Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Rules and Regulations 50183 

Code. Such adjusted rates may not 

exceed the new rate for Executive 

Schedule level II or other applicable 

maximum established for the critical 

position. However, the employee must 

have at least a rating of Fully Successful 

or equivalent, and subsequent 

adjustments must be based on labor 

market factors, recruitment and 

retention needs, and individual 

accomplishments and contributions to 

an agency’s mission. 

(d) Employees receiving critical 

position pay are not entitled to localitybased comparability payments 

established under 5 U.S.C. 5304, special 

rate supplements under 5 U.S.C. 5305, 

or other similar payments or 

supplements under other legal 

authority. 

(e) If an agency discontinues critical 

position pay for a given position (on its 

own initiative or because OPM, in 

consultation with OMB, terminates the 

authority under § 535.103(d)), the 

employee’s rate of basic pay will be set 

at the rate to which the employee would 

be entitled had he or she not received 

critical pay, as determined by the head 

of the agency, unless the employee is 

eligible for a higher payable rate under 

the General Schedule maximum payable 

rate rule in § 531.221 and the agency 

chooses to apply that rule. 

§ 535.106 Treatment as rate of basic pay. 

A critical position pay rate is 

considered a rate of basic pay for all 

purposes, including any applicable 

premium pay, except—

(a) Application of any saved pay or 

pay retention provisions (e.g., 5 U.S.C. 

5363); or 

(b) Application of any adverse action 

provisions (e.g., 5 U.S.C. 7512). 

§ 535.107 Annual reporting requirements. 

(a) OPM must submit an annual report 

to Congress on the use of the critical 

position pay authority. Agencies must 

submit the following information to 

OPM by January 31 of each year on their 

use of critical position pay authority for 

the previous calendar year: 

(1) The name, title, pay plan, and 

grade/level of each employee receiving 

a higher rate of basic pay under this 

subpart; 

(2) The annual rate or rates of basic 

pay paid in the preceding calendar year 

to each employee in a critical position; 

(3) The beginning and ending dates of 

such rate(s) of basic pay, as applicable; 

(4) The rate or rates of basic pay that 

would have been paid but for the grant 

of critical position pay. This includes 

what the rate or rates of basic pay were, 

or would have been, without critical 

position pay at the time critical position 

pay is initially exercised and any 

subsequent adjustments to basic pay 

that would have been made if critical 

position pay authority had not been 

exercised; and 

(5) Whether the authority is still 

needed for the critical position(s). 

PART 536—GRADE AND PAY 

RETENTION 

■ 4. The authority citation for part 536 

continues to read as follows: 

Authority: 5 U.S.C. 5361–5366; sec. 4 of 

the Performance Management and 

Recognition System Termination Act of 1993, 

Pub. L. 103–89, 107 Stat. 981; § 536.405 also 

issued under 5 U.S.C. 552, Freedom of 

Information Act, Pub. L. 92–502; § 536.308 

also issued under section 301(d)(2) of the 

Federal Workforce Flexibility Act of 2004, 

Pub. L. 108–411, 118 Stat. 2305. 

Subpart A–General Provisions 

■ 5. Amend § 536.102 as follows: 

■ a. Remove ‘‘or’’ at the end of 

paragraph (b)(7); 

■ b. Remove the period at the end of 

paragraph (b)(8) and add ‘‘; or’’ in its 

place; and 

■ c. Add paragraph (b)(9) to read as 

follows: 

§ 536.102 Coverage. 

* * * * * 

(b) * * * 

(9) Is reduced in pay upon 

termination of a critical position pay 

authority under 5 CFR part 535. 

* * * * * 

[FR Doc. E8–19758 Filed 8–25–08; 8:45 am] 

BILLING CODE 6325–39–P 

OFFICE OF PERSONNEL 

MANAGEMENT 

5 CFR Part 894 

RIN 3206–AL03 

Federal Employees Dental and Vision 

Insurance Program 

AGENCY: Office of Personnel 

Management. 

ACTION: Final rule. 

SUMMARY: The Office of Personnel 

Management (OPM) is issuing final 

regulations to administer the Federal 

Employee Dental and Vision Benefits 

Enhancement Act of 2004, signed into 

law December 23, 2004. This law 

establishes dental and vision benefits 

programs for Federal employees, 

annuitants, and their eligible family 

members. 

DATES: September 25, 2008. 

FOR FURTHER INFORMATION CONTACT: 

Nataya Battle, (202) 606–1874, or e-mail 

at nataya.battle@opm.gov. 

SUPPLEMENTARY INFORMATION: 

Background 

On December 23, 2004, Public Law 

108–496, 118 Stat. 4001, was signed into 

law. This law established a dental 

benefits and vision benefits program for 

Federal employees, annuitants, and 

their eligible family members. The first 

effective date of coverage was December 

31, 2006. 

