FEHB - Important Changes

FEHB Regulations to Enroll and Change Enrollment

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:

  • Employing Offices are now permitted to 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/she received the first written documentation (i.e., pay statement or enrollment change confirmation) indicating the error.

  • The initial opportunity period to enroll has been extended from 31 days to within 60 days after becoming eligible.

  • 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 employeeâs 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.

  • Examples of changes (other than marriage) in family status are:
    1. birth or acquisition of a child;
    2. issuance of a court order specifically requiring an employee to enroll for his/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.

  • 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.

  • Former spouses who meet eligibility and time limitation requirements may enroll at any time after the employing office establishes that these requirements have been met.

If you have any questions concerning the above, please call Scott Howell, Benefits Officer, at (202) 358-1558.

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Continued FEHB Coverage for Disabled Children Over Age 22

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.

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FEHB Employees In A Non-pay Status

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:

  • continue the enrollment and agree to pay the premium on a bi-weekly basis

  • incur a debt for the employeeÅs portion of the premium

  • prepay the full amount of the premiums, where the leave without pay period can be predicted

  • terminate the enrollment

If you choose to continue the enrollment, payment of the premiums may be made either on a current basis, or when you return to work.

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.

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Contact: Scott.Howell
Owner: Mary Shouse
Curator: SAIC Web Support
Date: December 20, 2000

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