`[Federal Register Volume 61, Number 132 (Tuesday, July 9, 1996)]
[Proposed Rules]
[Pages 35973-35982]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-17248]


 ========================================================================
 Proposed Rules
                                                 Federal Register
 ________________________________________________________________________
 
 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.
 
 ========================================================================
 

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

[[Page 35973]]



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 non-Federal 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 non-
Federal coverage in a specific situation is voluntary or involuntary. 
To make it

[[Page 35974]]

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 non-Federal 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 non-Federal 
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-
to-date 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 Sec. 831.606, which has been 
redesignated as Sec. 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; Sec. 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 Sec. 890.101, paragraph (a), the definitions for Enrolled and 
Enrollee are

[[Page 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:


Sec. 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 Sec. 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 Secs. 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 Sec. 890.303.
 * * * * *
    3. In Sec. 890.103, paragraphs (c) and (d) are redesignated as (d) 
and (e), and a new paragraph (c) is added to read as follows:


Sec. 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:


Sec. 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--

[[Page 35976]]

    (1) A return to pay status following loss of coverage under 
Sec. 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 non-Federal 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 non-Federal 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 Sec. 890.302, paragraph (f) is revised to read as follows:


Sec. 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 self-support 
during adulthood.
* * * * *
    6. In Sec. 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:


Sec. 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 Sec. 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 Sec. 890.304, paragraph (a)(2) is amended by removing 
``Sec. 890.301(ee)'' and adding in its place ``Sec. 890.301 (k)'', 
paragraph (b)(1) is amended by

[[Page 35977]]

removing ``Sec. 890.301 (q)'' and adding in its place ``Sec. 890.306 
(o)'', and the first two sentences of paragraph (d) are revised to read 
as follows:


Sec. 890.304  Termination of enrollment.

* * * * *
    (d) Cancellation. Except an provided in ``Sec. 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:


Sec. 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 Sec. 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 
Sec. 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 Sec. 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

[[Page 35978]]

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 
Sec. 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

[[Page 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 non-Federal 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 Sec. 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 Sec. 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.


Sec. 890.602  [Amended]

    9. Section 890.602 is amended by removing ``register'' and adding 
in its place ``elect to enroll''.


Sec. 890.803  [Amended]

    10. In Sec. 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 
``Secs. 831.613(a) and (b) and 842.605(a) and (b) of this chapter''.
    11. Section 890.806 is revised to read as follows:


Sec. 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 Sec. 890.803 and the application time 
limitation requirements of Sec. 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.

[[Page 35980]]

    (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 
Sec. 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 Sec. 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 
Sec. 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 Sec. 890.803 and met the application time 
limitations of Sec. 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 Sec. 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 Sec. 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

[[Page 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 non-Federal 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 Sec. 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:
Sec. 890.807  Termination of enrollment.
* * * * *
    (c) Failure to make an election under Sec. 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 Sec. 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 Sec. 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:
Sec. 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:


Sec. 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 Sec. 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 
Sec. 890.1104(c)(1), the date the former spouse received the notice 
from the agency described in Sec. 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 Sec. 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:
Sec. 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

[[Page 35982]]

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 
Sec. 890.301(f), an enrollee (except for a former spouse who is 
eligible for continued coverage under Sec. 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 Sec. 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 
Sec. 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 
Sec. 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 Sec. 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 Sec. 890.1107. Coverage does not extend beyond the 
expiration of the period described in Sec. 890.1107. The effective date 
of the reenrollment is the day following the termination of the 
coverage described in Sec. 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 non-Federal 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`