On October 15, 2007, OPM published 

interim regulations in the Federal 

Register (72 FR 58243–58248) to 

administer the Federal Employees 

Dental and Vision Insurance Program 

(FEDVIP). Comments were requested by 

December 15, 2007. OPM received 

comments from an employee union, a 

participating health plan in the FEHB 

Program, and an independent 

organization. 

One comment addressed the role of 

the carriers and the Administrator in the 

handling of the enrollment process. 

OPM contracts with the Administrator 

which has agreed to handle all aspects 

of the enrollment process on behalf of 

the carriers. Therefore the regulations 

have been revised to substitute 

‘‘Administrator’’ for ‘‘carrier’’ wherever 

there is a reference to the enrollment 

process. 

Another comment addressed concerns 

that OPM does not review appeals for 

denial of a claim. The dental and vision 

carriers conduct their own disputed 

claims process and are required to use 

an independent third party to conduct 

a final analysis of any dispute, upon 

appeal. This process was established to 

ensure an independent evaluation is 

conducted, but at minimal cost to 

Program enrollees. 

A comment indicated that it was not 

clear whether enrollment or coverage 

would be denied for preexisting dental 

conditions. Under this Program, neither 

enrollment nor benefits coverage is 

denied due to a preexisting dental 

condition. However, since the dental 

program was established in order to 

provide benefits for dental services for 

teeth and their surrounding tissues, a 

carrier may determine that coverage 

does not extend to replacements for 

teeth missing before the effective date of 

enrollment in the Program. 

Another comment suggested revising 

the language in § 894.601(a) to remove 

the reference to coverage ending at the 

end of the pay period ‘‘in which you 

were last eligible’’ and in § 894.601(b) to 

remove the reference to coverage ending 

at the end of the pay period for which 

the last premium allotment was made; 


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and replace them each with coverage 

ending ‘‘at the end of the period covered 

by your last premium payment.’’ It is 

not our intention to terminate an 

enrollment prior to the end of an 

enrollees’ eligibility for coverage. 

Therefore, we did not adopt this 

suggestion. 

The regulations have also been 

revised at § 894.602 to provide for a 

Qualifying Life Event that allows 

cancellation of enrollment when an 

enrollee or his or her spouse is called to 

active military service, and at 

§ 894.704(d) to advise an annuitant if 

his or her reemployment terminates, he 

or she must notify the Administrator 

within 30 days to have his or her 

FEDVIP allotments withheld from his or 

her annuity payments. Otherwise, their 

FEDVIP coverage will terminate due to 

non-payment of premiums. 

Regulatory Flexibility Act 

I certify that this regulation will not 

have a significant economic impact on 

a substantial number of small entities 

because the regulation only affects 

dental and vision benefits of Federal 

employees and annuitants. 

Executive Order 12866, Regulatory 

Review 

This rule has been reviewed by the 

Office of Management and Budget in 

accordance with Executive Order 12866. 

Federalism 

We have examined this rule in 

accordance with Executive Order 13132, 

Federalism, and have determined that 

this rule will not have any negative 

impact on the rights, roles, and 

responsibilities of State, local, or Tribal 

governments. 

List of Subjects in 5 CFR Part 894 

Administrative practice and 

procedure, Employee benefit plans, 

Government employees, Reporting and 

recordkeeping requirements, 

Retirement. 

Office of Personnel Management. 

Howard Weizmann, 

Deputy Director. 

■ For the reasons stated in the Preamble, 

OPM is revising part 894 to title 5, Code 

of Federal Regulations, to read as 

follows: 

PART 894—FEDERAL EMPLOYEES 

DENTAL AND VISION INSURANCE 

PROGRAM 

Subpart A—Administration and General 

Provisions 

Sec. 

894.101 Definitions. 

894.102 If I have a preexisting dental or 

vision condition, may I join FEDVIP? 

894.103 How do I enroll? 

894.104 Who makes enrollment decisions? 

894.105 Who may correct an error in my 

enrollment? 

Subpart B—Coverage and Types of 

Enrollment 

894.201 What types of enrollments are 

available under FEDVIP? 

894.202 If I enroll for self plus one, may I 

decide which family member to cover? 

894.203 If I have a self plus one enrollment, 

when may I change which family 

member I want to cover or change to self 

only? 

894.204 May I be enrolled in more than one 

dental or vision plan at a time? 

Subpart C—Eligibility 

894.301 Am I eligible to enroll in FEDVIP? 

894.302 What is an excluded position? 

894.303 What happens to my enrollment if 

I transfer to an excluded position? 

894.304 Am I eligible to enroll if I’m retired 

or receiving workers’ compensation? 

