This section of the FEDERAL REGISTER

contains notices to the public of the proposed

issuance of rules and regulations. The

purpose of these notices is to give interested

persons an opportunity to participate in the

rule making prior to the adoption of the final

rules.

Proposed Rules Federal Register

35973

Vol. 61, No. 132

Tuesday, July 9, 1996

OFFICE OF PERSONNEL

MANAGEMENT

5 CFR Part 890

RIN 3206–AH46

Federal Employees Health Benefits

Program: Opportunities to Enroll and

Change Enrollment

AGENCY: Office of Personnel

Management.

ACTION: Proposed rule.

SUMMARY: The Office of Personnel

Management (OPM) is issuing proposed

regulations to simplify and clarify the

existing Federal Employees Health

Benefits (FEHB) Program regulations

concerning opportunities to enroll and

change enrollment. The proposed

regulations would make it easier for

employing offices to determine whether

circumstances permit individuals to

enroll or change enrollment, and would

result in a reduced potential for error

and improved customer service.

DATE: We must receive comments on or

before September 9, 1996.

ADDRESSES: Send written comments to

Lucretia F. Myers, Assistant Director for

Insurance Programs, Retirement and

Insurance Service, Office of Personnel

Management, P.O. Box 57, Washington,

DC 20044, or deliver to OPM, Room

3451, 1900 E Street NW., Washington,

DC.

FOR FURTHER INFORMATION CONTACT:

Barbara Myers (202) 606–0004.

SUPPLEMENTARY INFORMATION: The

events that permit individuals to enroll

for FEHB coverage or change enrollment

are specified in regulation. When the

FEHB Program first began over thirty

years ago, there were few events that

permitted individuals to enroll or

change their enrollment. Since then,

additional events have been added to

accommodate changes to FEHB law,

establishment of other Federal programs

that affected Federal employees and

retirees, and changes in the personal

circumstances of employees and

annuitants.

Among the changes to FEHB law have

been (1) extending FEHB coverage to

certain former spouses and temporary

employees, (2) providing temporary

continuation of coverage (TCC) for

enrollees and family members who lose

coverage under certain conditions, and

(3) prorating of premiums for part-time

employees. Some other Federal

programs that have been established

since the FEHB Program began that

affect Federal employees and retirees

are Medicare and the Federal Employees

Retirement System (FERS). Also, to

adapt to changes in the personal

circumstances of employees and

annuitants, FEHB regulations now

permit enrollment upon loss of nonFederal coverage under certain

conditions.

The inquiries we receive from the

White House, Members of Congress,

Federal agencies, employees, and other

individuals indicate that it is becoming

increasingly difficult for employing

offices to locate and interpret the

appropriate regulation when an

individual request to enroll or change

his or her enrollment. In addition, when

an employing office denies a request

because they do not believe the

circumstances comply with the

regulations, the individual usually asks

for reconsideration of that decision.

OPM has issued final regulations (59

FR 66434, December 27, 1994) that

delegate to Federal agencies the

authority to reconsider disputes over

coverage and enrollment and to make

retroactive as well as prospective

corrections of administrative errors. Our

proposed regulations would also give

agencies the authority to correct

enrollee errors under certain

circumstances. We believe that these

proposed regulations would help to

reduce both the number of agency

denial of enrollee requests and the

volume of reconsideration requests.

More specifically, we believe these

proposed regulations would improve

administration of the FEHB Program by:

1. Organizing the opportunities to

enroll and change enrollment into

separate sections for employees,

annuitants, former spouses, and those

on Temporary Continuation of

Coverage. This would reduce the time it

takes for the employing office to locate

the regulation applicable to the

individual that is being assisted.

2. Grouping several of the enrollment

opportunities within each section by

similar characteristics, such as

opportunities based on a change in

employment status, or a loss of health

benefits coverage. This further

organization of the events would make

it easier for the reader to locate the

event that is needed.

3. Standardizing as much as possible

the timeframes for individuals to enroll

or change enrollment. In some cases the

existing timeframe will increase from 31

to 60 days after the event. In other

situations the timeframe will be

extended to include a period before the

event as well as after. This

standardization would reduce the

number of belated enrollment requests

the employing offices receive, and help

to assure continuous coverage for

employees and family members whose

eligibility to enroll in FEHB or change

enrollment is based on a loss of other

coverage.

