[Federal Register: April 14, 2006 (Volume 71, Number 72)]
[Proposed Rules]
[Page 19459-19460]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr14ap06-11]
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Proposed Rules
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains notices to the public of
the proposed issuance of rules and regulations. The purpose of these
notices is to give interested persons an opportunity to participate in
the rule making prior to the adoption of the final rules.
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[[Page 19459]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 875
RIN 3206-AK99
Federal Long Term Care Insurance Program: Miscellaneous Changes,
Corrections, and Clarifications
AGENCY: Office of Personnel Management.
ACTION: Proposed regulations.
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SUMMARY: The Office of Personnel Management (OPM) is issuing proposed
regulations to amend the Federal Long Term Care Insurance Program
(FLTCIP) regulations. The proposed regulations will make miscellaneous
changes, corrections, and clarifications to the FLTCIP regulations.
DATES: OPM must receive comments on or before June 13, 2006.
ADDRESSES: Send written comments to Anne S. Easton, Manager, Insurance
Group, Center for Employee and Family Support Policy, Strategic Human
Resources Policy Division, Office of Personnel Management, 1900 E
Street, NW., Washington, DC 20415; or deliver to OPM, Room 3425, 1900 E
Street, NW., or FAX to (202) 606-0633.
FOR FURTHER INFORMATION CONTACT: Anne Easton at (202) 606-0770.
SUPPLEMENTARY INFORMATION: The final FLTCIP regulations were published
in the Federal Register May 27, 2005 (70 FR 30605). In those
regulations OPM replaced references to ``Federal civilian and Postal
employees and members of the uniformed services'' with ``active
workforce member'' in several places. We are making a similar change in
2 additional places: Sec. Sec. 875.405 and 875.410. We are also
correcting an incorrect section reference in Sec. 875.209 of the
previously published regulations.
Section 875.408 of the FLTCIP regulations discusses
incontestability, a provision that allows coverage based on an
erroneous application to continue under certain circumstances. The
FLTCIP contractor often doesn't learn that coverage is based on an
erroneous application until someone files a claim, and the contractor
becomes aware that the information on the individual's application
differed from what is shown in that individual's medical records. If
the erroneous coverage has been in effect less than 2 years, or if the
application contained knowingly false or misleading information, the
contractor may rescind (void) the coverage and refund the individual's
premiums. Section 875.104 of the FLTCIP regulations contains procedures
for resolving disputes concerning eligibility for benefits and payment
of claims. These proposed regulations clarify that the claims dispute
procedures apply only to persons who have valid coverage under the
Program. They do not apply to individuals whose erroneous coverage has
been rescinded.
Executive Order 12866, Regulatory Review
This rule has been reviewed by the Office of Management and Budget
in accordance with Executive Order 12866.
Regulatory Flexibility Act
I certify that these regulations will not have a significant
economic impact on a substantial number of small entities because they
affect only enrollees in the Federal Long Term Care Insurance Program.
List of Subjects in 5 CFR Part 875
Administrative practices and procedures, Employee benefit plans,
Government contracts, Government employees, Health insurance, Military
personnel, Organization and functions, Retirement.
Office of Personnel Management.
Linda M. Springer,
Director.
Accordingly, OPM proposes to amend 5 CFR part 875, as follows:
PART 875--FEDERAL LONG TERM CARE INSURANCE PROGRAM
1. The authority citation for 5 CFR part 875 continues to read as
follows:
Authority: 5 U.S.C. 9008.
2. In Sec. 875.104 add paragraph (f) to read as follows:
Sec. 875.104 What are the steps required to resolve a dispute
involving benefit eligibility or payment of a claim?
* * * * *
(f) The procedures described in paragraphs (a), (b), (c), (d), and
(e) of this section apply only if you have valid coverage under the
FLTCIP. If the Carrier determines that your coverage was based on an
erroneous application and voids the coverage as described in Sec.
875.408 of this part, these provisions do not apply. The Carrier will
provide you with information on your review rights in its rescission
letter (letter voiding your coverage).
3. In Sec. 875.209 revise the last sentence of paragraph (b) to
read as follows:
Sec. 875.209 How do I demonstrate that I am eligible to apply for
coverage?
* * * * *
(b) * * * The incontestability provisions in Sec. 875.408 do not
apply to this section.
(4) In Sec. 875.405 revise the first sentence of paragraph (a)(1)
to read as follows:
Sec. 875.405 If I marry, may my new spouse apply for coverage?
(a)(1) If you are an active workforce member and you have married,
your spouse is eligible to submit an application for coverage under
this section within 60 days from the date of your marriage and will be
subject to the underwriting requirements in force for the spouses of
active workforce members during the most recent open season. * * *
* * * * *
5. In Sec. 875.408 revise paragraph (a) to read as follows:
Sec. 875.408 What is the significance of incontestability?
(a) Incontestability means coverage issued based on an erroneous
application may remain in effect. Such coverage will not remain in
effect under any of the following conditions:
(1) If your coverage has been in force for less than 6 months, the
Carrier may void your coverage upon a showing that information on your
signed application that was material to your approval for coverage is
different from what is shown in your medical records.
(2) If your coverage has been in force for at least 6 months but
less than 2 years, the Carrier may void your coverage upon a showing
that information on your signed application that was material to your
approval for coverage is different from what is shown in your medical
records and pertains to
[[Page 19460]]
the condition for which benefits are sought.
(3) After your coverage has been in effect for 2 years, the Carrier
may void your coverage only upon a showing that you knowingly and
intentionally made a false or misleading statement or omitted
information in your signed application for coverage regarding your
health status that was material to your approval for coverage.
(4) If your coverage is voided, as described in paragraph (a)(1),
(a)(2), or (a)(3) of this section, no claims will be paid. In addition,
the provisions of Sec. 875.104 relating to the procedures for
resolving a dispute involving benefits eligibility or claims denials do
not apply to your situation. You may request a review by the Carrier if
you believe that your coverage was voided in error. You must submit
your request in writing to the Carrier within 30 days of the date of
this rescission letter (letter voiding your coverage).
6. In Sec. 875.410 revise the first sentence to read as follows:
Sec. 875.410 May I continue my coverage when I leave Federal or
military service?
If you are an active workforce member, your coverage will
automatically continue when you leave active service, as long as the
Carrier continues to receive the required premium when due. * * *
[FR Doc. 06-3585 Filed 4-13-06; 8:45 am]
BILLING CODE 6325-39-M