894.305 Am I eligible to enroll if I am a 

former spouse receiving an 

apportionment of annuity? 

894.306 Are foster children eligible as 

family members? 

894.307 Are disabled children age 22 or 

over eligible as family members? 

Subpart D—Cost of Coverage 

894.401 How do I pay premiums? 

894.402 Do the premiums I pay reflect the 

cost of providing benefits? 

894.403 Are FEDVIP premiums paid on a 

pre-tax basis? 

894.404 May I opt out of premium 

conversion? 

894.405 What happens if I go into nonpay 

status or if my pay/annuity is 

insufficient to cover the allotments? 

Subpart E—Enrolling and Changing 

Enrollment 

894.501 When may I enroll? 

894.502 What are the Qualifying Life Events 

(QLEs) that allow me to enroll? 

894.503 Are belated enrollments or changes 

allowed? 

894.504 When is my enrollment effective? 

894.505 Are retroactive premiums paid 

with pre-tax dollars (premium 

conversion)? 

894.506 How often will there be open 

seasons? 

894.507 After I’m enrolled, may I change 

from one dental or vision plan or plan 

option to another? 

894.508 When may I increase my type of 

enrollment? 

894.509 What are the QLEs that are 

consistent with increasing my type of 

enrollment? 

894.510 When may I decrease my type of 

enrollment? 

894.511 What are the QLEs that are 

consistent with decreasing my type of 

enrollment? 

894.512 What happens if I leave 

Government and then return? 

Subpart F—Termination or Cancellation of 

Coverage 

894.601 When does my FEDVIP coverage 

stop? 

894.602 May I cancel my enrollment at any 

time? 

894.603 Is there an extension of coverage 

and right to convert when my coverage 

stops or when a covered family member 

loses eligibility? 

Subpart G—Annuitants and 

Compensationers 

894.701 May I keep my dental and/or vision 

coverage when I retire or if I start 

receiving workers’ compensation? 

894.702 May I participate in open seasons 

and make changes to my enrollment as 

an annuitant or compensationer? 

894.703 How long does my coverage as an 

annuitant or compensationer last? 

894.704 What happens if I retire and then 

come back to work for the Federal 

Government? 

Subpart H—Benefits in Underserved Areas 

894.801 Will benefits be available in 

underserved areas? 

Authority: 5 U.S.C. 8962; 5 U.S.C. 8992. 

Subpart A—Administration and 

General Provisions 

§ 894.101 Definitions. 

This part is written as if the reader 

were an applicant or enrollee. 

Accordingly, the terms ‘‘you,’’ ‘‘your,’’

etc., refer, as appropriate, to the 

applicant or enrollee. 

Acquiring an eligible child means one 

of the following: 

(1) Birth of a child; 

(2) Adoption of a child; 

(3) Acquisition of a foster child as 

described in § 890.101(a)(8) of this 

chapter; 

(4) Residence change of the enrollee’s 

stepchild or recognized natural child 

who moves in with the enrollee; 

(5) Establishment of dependency of a 

recognized natural child as described in 

§ 890.302(b) of this chapter; and 

(6) An otherwise eligible child’s loss 

of spouse due to divorce or annulment 

of marriage, or death. 

Administrator means the entity with 

which the Office of Personnel 

Management contracts to manage the 

enrollment and premium payment 

process for the Federal Employees 

Dental and Vision Insurance Program 

(FEDVIP). 

Annuitant means an individual 

defined at 5 U.S.C. 8901(3). Generally, 

the term means a former employee who 

is entitled to an immediate annuity or 

a disability annuity under a retirement 

system established for employees. The 

term also generally includes those 

receiving a survivor annuity due to the 

death of a Federal employee or 


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annuitant (survivor annuitants) and 

those receiving compensation from the 

Office of Workers’ Compensation 

Programs (compensationers). The term 

does not include former employees who 

retire with a deferred annuity under 5 

U.S.C. 8413, or former spouses of 

annuitants. 

Carrier means a company with which 

the Office of Personnel Management 

contracts to provide dental and/or 

vision benefits. 

Child means one of the following: 

(1)(i) A child born within marriage; 

(ii) An adopted child; 

(iii) A stepchild or foster child who 

lives with the enrollee in a regular 

parent-child relationship; or 

(iv) A recognized natural child. 

(2) This definition does not include a 

grandchild (unless the grandchild meets 

all the requirements of a foster child as 

stated in § 890.101(a)(8) of this chapter). 

(3) The child must be unmarried and 

under age 22. A child age 22 or over is 

eligible if the child is incapable of selfsupport because of a physical or mental 

disability that existed before the child 

reached age 22. 

Compensation has the same meaning 

as found under subchapter I of chapter 

81 of title 5, United States Code, which 

is payable because of an on-the-job 

injury or disease. 