4. Locating effective date information

within the paragraph that describes the

enrollment or change opportunity.

Current regulations provide information

on enrollment opportunities in one

section and their corresponding

effective dates in another. This revision

would improve processing by making it

easier for the reader to determine the

appropriate effective date for a specific

enrollment or change opportunity.

5. Clarifying some of the

opportunities by removing certain hard

to define requirements that individuals

must meet to become eligible to enroll

or change enrollment. This increased

flexibility would make it easier for

employees to provide FEHB coverage for

their eligible children. It would also

make it easier for agencies to make

enrollment decisions, and reduce the

number of agency denials of requests to

enroll or change enrollment. Several

examples of the clarified opportunities

include:

a. Under current regulations

(paragraph 890.301(y)), an employee

may enroll, and an employee or

annuitant may change enrollment when

the employee or a family member

involuntarily loses coverage under a

non-Federal health plan. This

requirement has generated numerous

questions, denials, and reconsideration

request about whether the loss of nonFederal coverage in a specific situation

is voluntary or involuntary. To make it
35974 Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules

easier for families to continue their

health insurance protection upon loss of

non-Federal coverage, we are no longer

requiring agencies to determine what

constitutes an involuntary loss of nonFederal coverage. We also are extending

to enrollees covered under the former

spouse and TCC provisions the

opportunity to change from a self-only

to self and family enrollment when an

eligible family member loses nonFederal coverage.

b. Current regulations (paragraph

890.301(e)) permit an employee to

enroll upon a change in marital status,

but not upon any other change in family

status. We recognize that in some

situations an employee may have a

change in family status without a

change in marital status. Such situations

may include (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. Therefore, we are expanding this

regulation to also permit an employee to

enroll upon any other change in family

status.

Under current regulations, a new

enrollment takes effect at the beginning

of the pay period after the enrollment

request is received by the employing

office and that follows a pay period

during any part of which the employee

is in pay status. We recognize that in

some situations, the birth or acquisition

of a child may occur while an employee

is in a leave without pay status.

Therefore, in this situation only, we are

allowing the enrollment to take 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 a pay status the

previous pay period.

c. Under current regulations

(paragraph 890.301(g)(4)), an employee,

annuitant, or former spouse who

qualifies for FEHB coverage under

section 890.803, who loses coverage

because of cancellation of the covering

enrollment must enroll in the same plan

and option as that from which coverage

was lost. We recognize that there may be

situations in which the individual

enrolled for self and family cancels the

enrollment but the family member who

loses coverage does not want to enroll

in the same plan; or the enrollee of a

prepaid plan cancels the enrollment but

the family member who loses coverage

lives in a different geographic location.

As part of our effort to accommodate the

complex family situations that can

occur, we are eliminating this

requirement and permitting enrollment

in any plan or option when coverage is

lost because the covering enrollment has

been cancelled.

d. Current regulations (paragraph

890.301(t)) permit an employee to enroll

if his or her coverage under the

Medicaid program (State program of

medical assistance for the needy) should

terminate. They also permit an

employee who is enrolled for self only

to change to a self and family

enrollment if a family member loses

Medicaid coverage. Under our proposed

regulations, an employee who is not

enrolled may enroll if a family member

should lose Medicaid coverage.

Enrollees covered under the former

spouse and TCC provisions may change

from self only to self and family if an

eligible family member loses Medicaid

coverage. We also are extending to

annuitants and former spouses who

cancel their enrollment because they

qualify for Medicaid coverage the

opportunity to reenroll in the FEHB

Program upon loss of the Medicaid

coverage.

e. Under current regulations

(paragraph 890.301(h)), an enrollee in a

comprehensive medical plan who loses

coverage or access to health services

because of a change of address or place

of employment may change enrollment.

The enrollee must provide the

employing office with written

notification of his or her move or

employment change or ‘‘satisfactory’’

evidence of a family member’s move. To

accommodate alternative and more

automated systems of processing

enrollment changes, and to make it

easier for agencies to process enrollment

changes under this event, we are

removing the written notification

requirement and no longer requiring

agencies to determine what constitutes

‘‘satisfactory’’ evidence.

