[Federal Register: October 1, 2003 (Volume 68, Number 190)]
[Rules and Regulations]
[Page 56523-56525]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01oc03-1]
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Rules and Regulations
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains regulatory documents
having general applicability and legal effect, most of which are keyed
to and codified in the Code of Federal Regulations, which is published
under 50 titles pursuant to 44 U.S.C. 1510.
The Code of Federal Regulations is sold by the Superintendent of Documents.
Prices of new books are listed in the first FEDERAL REGISTER issue of each
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[[Page 56523]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Parts 890 and 892
RIN 3206-AJ34
Federal Employees Health Benefits Children's Equity
AGENCY: Office of Personnel Management.
ACTION: Interim rule with request for comments.
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SUMMARY: The Office of Personnel Management (OPM) is issuing interim
regulations to implement the Federal Employees Health Benefits
Children's Equity Act of 2000, which was enacted October 30, 2000. This
law mandates the enrollment of a Federal employee for self and family
coverage in the Federal Employees Health Benefits (FEHB) Program, if
the employee is subject to a court or administrative order requiring
him/her to provide health benefits for his/her child(ren) and the
employee does not provide documentation of compliance with the order.
DATES: Interim rules are effective October 31, 2003. OPM must receive
comments on or before December 1, 2003.
ADDRESSES: Send written comments to Abby L. Block, Senior Advisor for
Employee and Family Support, Strategic Human Resources Policy Division,
Office of Personnel Management, 1900 E Street NW., Washington DC 20415-
3666; or deliver to OPM, Room 3425, 1900 E Street NW., Washington, DC;
or FAX to (202) 606-0633.
FOR FURTHER INFORMATION CONTACT: Nataya Battle (202) 606-0004.
SUPPLEMENTARY INFORMATION: On October 30, 2000, Public Law 106-394, 114
Stat. 1629, was enacted. This law, the Federal Employees Health
Benefits Children's Equity Act of 2000, mandates compliance with court
or administrative orders requiring Federal employees to provide health
benefits for their children. The law was effective upon enactment.
Before the enactment of Public Law 106-394, a court or State
administrative agency could issue an order for an individual to provide
health benefits for his or her child(ren); however, there was nothing
in the FEHB law to require compliance. While the issuance of such an
order was an event that allowed an employee to enroll or to change from
self only to self and family, the enrollment was voluntary on the
employee's part.
The law now makes compliance with the court or administrative order
mandatory. A Federal employee subject to such an order must enroll for
self and family coverage in a health plan that provides full benefits
in the area where the children live or provide documentation to the
agency that he or she has obtained other health benefits for the
children. If the employee does not do so, the agency will enroll the
employee involuntarily as follows: (1) If the employee has no FEHB
coverage, the agency will enroll him or her for self and family
coverage in the option of the Blue Cross and Blue Shield Service
Benefit Plan that provides the lower level of coverage; (2) if the
employee has a self only enrollment in a fee-for-service plan or in an
HMO that serves the area where the children live, the agency will
change his or her enrollment to self and family in the same option of
the same plan; (3) if the employee is enrolled in an HMO that does not
serve the area where the children live, the agency will change his or
her enrollment to self and family in the lower option of the Blue Cross
and Blue Shield Service Benefit Plan.
As long as the court or administrative order is in effect, and the
employee has at least one child identified in the order who is still
eligible under the FEHB Program, the employee cannot cancel his or her
enrollment, change to self only, or change to a plan that does not
serve the area in which the child or children live, unless he or she
provides documentation that he or she has other coverage for the
children. If the court or administrative order is still in effect at
the time the employee retires, and if at least one child is still
eligible for FEHB, the employee must continue FEHB into retirement (if
eligible) and cannot make any of these changes after retirement for as
long as the order remains in effect and the child continues to be
eligible under 5 U.S.C. 8901(5).
