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United States 

Office of 

Personnel Management 

The Federal Government’s Human Resources Agency

Benefits Administration Letter

Number: 15-205 Date: September 17, 2015

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

Published

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. 

This Benefits Administration Letter (BAL) highlights several important aspects of the final rule, including: 

 First opportunity to elect Self Plus One 

 Limited Enrollment Period 

 Definition of increase and decrease enrollment 

 Qualifying Life Events (QLEs) that provide opportunities to increase and/or decrease enrollment 

 QLEs that provide opportunities to switch a covered family member 

 Application of the 31 day extension of coverage 

 Rates and rate-setting 

First opportunity to elect Self Plus One 

The Self Plus One enrollment type will be available beginning plan year 2016. Enrollees will be able to 

select a Self Plus One enrollment type during the 2015 Open Season for effective dates in January of 

2016. 

Limited Enrollment Period 

Given that the addition of a new enrollment type is a change of unprecedented proportion in the FEHB 

Program, OPM has amended §892.207(d) in the final rule to include an additional Limited Enrollment 

Period to be held in early 2016. OPM will allow certain enrollment changes to be made during the 
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Limited Enrollment Period that will run from February 1, 2016 until February 29, 2016. This Limited 

Enrollment Period is intended to allow individuals who miss Open Season and want to change their 

enrollment from Self and Family to Self Plus One. It will not apply to annuitants and other individuals 

who do not participate in premium conversion because they may decrease their enrollment at any time. 

The Limited Enrollment Period is not an extension of Open Season. Enrollees should be encouraged to 

utilize Open Season to select the appropriate coverage for themselves and their family for plan year 

2016.

The following applies to changes made during this Limited Enrollment Period: 

• Only for employees enrolled in Self and Family. 

• Only those who participate in premium conversion will be allowed to decrease enrollment to 

Self Plus One (others may decrease enrollment at any time) using the Limited Enrollment Period 

QLE code. 

• Decreases in enrollment to Self Plus One will be the only allowed enrollment changes. 

• No changes in plans, no option changes, no increases or other decreases in enrollment will be 

allowed. 

• All enrollment changes will be prospective to the first day of the first pay period following the 

one in which the change is requested. 

• QLE code 1Z should be utilized to initiate a change during the Limited Enrollment Period. 

Definition of increase and decrease enrollment 

The final rule implements the following definitions for the terms “decrease enrollment type” and 

“increase enrollment type”: 

 Decrease enrollment type means a change in enrollment from Self and Family to Self Plus One 

or to Self Only, or a change from Self Plus One to Self Only. 

 Increase enrollment type means a change in enrollment from Self Only to Self Plus One or to 

Self and Family, or a change from Self Plus One to Self and Family. 

QLEs that provide opportunities to increase and/or decrease enrollment 

The final rule allows individuals with a Self Plus One enrollment to make enrollment changes during 

Open Season and consistent with the guidelines for current FEHB QLEs. The following chart summarizes 

when enrollment changes may be allowed. Definitions for each of the event codes can be found on the 

SF2809 at http://www.opm.gov/forms/pdf_fill/sf2809.pdf. 

For Enrollees Participating in Premium Conversion

Change Permitted for the following event codes

Increase enrollment 1B, 1C, 1E, 1F, 1I, 1J, 1K, 1M, 1N, 1O, 1R

Decrease enrollment 1B, 1C, 1E, 1F, 1G, 1H, 1J, 1M, 1N, 1O, 1P, 1Q, 1R

 

 
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For Annuitants (decreases in enrollment type are allowed at any time)

Change Permitted for the following event codes

Increase enrollment 2A, 2B, 2F, 2G, 2H, 2I, 2J, 2K 

 

For Former Spouses Under the Spouse Equity Provision (decreases in enrollment type are allowed at 

any time)

Change Permitted for the following event codes

Increase enrollment 3B, 3C, 3F, 3G, 3H, 3I

For Temporary Continuation of Coverage (TCC) for Eligible Former Employees, Former Spouses, and 

Children (decreases in enrollment type are allowed at any time)

Change Permitted for the following event codes

Increase enrollment 4A (for eligible former employees only), 4B, 4C, 4D, 4F, 4G, 

4H

 

For Employees Not Participating in Premium Conversion (decreases in enrollment type are allowed at 

any time)

Change Permitted for the following event codes

Increase enrollment 5B, 5C, 5D, 5E, 5F, 5G, 5H, 5I, 5J, 5N

QLEs that provide opportunities to switch a covered family member 

The final rule provides enrollees with limited opportunities to switch their covered family member 

during the annual Open Season and outside of Open Season upon experiencing a change in family 

status, a change in coverage, or a change in eligibility. Switching a covered family member may be 

allowed based on the QLEs outlined in the following chart. Definitions for each of the event code can be 

found on the SF2809 at: http://www.opm.gov/forms/pdf_fill/sf2809.pdf. 