As part of our continuing effort to

improve service to FEHB enrollees, we

are revising paragraph 890.302(f)

concerning determinations of incapacity

for children over age 22. Under FEHB

law, a child’s coverage ends at age 22

unless the child is determined incapable

of self-support because of a physical or

mental disability that existed before age

22. Since current regulations require the

employing office (the retirement system

is the employing office for annuitants)

to make determinations of incapacity,

enrollees who contact their insurance

carrier to request continued coverage for

a disabled child are referred back to the

employing office. There are certain

medical conditions that would cause

children to be incapable of self-support

during adulthood, and if a child has one

of these conditions, we believe that

carriers should be able to extend

coverage without going back to the

employing agency. Therefore, we are

revising the regulations to permit either

the employing office or the carrier to

make determinations of incapacity in

such cases. We will provide an up-todate list of these medical conditions in

a Benefits Administration Letter and an

FEHBP Letter to All Carriers; if we need

to add or delete a condition in the

future, we will notify employing offices

and carriers promptly by means of these

publications. If a child has a medical

condition that is not on the list, the

employing office will continue to make

the determination.

We also will be adding the term

‘‘appropriate request’’ to our definitions.

This new definition will allow for

alternative and more automated

methods of processing enrollments.

These methods, which include

Employee Express, should result in

faster enrollment processing and

improved customer service.

Finally, we will be making a

conforming change to paragraph

890.803(a)(3)(i) to correct a reference to

§ 831.606, which has been redesignated

as § 831.613.

Regulatory Flexibility Act

I certify that these regulations will not

have a significant 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,

Retirement.

U.S. Office of Personnel Management.

James B. King,

Director.

Accordingly, OPM proposes to amend

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
Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules 35975

revised, the definitions for Cancellation,

Change of enrollment, Register, and

Register to enroll are removed, and the

definitions for Appropriate request,

Cancel, Change the enrollment, 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.

In addition, for an enrollment or

cancellation to be valid, the signature of

the requesting individual must be on the

request, or on a form from the

employing office that notifies the

requesting individual of the enrollment

or cancellation and requests his or her

confirmation. For changes of

enrollments, the signature of the

requesting individual is not required but

the employing office must promptly

give the requesting individual notice of

the change of enrollment. For purposes

of § 890.301, 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).

* * * * *

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 canceled.

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. 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 day 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 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 after 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 OPM 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 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—
35976 Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules

(1) A return to pay status following

loss of coverage under § 890.304(a)(1)(v)

due to the expiration of 365 days in

leave without pay (LWOP) status.

(2) Reemployment after a break in

service of more than 3 days.

(3) Restoration to a civilian position

under part 353 of this chapter or other

similar authority after being ordered to

duty in a uniformed service for 31 days

or more.

(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 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 enrolling under this

paragraph (h)(6) must enroll or change

the enrollment 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 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 or loss of access

to health services because the employee

or a covered family member in a

comprehensive medical plan moves or

becomes employed outside the

enrollment or service area, or, if already

outside the enrollment or service area,

moves or becomes employed further

from the enrollment or service area. The

employee may change the enrollment

upon notifying the employing office of

the move or change of place of

employment. The change of enrollment

takes effect on the first day of the pay

period that begins after the employing

office receives an appropriate request.

(4) Loss of coverage due to the

termination of membership in an

employee organization sponsoring or

underwriting an FEHB plan.

(5) 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)(5):

(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.

(6) Loss of coverage under the

Medicaid program (State program of

medical assistance for the needy).

(7) Loss of coverage under a nonFederal 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.

(8) Loss of coverage under a nonFederal health plan.

(j) 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.

(k) 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.

5. 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.

* * * * *

6. 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.

* * * * *

(7) In § 890.304, paragraph (a)(2) is

amended by removing ‘‘§ 890.301(ee)’’

and adding in its place ‘‘§ 890.301 (k)’’,

paragraph (b)(1) is amended by
Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules 35977

removing ‘‘§ 890.301 (q)’’ and adding in

its place ‘‘§ 890.306 (o)’’, and the first

two sentences of paragraph (d) are

revised to read as follows:

§ 890.304 Termination of enrollment.