Compensationer means an individual 

who is receiving compensation and who 

the Department of Labor determines is 

unable to return to duty. 

Covered position means a position in 

which an employee is not excluded 

from FEDVIP eligibility by law or 

regulation. 

Days means calendar days. 

Dependent means an unmarried child 

who is living with or receiving regular 

and substantial support from the 

enrollee. 

Employee means an individual 

defined in 5 U.S.C. 8901. For the 

purposes of this subpart, the term 

employee additionally means an 

employee of the United States Postal 

Service and an employee of the District 

of Columbia courts. 

Enrollment reconsideration means the 

Administrator’s review of its initial 

enrollment decision to determine if it 

followed the law and regulations 

correctly in making the initial decision 

concerning FEDVIP eligibility. 

Family member means a spouse 

(including a spouse under a valid 

common law marriage) and/or 

unmarried dependent child(ren). 

OPM means the Office of Personnel 

Management. 

OWCP means the Office of Workers’

Compensation Programs, U.S. 

Department of Labor. 

Premium conversion means the 

payment of FEDVIP premiums using 

pre-tax dollars. See § 892.102 of this 

chapter for a discussion of how 

premium conversion works. 

QLE means a qualifying life event. 

Recognized natural child means a 

biological child born outside of 

marriage. A recognized natural child is 

an eligible family member if the child 

lives with the enrollee or receives 

financial support from the enrollee. 

Regular parent-child relationship 

means that the enrollee is exercising 

parental authority, responsibility, and 

control over the child; is caring for, 

supporting the child; and is making the 

decisions about the child’s education 

and medical care. 

Type of enrollment means one of the 

following: 

(1) Self only; 

(2) Self plus one; or 

(3) Self and family. 

§ 894.102 If I have a pre-existing dental or 

vision condition, may I join FEDVIP? 

Yes. Pre-existing conditions do not 

exclude you from coverage under 

FEDVIP. The Administrator may not 

deny an individual the right to enroll 

solely because of a preexisting dental or 

vision condition. 

§ 894.103 How do I enroll? 

You may enroll through an 

Administrator contracted by OPM to 

facilitate the enrollment process. Your 

Federal agency, retirement system, or 

OWCP office will advise you of the 

enrollment process available to you. 

§ 894.104 Who makes enrollment 

decisions and reconsiderations? 

The Administrator makes enrollment 

decisions and the Administrator reviews 

requests for reconsideration of an 

enrollment decision. The 

Administrator’s initial enrollment 

decision denying enrollment or an 

opportunity to change coverage must be 

in writing and must inform you about 

your right to reconsideration. 

§ 894.105 Who may correct an error in my 

enrollment? 

(a) The Administrator may correct 

administrative errors about the 

processing of your enrollment or 

changes in enrollment. 

(b) OPM may order correction of an 

administrative error if it receives 

evidence that it would be against equity 

(fairness) and good conscience not to 

order the correction. This decision is 

made at the discretion of OPM and is 

not subject to review. 

(c) If the correction gives you 

retroactive coverage, you must pay the 

premiums for all periods of the 

retroactive coverage. These premiums 

will not be on a pre-tax basis (they are 

not subject to premium conversion). 

Subpart B—Coverage and Types of 

Enrollment 

§ 894.201 What types of enrollments are 

available under FEDVIP? 

FEDVIP has three types of enrollment: 

(a) Self only, which covers only the 

enrolled employee or annuitant; 

(b) Self plus one, which covers the 

enrolled employee or annuitant plus 

one eligible family member; and 

(c) Self and family, which covers the 

enrolled employee or annuitant and all 

eligible family members. 

§ 894.202 If I enroll for self plus one, may 

I decide which family member to cover? 

Yes, if you enroll for self plus one, 

you must state at the time you enroll 

which eligible family member you want 

to cover under your enrollment. 

§ 894.203 If I have a self plus one 

enrollment, when may I change which 

family member I want to cover or change to 

self only? 

You may change your covered family 

member under a self plus one 

enrollment or change to self only 

coverage in the following situations: 

(a) During the annual open season; 

(b) If your covered family member 

dies during the year; or 

(c) If your covered family member 

loses eligibility during the year. 

§ 894.204 May I be enrolled in more than 

one dental or vision plan at a time? 

You may be enrolled in a FEDVIP 

dental plan and a separate FEDVIP 

vision plan at the same time. But no one 

may enroll or be covered as a family 

member in a FEDVIP dental or vision 

plan if he or she is covered under 

another person’s FEDVIP dental or 

vision self plus one or self and family 

enrollment, except as provided under 

§ 890.302 (a)(2) through (4) of this 

chapter, with respect to dual 

enrollments. 

Subpart C—Eligibility 

§ 894.301 Am I eligible to enroll in the 

FEDVIP? 