If such an employee goes into a nonpay status, or if his or her
salary becomes insufficient to make the premium withholdings, he or she
cannot choose to terminate the enrollment. Instead, the employee must
continue the coverage and either make direct premium payments or incur
a debt to the Government. (By law, an employee's enrollment still
terminates after 1 year in nonpay status.) If the annuity of an
employee who remained subject to such a court or administrative order
upon retirement becomes insufficient to make the premium withholdings,
the annuitant cannot choose to terminate the enrollment. Instead, he or
she must continue the coverage and make direct premium payments for as
long as the order remains in effect and the child continues to be
eligible under 5 U.S.C. 8901(5).
Waiver of Notice of Proposed Rulemaking
In accordance with Sec. 553(b)(3)(B) of title 5 of the U.S. Code,
I find that good cause exists for waiving the general notice of
proposed rulemaking. Notice is being waived to implement currently
effective legislation. There is an immediate need for implementation of
an interim regulation in order to expand the processing of child
medical support court orders for children of Federal employees who
become annuitants. Public Law 106-394 does not address what happens to
the child medical support court order once the employee retires. As a
result, the children of retirees are being harmed without regulation to
authorize OPM to enforce the court orders that began while the parent
was an employee. Public Law 106-394 has been in effect for three years
and any further delay in effecting this regulation would be unnecessary
and contrary to the public interest.
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
will only affect health benefits of certain Federal employees and
retirees.
[[Page 56524]]
Executive Order 12866, Regulatory Review
This rule has been reviewed by the Office of Management and Budget
in accordance with Executive Order 12866.
List of Subjects
5 CFR Part 890
Administrative practice and procedure, Government employees, Health
facilities, Health insurance, Health professions, Hostages, Iraq,
Kuwait, Lebanon, Military personnel, Reporting and recordkeeping
requirements, Retirement.
5 CFR Part 892
Administrative practice and procedure, Government employees, Health
insurance, Taxes, Wages.
U.S. Office of Personnel Management.
Kay Coles James,
Director.
0
Accordingly, OPM is amending 5 CFR parts 890 and 892 as follows:
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
0
1. The authority citation for part 890 revised to read as follows:
Authority: 5 U.S.C. 8913; Sec. 890.303 also issued under 50
U.S.C. 403(p), 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;
Sec. 890.102 also issued under sections 11202(f), 11232(e), and
11246(b) and (c) of Pub. L. 105-33, 111 Stat. 251; and section 721
of Pub. L. 105-261, 112 Stat. 2061 unless otherwise noted.
0
2. In Sec. 890.301 revise paragraphs (e)(1) and (f)(3) and add new
paragraphs (g)(3) and (g)(4) to read as follows:
Sec. 890.301 Opportunities for employees who are not participants in
premium conversion to enroll or change enrollment; effective dates.
* * * * *
(e) Change to self only. (1) Subject to two exceptions, an employee
may change the enrollment from self and family to self only at any
time. Exceptions:
(i) An employee participating in health insurance premium
conversion may change to self only during an open season or because of
and consistent with a qualifying life event as defined in Part 892 of
this chapter.
(ii) An employee who is subject to a court or administrative order
as discussed in Sec. 890.301(g)(3) cannot make this change as long as
the court or administrative order is still in effect and the employee
has at least one child identified in the order who is still eligible
under the FEHB Program, unless the employee provides documentation to
the agency that he or she has other coverage for the child(ren).
* * * * *
(f) * * *
(3) With one exception, during an open season, an eligible employee
may enroll and an enrolled employee may change his or her existing
enrollment from self only to self and family, may change from one plan
or option to another, or may make any combination of these changes.
Exception: An employee who is subject to a court or administrative
order as discussed in Sec. 890.301(g)(3) cannot cancel his or her
enrollment, change to self only, or change to a comprehensive medical
plan that does not serve the area where his or her child or children
live as long as the court or administrative order is still in effect
and the employee has at least one child identified in the order who is
still eligible under the FEHB Program, unless the employee provides
documentation to the agency that he or she has other coverage for the
child(ren).