* * * * *

(d) Cancellation. Except an 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

canceling the enrollment is received by

the employing office, except that the

cancellation of an enrollee having a

monthly or 4-weekly pay period takes

effect at the end of the pay period in

which the appropriate request is

received if the request is received

between the first and fifteenth day of the

pay period.* * *

* * * * *

8. 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 retirements, 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 clause 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 empoloying 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.

(2) A change of enrollment to self only

takes effect on the first day of the first

pay period after 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 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 sections 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

(State 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

Medicaid 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.

(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 sections 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 the Medicaid program.

(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

(State program of medical assistance for

the needy), and who involuntarily loses

coverage under Medicaid, 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 coverage. A reenrollment

under this paragraph (i) takes effect on

the date following the date of loss of

Medicaid coverage.

(2) An annuitant who cancelled his or

her enrollment because he or she

furnished proof of eligibility for

Medicaid coverage, and who wishes to

reenroll in a plan under this part for
35978 Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules

reasons other than an involuntary loss

of Medicaid 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

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

the 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, 1976,

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 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 losses 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 or loss of access

to health services because the annuitant

or a covered family member in a

comprehensive medical plan moves or

becomes employed outside the

enrollment or service area, or, if already

outside the enrollment or service area,

moves or becomes employed further

from the enrollment or service area. The

annuitant may change the enrollment

upon notifying the employing office of

the move or change of place of

employment. The change of enrollment

takes effect on the first day of the pay

period that begins after the employing

office receives an appropriate request.

(4) Loss of coverage due to the

termination of membership in an

employee organization sponsoring or

underwriting an FEHB plan;

(5) 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)(5)—

(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 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.

(iii) 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
Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules 35979

procedures that are provided under

sections 831.1305(d)(2) and

845.205(d)(2) of this chapter apply to

elections under this paragraph;

(6) Loss of coverage under the

Medicaid program (State program of

medical assistance for the needy).

(7) Loss of coverage under a nonFederal health plan.

(m) 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.

(n) 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.

(o) 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 may be made only once.

(p) Annuity insufficient to pay

withholdings. (1) If an annuity is

sufficient 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(f); or

(ii) Enroll in any plan in which the

annuitant’s share of the premium is less

than that 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, 1990.

(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 (p)(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.

(q) 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.

(r) 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.

§ 890.602 [Amended]

9. Section 890.602 is amended by

removing ‘‘register’’ and adding in its

place ‘‘elect to enroll’’.

§ 890.803 [Amended]

10. 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

‘‘§§ 831.613(a) and (b) and 842.605(a)

and (b) of this chapter’’.

11. 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 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 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.
35980 Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules

(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 after 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 sections 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 canceled

the enrollment under this part because

he or she furnished proof of eligibility

for coverage under the Medicaid

program (State 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 Medicaid 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 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 canceled enrollment to enroll in a

Medicare-sponsored Coordinated Care

Plan. (1) A former spouse who had been

enrolled for coverage under this part

and canceled enrollment for the purpose

of enrolling in a prepaid health plan

under sections 1833 or 1876 of the

Social Security Act, 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 canceled enrollment because of

eligibility under the Medicaid program.

(1) A former spouse who had been

enrolled (or was otherwise eligible to

enroll) for coverage under this part and

canceled the enrollment because he or

she furnished proof of eligibility for

coverage under the Medicaid program

(State program of medical assistance for

the needy), and who involuntarily loses

coverage under Medicaid, 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 coverage. A reenrollment

under this paragraph (i) takes effect on

the date following the date of loss of

Medicaid coverage.