For Enrollees Participating in Premium Conversion

Change Permitted for the following event codes

Switch covered family member under a 

Self Plus One enrollment

1B, 1C, 1I, 1J, 1M, 1N, 1O, 1P, 1Q, 1R

 

For Annuitants 

Change Permitted for the following event codes

Switch covered family member under a 

Self Plus One enrollment

2A, 2B, 2F, 2G, 2H, 2I, 2J

 
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For Former Spouses Under the Spouse Equity Provision

Change Permitted for the following event codes

Switch covered family member under a 

Self Plus One enrollment

3B, 3C, 3F, 3G, 3H, 3I

 

For Temporary Continuation of Coverage (TCC) for Eligible Former Employees, Former Spouses, and 

Children 

Change Permitted for the following event codes

Switch covered family member under a 

Self Plus One enrollment

4B, 4C, 4D, 4F, 4G, 4H

 

For Employees Not Participating in Premium Conversion 

Change Permitted for the following event codes

Switch covered family member under a 

Self Plus One enrollment

5B, 5C, 5F, 5G, 5H, 5I, 5J, 5N

The final rule clarifies that switching a covered family member must be consistent with the QLE 

experienced. 

For example, if an enrollee has a spouse and a child, but only covers their spouse with a Self Plus One 

enrollment, in the event that the enrollee and spouse are divorced, the enrollee may choose to stay in 

Self Plus One and switch their covered family member to terminate their spouse’s coverage and add 

their eligible child to the enrollment. However, if an enrollee covers a spouse under a Self Plus One 

enrollment and then has a child, the enrollee would be allowed to increase to Self and Family to cover 

all of their eligible family members, but not to switch from covering their spouse to covering their new 

child under a Self Plus One enrollment. In both of these scenarios, QLE code 1C may permit these 

changes if they are consistent with the QLE experienced. Note that in the first example, the designated 

family member is no longer legally eligible to be covered under an FEHB enrollment as a family member 

as a result of the divorce. Thus, switching a covered family member is consistent with the QLE 

experienced. However in the second example, the eligibility of the spouse has not changed. Therefore, 

terminating or cancelling the spouse’s coverage in order to cover the eligible child, based solely on the 

birth of the child, is not a change consistent with the QLE experienced. 

To clarify effective dates for switching a covered family member, 5 CFR §892.207(b) has been updated in 

the final rule. Enrollment changes made under §892.207 are, in general, effective on the first day of the 

first pay period following the one in which the appropriate paperwork is received by the employing 

office. In addition, paragraph (f)(2) has been added to §890.302 in the final rule to specify that the 

effective date for switching a covered family member will be prospective. Like other enrollment changes 

based on QLEs, enrollees will have from 31 days before until 60 days after the QLE to make their 

enrollment change. 
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Enrollees will need to complete a Standard Form (SF) 2809 to switch a covered family member although 

their enrollment code will not change. Carriers will not be able to switch a covered family member 

under a Self Plus One enrollment without a SF 2809. OPM is coordinating with electronic enrollment 

systems government-wide to implement this change. 

Application of the 31 day extension of coverage 

Switching a covered family member may occur as the result of either a termination or a cancellation. 

Eligibility for the 31-day extension of coverage is provided under 5 CFR 890.401(a)(1) for covered family 

members whose coverage is terminated other than by cancellation of the enrollment or discontinuance 

of the plan, in whole or in part. For covered family members, terminations are typically based on a loss 

of eligibility such as, in the case of a child, turning age 26; or, in the case of a spouse, a divorce. When an 

enrollee switches a covered family member due to a termination, the family member whose enrollment 

has been terminated is eligible for the 31-day extension of coverage. 

Cancellation is typically a voluntary election to no longer be covered under an FEHB plan. For example, 

when a designated family member becomes eligible for other group coverage, the enrollee may elect to 

cancel FEHB coverage for that family member and designate another eligible family member under the 

Self Plus One enrollment. When an enrollee switches a covered family member due to a cancellation, 

the family member whose coverage has been cancelled is not eligible for the 31-day extension of 

coverage. 

 Rates and rate-setting 

The final rule does not set differentials between enrollment tiers, nor does it impose caps on premium 

growth. Under the three tier system, carriers will set rate differentials between tiers that are 

appropriate for the population they will be covering, just as they do under the two tier system. The 

2015 Self and Family headcount will be used to calculate the weighted average for both the 2016 Self 

Plus One and Self and Family tiers. The weighted average for Self Plus One will be based on the 2016 Self 

Plus One premiums and the 2015 Self and Family headcount. 

Additional guidance is forthcoming on these and other topics. For follow up questions, please contact 

selfplusone@opm.gov. 

Sincerely, 

 John O’Brien

Director 

 Healthcare and Insurance