on SF 2809 no later than close of business on

December 11, 1995, for the change to be considered filed

on time.

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 Belated An employing office has the authority to accept a late

 Registration registration, if it determines that the employee was unable to

submit SF 2809 on time because of circumstances beyond

the employee's control. While we

normally encourage agencies to make limited use of this

authority, we recommend that you take a liberal view in

cases where an employee's plan is terminating its FEHB

participation.

If you decide to accept an employee's late registration, write

"Belated Open Season Enrollment/Change" in the

"Remarks" section of the SF 2809. Attach to copy 1 of the

SF 2809 the employee's statement explaining why he/she

could not register on time, or add your own note if the

reason was an agency problem.

If you decide that the delay in filing is not due to a cause

beyond the employee's control, do not accept the

employee's late request. Notify the employee in writing that

you are not approving the late enrollment. Give the reason

for your denial and include a statement of the employee's

right to request reconsideration within 30 days after the date

of your notice.
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Benefits Administration Letter 95-406

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 Effective Dates From not enrolled to enrolled - Effective the first day of the

first pay period which begins on or after January 1, 1996,

and which follows a pay period in any part of which the

employee was in pay status.

! However, enrollment of a new employee who

happens to register for the first time during open

season is effective the same as for all new

employees, i.e., the first day of the first pay period

after the employing office receives the SF 2809.

Enrollment change - Effective the first day of the first pay

period which begins on or after January 1, 1996, regardless

of whether or not the employee was in pay status during the

preceding pay period.

Belated open season action - Effective retroactive to the first

day of the first pay period which begins on or after January

1, 1996. This effective date is the same as that of an open

season change filed on time.

! If the belated change is from not enrolled to enrolled,

the requirement of having been in pay status during

the preceding pay period also must be met.

Cancellation - Effective the last day of the pay period in

which the employing office receives SF 2809.

! Enrollees may cancel their health insurance at any

time, without waiting for an "event" or an open

season. The effective date is therefore different from

the effective date of actions related to open season.
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Benefits Administration Letter 95-406

 Cancellation Agencies should counsel employees about the

consequences of cancelling their enrollment.

Remember that an employee must have been covered under

the FEHB Program continuously for the five years of service

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

all periods of service during which he/she was eligible for

FEHB coverage and for participation in a retirement system)

in order to continue health benefits coverage after

retirement.

! If an employee is cancelling his/her enrollment to be

picked up by a spouse's open season enrollment, be

sure to coordinate the cancellation with the effective

date of the spouse's enrollment to prevent a break in

coverage.

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 Deductibles If an employee changes plans, covered expenses incurred

between January 1, 1996, and the effective date of the open

season change will count toward the 1995 deductible of the

plan from which he/she is changing.

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AGENCY ACTIONS

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 Prompt It is imperative that agencies process open season

 Processing enrollments and enrollment changes promptly. Payroll

offices should process enrollee and carrier copies of SF
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2809 on a daily basis.

! Gaining carriers must be notified of new enrollments

so the carrier can complete the paperwork necessary

to provide coverage for the employee and covered

family members and issue identification cards to the

new enrollees.

Benefits Administration Letter 95-406

! Losing carriers must be notified as soon as possible

of enrollment terminations, so they won't guarantee or

provide benefits to employees or family members

after the termination.

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 Verification Employees often become concerned when they do not

 of Employee receive their identification card(s) from a new plan

 Coverage within a short time after the end of open season. If an

employing office receives this type of inquiry, it should first

contact the payroll office to determine when the carrier was

notified of the change. If more than a month has passed

since the SF 2809 was sent, the employing office should

contact the carrier to determine the reason for the delay and

to relay the employee's request for identification cards.

An employee may need verification of coverage under

his/her plan before processing of the enrollment or

enrollment change has been completed. Employing offices

should verify that the employee is covered under the plan

and inform the requesting party (e.g., carrier, doctor,

hospital) of the effective date of the coverage.

Employing offices should also remind employees that their

copy of the SF 2809 is acceptable as proof of enrollment

until they receive their identification card(s) from the plan.

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Benefits Administration Letter 95-406

 Reconciliation After open season is completed, agencies will receive

 Requests requests from carriers to reconcile enrollment records. 

These requests should receive the highest priority. The

reconciliation process is critical to ensure that carriers

receive the proper premium payments and that enrollees are

properly reflected on plans' records.

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Abby L. Block, Chief

Insurance Policy

 and Information Division