(2) A former spouse who canceled his

or her enrollment because he or she

furnished proof of eligibility for

Medicaid coverage, and who wishes to

reenroll in a plan under this part for

reasons other than an involuntary loss

of Medicaid 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. A

former spouse who has established

eligibility for health benefits under

§ 890.803 and met the application time

limitations of § 890.805, and who is not

enrolled as a former spouse but is

covered by another enrollment under

this part or under another group health

benefits plan, may enroll upon loss of

the other coverage. 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 enroll or change the enrollment

within the period beginning 31 days

before and ending 60 days after the 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 or access to

health services because the former

spouse or a covered family member in

a comprehensive medical plan moves or

becomes employed outside the

enrollment or service area, or, if already

outside the enrollment or service area,

moves or becomes employed further

from the enrollment or service area. The

former spouse may change the

enrollment upon notifying the

employing office of the move or change

of place of employment. The change of

enrollment takes effect on the first day

of the pay period that begins after the

employing office receives an

appropriate request.

(4) Loss of coverage due to the

termination of membership in an

employee organization sponsoring or

underwriting an FEHB plan;

(5) 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)(5)—

(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
Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules 35981

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. (6) Loss of coverage under the

Medicaid program (State program of

Medical assistance for the needy). (7) Loss of coverage under a nonFederal health plan. (k) 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. (1) 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 will be subject to the

provisions of section 890.807(c). (12) Section 890.807 is amended by

revising the heading for paragraph (c)

and revising paragraph (c)(1) to read as

follows:

§ 890.807 Termination of enrollment.

* * * * *

(c) Failure to make an election under

§ 890.806(l). (1) If the 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.

* * * * *

13. 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).

14. Section 890.1105 is amended by

revising the section heading and adding

headings for paragraphs (b), (c), (d), and

(f), by revising paragraphs (d) and (f),

and by adding a new paragraph (g) to

read as follows:

§ 890.11.05 Initial election of temporary

continuation of coverage; application time

limitations and effective dates.

* * * * *

(b) Former employees. * * *

(c) Children. * * *

(d) Former spouses. (a) 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 or former spouse

notified the agency 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 agency described in

§ 890.1104(c)(2). If neither the employee

nor the former spouse notified the

agency 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

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. 15. 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 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 after 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
35982 Federal Register / Vol. 61, No. 132 / Tuesday, July 9, 1996 / Proposed Rules

day of the pay period following the one

in which there was no family member.

(e) Open season. (1) During the 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 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 alone 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

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 or loss of access

to health services because the enrollee

or a covered family member in a

comprehensive medical plan moves or

becomes employed outside the

enrollment or service area, or, if already

outside the enrollment or service area,

moves or becomes employed further

from the enrollment or service area. The

enrollee may change the enrollment

upon notifying the employing office of

the move or change of place of

employment. The change of enrollment

takes effect on the first day of the pay

period that begins after the employing

office receives an appropriate request.

(4) Loss of coverage due to the

termination of membership in an

employee organization sponsoring or

underwriting an FEHB plan.

(5) 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)(5)—

(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.

(6) Loss of coverage under the

Medicaid Program (State program of

medical assistance for the needy).

(7) Loss of coverage under a nonFederal health plan.

(i) 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.

[FR Doc. 96–17248 Filed 7–8–96; 8:45 am]

BILLING CODE 6325–01–M

DEPARTMENT OF AGRICULTURE

Agricultural Marketing Service

7 CFR Part 1280

[Docket Number LS–96–006]

Sheep Promotion, Research, and

Information Program

AGENCY: Agricultural Marketing Service;

USDA.

ACTION: Notice of Referendum;

Referendum Order.

SUMMARY: The Agricultural Marketing

Service (AMS) is announcing that a

second referendum will be conducted

among eligible sheep producers, sheep

feeders, and importers of sheep and

sheep products to determine whether

the Sheep and Wool Promotion,

Research, Education, and Information

Order (Order) will become effective as

authorized under the Sheep Promotion,

Research, and Information Act of 1994

(Act). This action is a result of a review

conducted by the Department of

Agriculture (Department) that revealed

that the referendum rules were applied

inconsistently at the official polling

places during the February 6, 1996,

nationwide referendum. Consequently,

the results of the February 6, 1996,

nationwide referendum were voided.

DATES: Referendum Dates: In-person

voting in the referendum will be

conducted on October 1, 1996, by

county Cooperative Extension Service

(CES) offices. Absentee ballots will be

available at county CES offices from

August 26, 1996, through September 17,

1996. The representative period to

establish voter eligibility will be the

period from January 1, 1994, through

December 31, 1994.