FEHB - Important Changes
The Office of Personnel Management (OPM) has simplified and clarified the Federal Employees Health Benefits (FEHB) Program regulations concerning opportunities to enroll and change enrollment. Highlights of these changes are as follows:
If you have any questions concerning the above, please call Scott Howell, Benefits Officer, at (202) 358-1558.
The Office of Personnel Management (OPM) has issued guidance on a regulatory change affecting certain disabled children over the age of 22, who are eligible to retain coverage as dependents under the employee‰s self and family FEHB enrollment. Under the previous regulations, the final determination of incapability for self-support due to an existing disability was made solely by the employing office.
The new procedure permits either the employing office or the FEHB carriers to make the determination to permit continued coverage under the self and family enrollment for children over age 22 who meet certain medical conditions. (For a list of these conditions, please contact Scott Howell in the Headquarters Human Resources Management Division, Code CP, 358-1558.) These medical conditions are considered to be of such a severe nature that it removes doubt of the child‰s capability for self-support. Determination of incapacity for conditions outside of those specified on the list will still need to be made by the Headquarters Human Resources Management Division.
When the employing office determines incapacity, it must notify the appropriate carrier of this determination. In view of these new regulations, OPM has instructed the carriers that they must send a notice of approval to the enrollee and advise the enrollee to give a copy of the notice to his/her employing office. Therefore, if an employee receives such a notice from the FEHB carrier, it is the employee‰s responsibility to notify the Headquarters Human Resources Management Division.
This notice provides information about revised regulations for employees who are enrolled in the Federal Employees Health Benefits (FEHB) Program and who enter nonpay status (including leave without pay), or whose pay becomes insufficient to cover premiums.
Employees who are enrolled in the FEHB Program are responsible for payment of their regular premium for each pay period they are enrolled. When an employee enters nonpay status, or when pay is insufficient to cover the cost of the premium, the employing office must provide the employee written notification of the following options:
Previously, the agency was only responsible for paying its share of the premium while an employee was in a nonpay status and the employee was responsible for paying the employeeÅs share of premiums directly to OPM. However, OPM has revised the rules which now make the agency responsible for remitting both the agency and employee portions of FEHB premiums while the employee is in a nonpay status or pay is insufficient to cover premiums; the agency must then collect the appropriate amount from the employee.
Since NASA will be submitting both the agency and employee share of premiums, the debt the employee incurs will be to NASA. Therefore, to make arrangements for payment of FEHB premiums while on LWOP, please contact your Personnel Management Specialist.