You are eligible if you meet the 

definition of employee in 5 U.S.C. 

8901(1), unless you are in an excluded 

position. You are eligible if you are an 

employee of the United States Postal 

Service or the District of Columbia 

courts. 

§ 894.302 What is an excluded position? 

Excluded positions are described in 5 

U.S.C. 8901 (1)(I) and 5 CFR 890.102 (c), 

except that employees of the United 


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States Postal Service and District of 

Columbia courts are not excluded 

positions. 

You are in an excluded position if you 

are: 

(a) An employee of a corporation 

supervised by the Farm Credit 

Administration, if private interests elect 

or appoint a member of the board of 

directors. 

(b) An employee who is not a citizen 

or national of the United States and 

your permanent duty station is outside 

the United States. Exception: You are 

eligible if you met the definition of 

employee on September 30, 1979, by 

service in an Executive agency, the 

United States Postal Service, or the 

Smithsonian Institution in the area that 

was then known as the Canal Zone. 

(c) An employee of the Tennessee 

Valley Authority. 

(d) An individual first employed by 

the Government of the District of 

Columbia on or after October 1, 1987, 

except employees of the District of 

Columbia Courts and those employees 

defined at § 890.102 (c)(8) of this 

chapter. 

(e) Serving under an appointment 

limited to 1 year or less. Exceptions: 

You are eligible if: 

(1) You are an acting postmaster; 

(2) You are a Presidential appointee 

appointed to fill an unexpired term; 

(3) You are an employee with a 

provisional appointment, as defined in 

§ 316.401 and § 316.403 of this chapter; 

or 

(4) You have completed 1 year of 

current continuous employment, 

excluding any break in service of 5 days 

or less. 

(f) You are expected to work fewer 

than 6 months in each year. Exception: 

You are eligible if you are employed 

under an OPM-approved career-related 

work-study program under Schedule B. 

To qualify, your work-study program 

must last at least 1 year, and you must 

be expected to be in pay status for at 

least one-third of the total period of time 

from the date of your first appointment 

to the date you complete the work-study 

program. 

(g) An intermittent employee (a nonfull-time employee without a 

prearranged regular tour of duty). 

(h) A beneficiary or patient employee 

in a Government hospital or home. 

(i) Paid on a contract or fee basis. 

Exception: You are eligible if you are a 

United States citizen, and you are 

appointed by a contract between you 

and the Federal employing authority. To 

qualify, your contract must require your 

personal service, and you must be paid 

on the basis of units of time. 

(j) Paid on a piecework basis. 

Exception: You are eligible if your work 

schedule provides for full-time or parttime service, and you have a regularly 

scheduled tour of duty. 

(k) The following positions are not 

excluded positions: 

(1) An employee appointed to perform 

‘‘part-time career employment,’’ as 

defined in section 3401 (2) of title 5, 

U.S.C., and 5 CFR part 430, subpart B; 

or 

(2) An employee serving under an 

interim appointment established under 

§ 772.102 of this chapter. 

§ 894.303 What happens to my enrollment 

if I transfer to an excluded position? 

(a) If you have FEDVIP coverage and 

you transfer to a position excluded 

under § 894.302(a) through (d), your 

enrollment stops. 

(b) If you have FEDVIP coverage and 

you transfer to a position excluded 

under § 894.302(e) through (j) with no 

break in service of more than 3 days, 

your enrollment is not affected. If you 

have a break in service of more than 3 

days, your enrollment stops. 

(c) If you did not elect to enroll in 

FEDVIP and then transfer to an 

excluded position, you lose all rights to 

enroll at that time. 

§ 894.304 Am I eligible to enroll if I’m 

retired or receiving workers’

compensation? 

If you are retired, receiving workers’

compensation, or are a survivor 

annuitant, you are eligible if you meet 

the definition of annuitant in 5 U.S.C. 

8901(3). 

§ 894.305 Am I eligible to enroll if I am a 

former spouse receiving an apportionment 

of annuity? 

No. Former spouses receiving an 

apportionment of annuity are not 

eligible to enroll in FEDVIP. 

§ 894.306 Are foster children eligible as 

family members? 

Yes, foster children may be eligible 

for coverage as family members under 

FEDVIP. 

§ 894.307 Are disabled children age 22 or 

over eligible as family members? 

A child age 22 or over is an eligible 

family member if the child is incapable 

of self-support because of a physical or 

mental disability that existed before the 

child reached age 22. 

Subpart D—Cost of Coverage 

§ 894.401 How do I pay premiums? 

(a) Employees pay premiums through 

payroll allotments. 

(b) Annuitants and survivor 

annuitants pay premiums through 

annuity allotments. 

(c) Compensationers pay premiums 

through allotments from compensation 

payments. 

