Compensationers

Tribal Employer Note: With limited exceptions, individuals who work under tribal employment are not eligible for the Federal Employees’ Compensation Act (FECA). Tribal employees who are receiving worker’s compensation benefits through their tribal employer are eligible for continued FEHB coverage for up to 365 days while in leave without pay status.

Requirements for Continued Coverage

An individual's health benefits enrollment will continue when they enter on the compensation rolls of the Office of Workers' Compensation Programs (OWCP) Federal Employees’ Compensation Act (FECA) program and the Secretary of Labor determines that the individual is unable to return to duty. If the FECA compensation lasts fewer than 29 days, OWCP won't transfer the enrollment. Instead, the enrollment will remain with the individual's employing office.

If an individual is receiving compensation, the enrollment may continue during the first 365 days in leave without pay status. After that period, the individual must meet the same participation requirements as for continuing an enrollment after retirement. The individual must meet the requirements as of the date they started receiving compensation. OWCP, not the employing office, is responsible for determining an individual's eligibility. Please see the OWCP FECA procedure manual for additional information.

Enrollment Types of OWCP

There are four types of payments that an employee can receive from OWCP:

o   Periodic Compensation Every 4 weeks  

o   Daily/Intermittent Payments for Disability (< 90 days)

o   Schedule awards for permanent impairment

o   Travel/medical reimbursement

An individual's enrollment will be transferred to the OWCP when:

o   OWCP requests the transfer by sending an SF 2810 to the Agency and Carrier.

o   ten months of leave without pay status have elapsed and OWCP has not requested transfer; or

o   the individual separates from service before OWCP requests the transfer.

OWCP normally does not request an enrollment transfer unless it expects the individual's compensation to continue for 90 days or longer. Most employees return to work in less than 90 days.

Withholdings and Contributions

OWCP makes health benefits withholdings regardless of whether an enrollment is transferred to OWCP. Withholdings begin on the later of:

o   the date compensation begins; or

o   the date following the day the employing office stops making withholdings and contributions.

When OWCP begins making the withholdings from compensation, its contributions are made from the Congressional appropriation authorized for the payment of Government contributions for retirees and Compensationers.

Reporting Enrollment to OWCP

When the employing office reports a compensable injury or illness on OWCP Form CA 7, it will show whether the individual was enrolled for health benefits on the date the individual's pay stopped, the plan's enrollment code, and the ending date of the last pay period that insurance withholdings were made.

If the individual separated before the employing office received OWCP's request to transfer the enrollment, the employing office must check with OWCP to determine the status of the compensation claim. If the compensation is to continue beyond the date of separation, it will transfer the enrollment to OWCP. The employing office should not terminate FEHB enrollment without checking OWCP claim status with OWCP.

If an individual makes any permissible change in enrollment before the employing office receives OWCP's request for transfer, the employing office must promptly notify OWCP by letter of the change and its effective date.

Transferring the Enrollment at OWCP's Request

An individual's employing office will transfer an individual's enrollment by attaching to the request form a Health Benefits Election Form (SF 2809). The employing office must keep a copy of the request form (and back-up copies of all other health benefits documentation) in the individual's Official Personnel Folder to show that OWCP has the health benefits documentation. When OWCP receives the health benefits documentation, it must complete an SF 2810 transferring the enrollment to OWCP.

Transferring an Enrollment without a Request by OWCP

If an individual is being separated or he/she has been in leave without pay status for 10 months and OWCP hasn't requested that the enrollment be transferred, the employing office must check with OWCP on the status of the FECA claim. If compensation will continue beyond the individual's separation date the employing office must transfer the enrollment to OWCP by sending the SF 2809 and any other related health benefits documentation to OWCP by letter, ECOMP or sending an email to: OWCP-DFEC-FEHB@dol.gov explaining the reason for the action. When OWCP receives the documentation, it must complete an SF 2810 transferring the enrollment to OWCP.

End of Compensation Return to Duty

If compensation ends and the individual returns to duty, the employing office is to send the transfer SF 2810 to OWCP by adding to ECOMP or by sending an email to: OWCP-DFEC-FEHB@dol.gov. In addition, the employing office is to send a copy to the FEHB Carrier via the Macon Data Hub or by identifying and sending directly the carrier contact located here: www.opm.gov/plancontacts.If an individual is eligible for continued FEHB coverage, the employing office will transfer the enrollment in to the agency by completing a Notice of Change in Health Benefits Enrollment (SF 2810). The effective date of the transfer is the day after the individual's compensation terminated.

If the individual isn't eligible for continued FEHB coverage, the employing office will complete an SF 2810 terminating the enrollment effective with the date the compensation ended. A copy of OWCP's letter transferring the enrollment back to the employing office must be attached to the carrier copy of the SF 2810.

Return to Duty Part-time

When returning to duty on a part-time basis and compensation payments continue, but the part-time salary is insufficient to pay the FEHB premiums, OWCP may keep the individual's enrollment and continue to make withholdings and contributions for the individual.