[Federal Register: September 23, 2004 (Volume 69, Number 184)]
[Rules and Regulations]
[Page 56927-56929]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr23se04-1]
========================================================================
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
week.
========================================================================
[[Page 56927]]
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: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Office of Personnel Management (OPM) is issuing final
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 or her to provide health benefits for his or her child or children
and the employee does not provide documentation of compliance with the
order.
DATES: Effective Date: October 25, 2004.
FOR FURTHER INFORMATION CONTACT: Nataya Battle (202) 606-0004, or e-
mail to nataya.battle@opm.gov.
SUPPLEMENTARY INFORMATION:
Background
On October 1, 2003, OPM issued interim regulations in the Federal
Register (68 FR 56523) to mandate compliance with court or
administrative orders requiring Federal employees to provide health
benefits for their children. The interim regulations were effective on
October 31, 2003, and are located at parts 890 and 892.
On October 30, 2000, the Federal Employees Health Benefits
Children's Equity Act of 2000 (Pub. L. 106-394, 114 Stat. 1629) was
enacted. This law mandates compliance with court or administrative
orders requiring Federal employees to provide health benefits for their
children.
Before the enactment of Pub. L. 106-394, a court or State
administrative agency could issue an order for an individual to provide
health benefits for his or her child or children; 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 may not 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 may not 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
may not 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 may not 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).
OPM received comments from one Federal agency, three State
agencies, and one independent organization. Several of the comments
addressed the same issue concerning mandating that the National Medical
Support Notice (NMSN) be accepted as an administrative order for
medical support orders. OPM has addressed this issue in a Benefits
Administration Letter instructing agencies to recognize the NMSN as an
administrative order and to respond to the questions therein. Two
comments suggested establishing an interagency procedure to determine
health coverage requirements, including requesting copies of policies.
The Public Law requires employees to provide evidence of full health
benefits coverage and services in the location in which the child
resides. It is not the intent of OPM to require agencies to analyze
that coverage to compare benefits. One comment addressed the need for
edits in the National Finance Center (NFC) system to prevent affected
employees from making unlawful changes in their enrollment. The NFC has
had these edits in place for nearly two years. One comment addressed
the need to extend health care coverage to all eligible children of
non-custodial parents and to assure that the coverage covers siblings
that may live in different geographical locations. Custodial parents
must look
[[Page 56928]]
to the court system or administrative agency to issue an order for an
individual to be required to provide health benefits for his or her
children. This regulation stipulates that the health coverage provided
must cover all eligible children wherever they may live. Another
suggestion was that employees who allow their alternate health benefits
coverage to lapse should then lose the option to provide alternate
coverage and be restricted to enrollment in the FEHB Program only. We
do not believe the final regulations needs to impose such a
restriction. OPM is not aware that lapses in coverage occur with any
frequency. In addition, it is clearly the intent of the law that
employees be allowed to provide alternate coverage.
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.
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.
Office of Personnel Management.
Kay Coles James,
Director.
0
Accordingly, the interim rule amending 5 CFR parts 890 and 892, which
was published at 68 FR 56523 on October 1, 2003, is adopted with only
minor editorial changes for greater clarity as follows:
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
0
1. The authority citation for part 890 is 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)(ii), (f)(3) and (g)(4)(i)
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) * * *
(1) * * *
(ii) An employee who is subject to a court or administrative order
as discussed in Sec. 890.301(g)(3) may not 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) may not 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) * * *
(4) * * *
(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. Effective dates may not be retroactive
to a date more than 2 years earlier, or prior to October 30, 2000.
* * * * *
0
3. In Sec. 890.304 revise paragraph (d)(1) 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 any time 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, may not 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 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 When can annuitants or survivor annuitants change
enrollment and what are the 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 may not 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
[[Page 56929]]
subject to a court or administrative order as discussed in
Sec. 890.301(g)(3) at the time he or she retired may not 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 revise the second sentence in paragraph (b)(2) and
revise 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) may not 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 may not 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. Revise 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. 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 may not 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. Revise 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 may not 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. 04-21304 Filed 9-22-04; 8:45 am]
BILLING CODE 6325-39-P