(d) In limited circumstances, 

individuals may make direct premium 

payments. See § 894.405. 

§ 894.402 Do the premiums I pay reflect 

the cost of providing benefits? 

The premiums you pay shall 

reasonably and equitably reflect the cost 

of the benefits provided. 

§ 894.403 Are FEDVIP premiums paid on a 

pre-tax basis? 

(a) Your FEDVIP premiums are paid 

on a pre-tax basis (called premium 

conversion) if you are an active 

employee, your salary is sufficient to 

make the premium allotments, and your 

agency is able to make pre-tax 

allotments. 

(b) Your FEDVIP premiums are not 

paid on a pre-tax basis if: 

(1) You are an employee in nonpay 

status or an employee whose salary is 

not high enough to make premium 

allotments, or your agency is unable to 

make pre-tax allotments; 

(2) You are an annuitant, a survivor 

annuitant, or a compensationer; 

(3) Your enrollment change was made 

effective retroactively which resulted in 

additional premium withholdings, 

unless it is as a result of birth or 

adoption of a child. 

(4) You have been approved to pay 

premiums directly to the Administrator. 

§ 894.404 May I opt out of premium 

conversion? 

No, all enrolled employees whose 

salary is sufficient to make premium 

allotments and whose agency is able to 

make pre-tax allotments must 

participate in premium conversion. 

§ 894.405 What happens if I go into 

nonpay status or if my pay/annuity is 

insufficient to cover the allotments? 

(a) If your pay, annuity, or 

compensation is too low to cover the 

premium allotments, or if you go into a 

nonpay status, contact the 

Administrator to arrange to pay your 

premiums directly to the Administrator. 

(b) If you do not make the premium 

payments, your FEDVIP coverage will 

stop. You will not be able to reenroll 

until the next open season after: 

(1) You are in pay status; or 

(2) Your pay is sufficient to make the 

premium allotments. 


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Subpart E—Enrollment and Changing 

Enrollment 

§ 894.501 When may I enroll? 

You may enroll: 

(a) During the annual open season; 

(b) Within 60 days after you first 

become eligible as: 

(1) A new employee; 

(2) A previously ineligible employee 

who transfers to a covered position; or 

(3) A new survivor annuitant, if not 

already covered under FEDVIP. 

(c) Within 60 days of when you return 

to service following a break in service of 

at least 30 days; or 

(d) Within 60 days of a QLE that 

allows you to enroll. 

§ 894.502 What are the Qualifying Life 

Events (QLEs) that allow me to enroll? 

(a) You or an eligible family member 

lose other dental/vision coverage; 

(b) Your annuity or compensation is 

restored after having been terminated; or 

(c) You return to pay status after being 

on leave without pay due to deployment 

to active military duty. 

§ 894.503 Are belated enrollments or 

changes allowed? 

(a) The time limit for enrolling or 

changing your enrollment may be 

extended up to 3 months after the date 

you became newly eligible or had a QLE 

or after the end of an open season. To 

qualify, you must demonstrate to the 

Administrator that you were not able to 

enroll or change your enrollment on 

time for reasons beyond your control. 

(b) If the Administrator allows you to 

make a belated enrollment or 

enrollment change, you must enroll or 

change within 30 days after the 

Administrator notifies you of its 

determination. 

§ 894.504 When is my enrollment 

effective? 

(a) Open season enrollments are 

effective on the date set by OPM. 

(b) If you enroll when you first 

become eligible your enrollment is 

effective the 1st day of the pay period 

following the one in which the 

Administrator receives your enrollment, 

but no earlier than December 31, 2006. 

(c)(1) A belated open season 

enrollment is effective retroactive to the 

date it would have been effective if you 

had made a timely enrollment or request 

for a change. 

(2) Any other belated enrollment or 

change is effective retroactive to the 1st 

day of the pay period following the one 

in which you became newly eligible or 

the date of your QLE. 

(3) You are responsible for any 

retroactive premiums due to a belated 

enrollment or request for a change. 

§ 894.505 Are retroactive premiums paid 

with pre-tax dollars (premium conversion)? 

Retroactive premiums are not paid 

under premium conversion, except 

when you are changing your enrollment 

retroactively as a result of birth or 

adoption of a child. Any additional 

withholdings for retroactive premiums 

that are due must be made with after-tax 

dollars. The Administrator will bill you 

directly for any retroactive premiums 

that must be paid with after-tax dollars. 

§ 894.506 How often will there be open 

seasons? 

There will be an annual open season 

for FEDVIP at the same time as the 

annual Federal Benefits Open Season. 

§ 894.507 After I’m enrolled, may I change 

from one dental or vision plan or plan 

option to another? 

(a) You may change from one dental 

and/or vision plan to another plan or 

one plan option to another option in 

that same plan during the annual open 

season. 

