Former Spouses
Page 3 of 7
Information for Former Spouses (Continued)
Enrollment (Continued)
Retirement System
Addresses
|
Employee's Retirement System:
|
Request for Review Sent to: |
CSRS or FERS |
Office of Personnel Management, Retirement and Insurance
Service, Office of Retirement Programs, P.O. Box 17, Washington, D.C. 20044. |
CIA |
CIA Retirement and Disability System, Central
Intelligence Agency, P.O. Box 1925, Washington, D.C. 20505. |
Foreign Service |
Foreign Service Retirement and Disability System, Department
of State, Retirement Division, Room 1251, Washington, D.C. 20520. |
| Any Other Retirement System |
You must obtain that retirement system's certification of
your eligibility to a portion of the employee's future annuity or a former spouse survivor
annuity, and must submit the certificate to OPM when applying for eligibility to enroll. |
Determining Your Eligibility
When you apply for eligibility to enroll under the Spouse Equity provisions, the
employing office must first verify that
the employee was employed by the agency at the time of your divorce. If the employee
separates from Federal service before becoming eligible for an immediate annuity, you are
eligible to enroll only if your marriage ended before he/she left Federal service.
The employing office must then determine if you are eligible to enroll. To be eligible,
you must meet all of the following requirements:
- You must not have remarried before age 55;
- You must have been covered as a family member in an FEHB plan at least one day during
the 18 months before your marriage ended;
- You must provide documentation from OPM (or the CIA or Foreign Service retirement
system, if applicable) of entitlement
to a portion of the employee's future annuity, or a former spouse survivor annuity.
If the employee worked for the CIA, you could qualify to enroll based on his/her CIA
employment, if you were married for at least 10 years during his/her CIA service, at least
5 years of which both of you spent outside the United States, and your marriage ended
before May 7, 1985.
If the employee worked for the Foreign Service, you could also qualify to enroll based
on his/her Foreign Service employment if you were married for at least 10 years during
his/her Government service, and your marriage ended before May 7, 1985.
Employing Office
Decision
If you are eligible for health benefits coverage, the employing office will write to you confirming its decision, give you a premium payment schedule, and provide you a certification form to sign and date stating the requirements for continued enrollment.
If you are not eligible for health benefits coverage, the employing office will notify
you in writing and give the reason for the denial. The notice will also explain that you have a
right to request that the employing office reconsider
its decision.
Enrollment Procedures
If you didn't submit a Health Benefits Election Form (SF 2809) or other enrollment
request as your application to enroll, you
must complete one to enroll. You must put your own name, date of birth, and Social
Security number on Part A of the SF 2809. The employee, former employee, or annuitant's
name and date of birth must be entered in the Remarks section.
Certification
When you elect health benefits coverage under the Spouse Equity provisions, you must
certify that you will notify the employing office within 31 days of an event that would
terminate your eligibility. The employing office keeps the original certification in your health benefits file and gives you a copy.
Sample Certification
The employing office will require that you sign and date the following certification:
"I understand that I must notify the office maintaining my enrollment within
31 days after the occurrence of any of the following events that would end my eligibility
for enrollment in the Federal Employees Health Benefits Program:
(1) The court order ceases to provide my entitlement to a portion of a retirement
annuity or a former spouse survivor annuity under a retirement system for Government
employees.
(2) I remarry before age 55.
(3) The employee on whose service my benefits are based dies and no former spouse
survivor annuity is payable.
(4) The separated employee on whose service my benefits are based dies before
meeting the requirements for a deferred annuity.
(5) The employee on whose service my benefits are based leaves Federal service
before establishing title to an immediate annuity or a deferred annuity.
(6) The retirement system pays a refund of retirement contributions to the
separated employee on whose service my health benefits are based."
Signature
Date
Health Benefits File
The employing office must establish and
maintain a health benefits file for you, even when it has denied eligibility for coverage.
Effective Date
The effective date of your enrollment is the first day of the first pay period after
the employing office receives the Health Benefits Election Form (SF 2809) and has approved
eligibility.
If you request immediate coverage, and the employing office
receives the Health Benefits Election Form (SF 2809) and satisfactory proof of eligibility
within 60 days after the date of the divorce, the enrollment may be made effective on the
same day that temporary continuation of
coverage would otherwise take effect.
Except as specified in this section, an enrollment change is effective on the first day
of the first pay period beginning after the date the employing office receives the SF
2809.
Opportunities to Enroll or Change Enrollment
When the employing office determines that you are eligible,
you may enroll at any time.
Belated Enrollment
When the employing office determines that you weren't able to enroll or change enrollment within the required time frame for reasons beyond your control, you may do so within 60 days after the employing office advises you of its determination.
Enrollment by Proxy
The employing office may permit your representative to enroll or change your enrollment for you with your
written authorization.
Change to Self Only
You may change your enrollment from Self and Family to Self Only at any time. A change
to a Self Only enrollment is effective on the first day of the first pay period beginning
after the employing office receives the Health Benefits Election Form (SF 2809). At your
written request and with proof that there was no family member eligible for coverage, the
employing office may make the change retroactive to the first day of the pay period
following the one in which there were no remaining eligible family members.
Open Season
During Open Season, you may change your
enrollment from Self Only to Self and Family, from one plan or option to another, or make
any combination of these changes. With a Self and Family enrollment, the only eligible
family members are the natural or adopted children of you and the Federal employee or
annuitant on whose service your coverage is based.
If you:
- suspended your Spouse Equity enrollment to enroll in a Medicare managed care plan or Medicaid (or a
similar State-sponsored program of medical assistance for the needy); and
- later voluntarily disenroll,
you may reenroll under the Spouse Equity provisions during Open Season provided you:
If you involuntarily lose this coverage, you can immediately reenroll.
An Open Season reenrollment or change in enrollment is effective on the first day of
the first pay period beginning in January of the following year. When the employing office
accepts a belated Open Season reenrollment or change in
enrollment it takes effect on the date it normally would have been effective if it had
been received on time.
Change in Family Status
You may change from Self Only to Self and Family, from one plan or option to another,
or make any combination of these changes from 31 days before to 60 days after the birth or
acquisition of a natural or adopted child of you and the Federal employee or annuitant on
whose service your coverage is based. The change to Self and Family coverage is effective
on the first day of the pay period in which the child is born or becomes an eligible
family member.
Loss of
Other FEHB Coverage or Coverage under Another Group Insurance Plan
You may change from Self Only to Self and Family, from one plan or option to
another, or make any combination of these changes when you or an eligible child loses other FEHB coverage or
coverage under another group health benefits plan. Unless stated otherwise, you must
change the enrollment from 31 days before to 60 days after the loss of coverage.
Examples of loss of coverage include:
- Loss of coverage under another FEHB enrollment because the covering enrollment was
terminated, canceled, or changed to Self Only;
- Loss of coverage under another federally-sponsored health benefits program;
- Loss of coverage because membership in
an employee organizationsponsoring or underwriting an FEHB plan was terminated;
- Loss of coverage because an FEHB plan was discontinued in whole or in part. If the
discontinuation is at the end of the contract year, you must change the enrollment during
the Open Season, unless OPM sets a different time frame. If the discontinuation is at a
time other than the end of the contract year, OPM will set the time and effective date for
changing the enrollment. If the whole plan is discontinued and you don't change within the
set time frame, you are considered to have canceled your enrollment. If only one option of
a two-option plan is discontinued and you don't change within the set time frame, you are
considered to be enrolled in the remaining plan option.
- Loss of coverage under the Medicaid program (or similar State-sponsored program of
medical assistance for the needy);
- Loss of coverage under a non-Federal health plan.