* * * * *
(g) * * *
(3)(i) If an employing office receives a court or administrative
order on or after October 30, 2000, requiring an employee to provide
health benefits for his or her child or children, the employing office
will determine if the employee has a self and family enrollment in a
health benefits plan that provides full benefits in the area where the
child or children live. If the employee does not have the required
enrollment, the agency must notify him or her that it has received the
court or administrative order and give the employee until the end of
the following pay period to change his or her enrollment or provide
documentation to the employing office that he or she has other coverage
for the child or children. If the employee does not comply within these
time frames, the employing office must enroll the employee
involuntarily as stated in paragraph (g)(3)(ii) of this section.
(ii) If the employee is not enrolled or does not enroll, the agency
must enroll him or her for self and family coverage in the option that
provides the lower level of coverage in the Service Benefit Plan. If
the employee has a self only enrollment, the employing office must
change the enrollment to self and family in the same option and plan,
as long as the plan provides full benefits in the area where the child
or children live. If the employee is enrolled in a comprehensive
medical plan that does not serve the area in which the child or
children live, the employing office must change the enrollment to self
and family in the option that provides the lower level of coverage in
the Service Benefit Plan.
(4) Subject to two exceptions, the effective date of an involuntary
enrollment under paragraph (g)(3) of this section is the 1st day of the
pay period that begins after the date the employing office completes
the enrollment request. Exceptions:
(i) If the court or administrative order requires an earlier
effective date, the effective date will be the 1st day of the pay
period that includes that date. Retroactive effective dates cannot be
to a date that is more than 2 years earlier, or prior to October 30,
2000.
(ii) If after an involuntary enrollment becomes effective and the
employing office finds that circumstances beyond the employee's control
prevented him or her from enrolling or changing the enrollment within
the time limits in this section, the employee may change the enrollment
prospectively within 60 days after the employing office advises the
employee of its finding.
* * * * *
0
3. In Sec. 890.304 revise paragraph (d)(1) and the section heading to
read as follows:
Sec. 890.304 Termination of enrollment.
* * * * *
(d) Cancellation or suspension. (1)(i) An employee who participates
in health insurance premium conversion as provided in Part 892 of this
chapter may cancel his or her enrollment only during an open season or
because of and consistent with a qualifying life event defined in Sec.
892.101 of this chapter.
(ii) Subject to the provisions of paragraph (d)(iii) of this
section, an enrollee who does not participate in premium conversion may
cancel his or her enrollment at anytime by filing an appropriate
request with the employing office. The cancellation is effective at the
end of the last day of the pay period in which the employing office
receives the appropriate request canceling the enrollment.
(iii) An employee who is subject to a court or administrative order
as discussed in Sec. 890.301(g)(3), or an annuitant who was subject to
such a court or administrative order at the time of his or her
retirement, cannot cancel or suspend his or her enrollment as long as
the court or administrative order is still in effect and the enrollee
has at least one child identified in the order who is still eligible
under the FEHB Program, unless the employee or annuitant provides
documentation to
[[Page 56525]]
the agency that he or she has other coverage for the child or children.
* * * * *
0
4. In Sec. 890.306 revise paragraphs (e)(1) and (f)(1)(i) to read as
follows:
Sec. 890.306 Opportunities for annuitants to change enrollment or to
reenroll; effective dates.
* * * * *
(e) Enrollment change to self only. (1) With one exception, an
annuitant may change the enrollment from self and family to self only
at any time. Exception: An annuitant who, as an employee, was subject
to a court or administrative order as discussed in Sec. 890.301(g)(3)
at the time he or she retired cannot change to self only after
retirement as long as the court or administrative order is still in
effect and the annuitant has at least one child identified in the order
who is still eligible under the FEHB Program, unless the annuitant
provides documentation to the retirement system that he or she has
other coverage for the child or children.
* * * * *
(f) * * *
(1) * * *
(i) With one exception, an enrolled annuitant may change the
enrollment from self only to self and family, may change from one plan
or option to another, or may make any combination of these changes.