(b)(1) If you are enrolled in a dental 

or vision plan with a geographically 

restricted service area, and you or a 

covered eligible family member move 

out of the service area, you may change 

to a different dental or vision plan that 

serves that area. 

(2) You may make this change at any 

time before or after the move, once you 

or a covered eligible family member has 

a new address. 

(3) The enrollment change is effective 

the first day of the pay period following 

the pay period in which you make the 

change. 

(4) You may not change your type of 

enrollment unless you also have a QLE 

that allows you to change your type of 

enrollment. 

§ 894.508 When may I increase my type of 

enrollment? 

(a) You may increase your type of 

enrollment: 

(1) during the annual open season; or 

(2) If you have a QLE that is consistent 

with increasing your type of enrollment. 

(b) Increasing your type of enrollment 

means going from: 

(1) Self only to self plus one; 

(2) Self only to self and family; or 

(3) Self plus one to self and family. 

(c) You may increase your type of 

enrollment during the time period 

beginning 31 days before the QLE and 

ending 60 days after the QLE. 

(d) Your new type of enrollment is 

effective the 1st day of the pay period 

following the pay period in which you 

make the change. 

(e) You may not change from one 

dental or vision plan to another, except 

as stated in § 894.507(b). 

§ 894.509 What are the QLEs that are 

consistent with increasing my type of 

enrollment? 

(a) Marriage; 

(b) Acquiring an eligible child; or 

(c) Loss of other dental or vision 

coverage by an eligible family member. 

§ 894.510 When may I decrease my type of 

enrollment? 

(a) You may decrease your type of 

enrollment 

(1) during the annual open season; or 

(2) If you have a QLE that is consistent 

with decreasing your type of enrollment, 

(b) Decreasing your type of enrollment 

means going from: 

(1) Self and family to self plus one; 

(2) Self and family to self only; or 

(3) Self plus one to self only. 

(c) You may decrease your type of 

enrollment during the time period 

beginning 31 days before your QLE and 

ending 60 days after your QLE. 

(d) Your new type of enrollment is 

effective the 1st day of the pay period 

following the one in which you make 

the change. 

(e) You may not change from one 

dental or vision plan or option to 

another, except as stated in § 894.507(b). 

§ 894.511 What are the QLEs that are 

consistent with decreasing my type of 

enrollment? 

(a) Loss of an eligible family member 

due to: 

(1) Divorce; 

(2) Death; or 

(3) Loss of eligibility of a previously 

enrolled child. 

(b) Your spouse deploys to active 

military service. 

§ 894.512 What happens if I leave Federal 

Government and then return? 

(a) Your FEDVIP coverage terminates 

at the end of the pay period in which 

you separate from government service. 

Exception: If you separate for retirement 

or while in receipt of workers’

compensation as defined in § 894.701, 

your FEDVIP coverage continues. 

(b)(1) If you return to Federal service 

after a break in service of fewer than 30 

days, and you were not previously 

enrolled in FEDVIP, you may not enroll 

until the next open season or unless you 

have a QLE that allows you to enroll. 

(2) If you return to Federal service 

after a break in service of fewer than 30 

days, and you were previously enrolled 

in FEDVIP, you may reenroll in the 

same plan(s) and plan option and with 

the same type of enrollment you had 

before you separated. Exceptions: 

(i) If you were enrolled in a dental or 

vision plan with a restricted geographic 

service area, and you have since moved 

out of the plan’s service area, you may 


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50188 Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Rules and Regulations 

change to a different dental or vision 

plan that serves that area. 

(ii) If you have since gained or lost an 

eligible family member, you may change 

your type of enrollment consistent with 

the change in the number of eligible 

family members. 

(3) If you return to Federal service as 

a new hire after a break in service of 30 

days or more, you may enroll if you 

were not previously enrolled, change 

your dental or vision plan, and/or 

change your type of enrollment. 

Subpart F—Termination or 

Cancellation of Coverage 

§ 894.601 When does my FEDVIP coverage 

stop? 

(a) If you no longer meet the 

definition of an eligible employee or 

annuitant, your FEDVIP coverage stops 

at the end of the pay period in which 

you were last eligible. 

(b) If you go into a period of nonpay 

or insufficient pay, and you do not make 

direct premium payments, your FEDVIP 

coverage stops at the end of the pay 

period for which your agency, 

retirement system, or OWCP last made 

a premium allotment from your pay. 

(c) If you are making direct premium 

payments, and you stop making the 

payments, your FEDVIP coverage stops 

at the end of the pay period for which 

you last made a payment. 

(d) If you cancel your enrollment 

during an open season, your FEDVIP 

coverage stops at midnight of the day 

before the effective date of an open 

season change as set by OPM. 

(e) If you are enrolled with a 

combination dental and vision carrier 

with a restricted service area, and you 

move outside the carrier’s service area 

to a service area that does not offer a 

combination carrier and you change to 

a dental only or vision only carrier, your 

existing combination plan coverage will 

stop at midnight of the day before the 

effective date of your new plan 

coverage. 

(f) If your FEDVIP carrier discontinues 

participation in the program at the end 

of the contract year, then you must 

change to another carrier 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 will establish a time 

and effective date for you to change 

your carrier. If you do not change your 

carrier within the time set by OPM, your 

coverage will stop at midnight of the 

day before the effective date set by OPM 

for coverage with another carrier. 

§ 894.602 May I cancel my enrollment at 

any time? 

No. You may only cancel your 

enrollment during an open season. 

Exceptions: You may cancel your dental 

and/or vision enrollment if you transfer 

to an eligible position with a Federal 

agency that provides dental and/or 

vision coverage with 50 percent or more 

employer-paid premiums. You may also 

cancel upon your deployment or your 

spouse’s deployment to active military 

duty. These cancellations will become 

effective at the end of the pay period 

that you submit your request. 

§ 894.603 Is there an extension of 

coverage and right to convert when my 

coverage stops or when a covered family 

member loses eligibility? 

No. There is no extension of coverage 

or right to convert to an individual 

policy or Temporary Continuation of 

Coverage (TCC) when your FEDVIP 

coverage stops or when a family 

member loses eligibility under the 

Program. 

Subpart G—Annuitants and 

Compensationers 

§ 894.701 May I keep my dental and/or 

vision coverage when I retire or start 

receiving workers’ compensation? 

(a) Your FEDVIP coverage continues if 

you retire on an immediate annuity or 

on a disability annuity, or start receiving 

compensation from OWCP. 

(b) If you retire on a Minimum 

Retirement Age +10 annuity that you 

elect to postpone in accordance with 5 

U.S.C. 8412(g), your FEDVIP coverage 

will stop when you separate from 

service. However, you may enroll again 

within 60 days of when your annuity 

starts. 

(c) If you retire on a deferred annuity 

in accordance with 5 U.S.C. 8413, your 

FEDVIP coverage stops and you are not 

eligible to enroll. 

§ 894.702 May I participate in open season 

and make changes to my enrollment as an 

annuitant or compensationer? 

Yes. Annuitants and compensationers 

may participate in open season and 

make enrollment changes under the 

same circumstances as active 

employees. 

§ 894.703 How long does my coverage as 

an annuitant or compensationer last? 

Your coverage as an annuitant or 

compensationer continues as long as 

you continue receiving an annuity or 

compensation and pay your premiums, 

unless you cancel your coverage during 

an open season or terminate coverage 

due to insufficient annuity or 

compensation. 

§ 894.704 What happens if I retire and then 

come back to work for the Federal 

Government? 

(a) If you have FEDVIP coverage as an 

annuitant, and you become reemployed 

in an eligible position in Federal 

service, you must contact the 

Administrator so it can send the request 

for allotments to your agency so your 

agency can start making the allotments 

from your pay. 

(b) If you did not enroll in FEDVIP 

coverage as an annuitant and become 

reemployed in an eligible Federal 

position, you have 60 days to enroll in 

FEDVIP. 

(c) If you enroll as an employee the 

Administrator will stop sending 

requests for allotments from your 

annuity. 

(d) If your reemployment terminates, 

you must notify the Administrator 

within 30 days to have your allotments 

withheld from your annuity payments. 

Otherwise, your FEDVIP coverage will 

terminate due to non-payment of 

premiums. 

Subpart H—Benefits in Underserved 

Areas 

§ 894.801 Will benefits be available in 

underserved areas? 

(a) Dental and vision plans under 

FEDVIP will include underserved areas 

in their service areas and provide 

benefits to enrollees in underserved 

areas. 

(b) In any area where a FEDVIP dental 

or vision plan does not meet OPM 

access standards, including underserved 

areas, enrollees may receive services 

from non-network providers. 

(c) Contracts under FEDVIP shall 

include access standards as defined by 

OPM and payment levels for services to 

non-network providers in areas that do 

not meet access standards. 

[FR Doc. E8–19761 Filed 8–25–08; 8:45 am] 

BILLING CODE 6325–39–P 

DEPARTMENT OF AGRICULTURE 

Agricultural Marketing Service 

7 CFR Part 987 

[Docket No. AMS–FV–08–0056; FV08–987–

1 IFR] 

Domestic Dates Produced or Packed in 

Riverside County, CA; Decreased 

Assessment Rate 

AGENCY: Agricultural Marketing Service, 

USDA. 

ACTION: Interim final rule with request 

for comments. 


sroberts on PROD1PC76 with RULES