Exception: An annuitant who, as an employee, was subject to a court or
administrative order as discussed in Sec. 890.301(g)(3) at the time he
or she retired cannot cancel or suspend his or her enrollment, change
to self only, or change to a comprehensive medical plan that does not
serve the area where his or her children live after retirement as long
as the court or administrative order is still in effect and the
annuitant has at least one child identified in the order who is still
eligible under the FEHB Program, unless the annuitant provides
documentation to the retirement system that he or she has other
coverage for the child or children.
* * * * *
0
5. In Sec. 890.502 add a new sentence after the first sentence in
paragraph (b)(2), redesignate paragraph (b)(4) as paragraph (b)(4)(i),
and add a new paragraph (b)(4)(ii) to read as follows:
Sec. 890.502 Employee withholdings and contributions.
* * * * *
(b) * * *
(2) * * * Exception: An employee who is subject to a court or
administrative order as discussed in Sec. 890.301(g)(3) cannot elect
to terminate his or her enrollment as long as the court/administrative
order is still in effect and the employee has at least one child
identified in the order who is still eligible under the FEHB Program,
unless the employee provides documentation that he or she has other
coverage for the child or children. * * *
* * * * *
(4)(ii) If the employee is subject to a court or administrative
order as discussed in Sec. 890.301(g)(3), the coverage cannot
terminate. If the employee does not return the signed form, the
coverage will continue and the employee will incur a debt to the
Government as discussed in paragraphs (b)(2)(i) and (b)(2)(ii) of this
section.
* * * * *
PART 892--FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH
BENEFITS PREMIUMS
0
6. The authority citation for part 892 continues to read as follows:
Authority: 5 U.S.C. 8913; 26 U.S.C. 125.
0
7. Amend by revising Sec. 892.207 to read as follows:
Sec. 892.207 Can I make changes to my FEHB enrollment while I am
participating in premium conversion?
(a) Subject to the exceptions described in paragraphs (b) and (c)
of this section, you can make changes to your FEHB enrollment for the
same reasons and with the same effective dates listed in Sec. 890.301
of this chapter.
(b) However, if you are participating in premium conversion there
are two exceptions: you must have a qualifying life event to change
from self and family enrollment to self only enrollment or to drop FEHB
coverage entirely. (See Sec. 892.209 and Sec. 892.210.) Your change
in enrollment must be consistent with and correspond to your qualifying
life event as described in Sec. 892.101. These limitations apply only
to changes you may wish to make outside open season.
(c) If you are subject to a court or administrative order as
discussed in Sec. 890.301(g)(3) of this chapter, your employing agency
can limit a change to your enrollment as long as the court or
administrative order is still in effect and you have at least one child
identified in the order who is still eligible under the FEHB Program,
unless you provide documentation to your agency that you have other
coverage for your child or children. See also Sec. 892.208 and Sec.
892.209.
0
8. Revise the section heading and add a new paragraph (c) to Sec.
892.208 to read as follows:
Sec. 892.208 Can I change my enrollment from self and family to self
only at any time?
* * * * *
(c) If you are subject to a court or administrative order as
discussed in Sec. 890.301(g)(3) of this chapter, you cannot change
your enrollment to self only as long as the court or administrative
order is still in effect and you have at least one child identified in
the order who is still eligible under the FEHB Program, unless you
provide documentation to your agency that you have other coverage for
your child or children. See also Sec. 892.207 and Sec. 892.209.
0
9. Add a new paragraph (c) to Sec. 892.209 to read as follows:
Sec. 892.209 Can I cancel FEHB coverage at any time?
* * * * *
(c) If you are subject to a court or administrative order as
discussed in Sec. 890.301(g)(3) of this chapter, you cannot cancel
your coverage as long as the court or administrative order is still in
effect and you have at least one child identified in the order who is
still eligible under the FEHB Program, unless you provide documentation
to your agency that you have other coverage for your child or children.
[FR Doc. 03-24792 Filed 9-30-03; 8:45 am]
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