523 Election Procedures

 

Reference Note:

For more material about information in 523 through 523.33, see:

523.1 Initial

All employees who initially become eligible must elect either to enroll or not to enroll in a plan by completing a PostalEASE FEHB Worksheet. An employee electing not to enroll is thereafter precluded from enrolling until the occurrence of an event permitting enrollment as stated in 524.52. Except as stated in 523.3, employees must register within 60 days after they become eligible. See 524.64 for effective date of coverage.

523.2 Employee Declines to Enroll

PostalEASE automatically creates an SF 2809 with a notation in the Remarks section indicating that the employee has waived coverage when an employee does not:

  1. Enroll in FEHB via PostalEASE, or
  2. Submit a completed PostalEASE FEHB Worksheet to the Human Resources Shared Service Center (HRSSC).

523.3 Late Enrollment or Change in Enrollment

523.31 Accepting Late Enrollment

If the HRSSC determines that an employee was unable, for causes beyond control, to enroll or to change enrollment within the prescribed time limits, it may accept the enrollment within 60 days after notifying the employee of its determination. The HRSSC must decide whether or not the employee’s reason for not enrolling on time was “cause beyond control.” See 523.32 for examples of causes beyond an employee’s control.

523.32 Causes Beyond Employee’s Control

An employee’s failure to enroll on time because of an error in judgment or because of failure to read informational material is not considered a cause beyond the employee’s control. Some examples of causes beyond an employee’s control are:

  1. Employee was on extended leave away from home, or detached service in another locality, during the time employee would ordinarily have been able to enroll.
  2. The HRSSC failed to give new employee information concerning health benefits coverage.
  3. The HRSSC officials previously advised the employee that he or she was not eligible to enroll.
  4. Employee formerly covered under someone else’s enrollment was not notified of the termination of coverage in a timely manner.
523.33 Procedures for Documenting Late Enrollment

When the HRSSC accepts a late enrollment or change in enrollment, it should record in the Remarks section of the PostalEASE FEHB Worksheet its determination that the employee was unable to enroll in a timely manner or to change enrollment due to causes beyond the employee’s control, giving the date the employee was notified of the determination. In the case of an employee who is enrolling, it is especially important that this information is documented on the PostalEASE FEHB Worksheet for purposes of meeting the “enrolled from first opportunity or last 5 years of service” requirement for continuing enrollment after retirement. The employee’s reason for failing to enroll on time need not be stated on the FEHB Worksheet; however, a memo stating the reason should be scanned into the electronic official personnel folder (eOPF).

523.34 Effective Date of Late Enrollment

 

Reference Note:

For additional material concerning the subject matter found in 523.34, see:

523.341 Belated FEHB Open Season Enrollment

FEHB Open Season enrollments or enrollment changes that are filed late due to circumstances beyond an employee’s control take effect retroactive to the effective date of the open season change. See 524.61 for information concerning effective date of an open season enrollment or enrollment change.

523.342 Late Enrollment Other Than FEHB Open Season

A late enrollment (other than open season) may not be made retroactively. When the Human Resources Shared Service Center (HRSSC) determines an employee was unable, for causes beyond the employee’s control, to enroll or to change an enrollment within the time limit prescribed, the HRSSC accepts the employee’s enrollment within 60 days after notifying the employee of the determination. For effective date, see 524.64.

523.4 Enrollment by Proxy

 

Reference Note:

For additional material concerning the subject matter found in 523.4 through 523.5, see:

The Human Resources Shared Service Center (HRSSC) may permit a representative of an employee to enroll for the employee if the representative has written authorization to do so. Enrollment by proxy is appropriate when an employee is unable to enroll on time (e.g., it is very difficult to reach the employee or the employee expects to be hospitalized when the next enrollment opportunity occurs, etc.).

When enrolling for an employee, the representative signs his or her own name on the PostalEASE FEHB Worksheet and adds after it “For [__name of employee__].” The HRSSC writes “Authorization attached” in the Remarks section of the FEHB Worksheet and scans the FEHB Worksheet and the written authorization into the electronic official personnel folder (eOPF).

523.5 Enrollment in an Employee Organization Plan

Employees who are not members of employee organizations may enroll in a plan sponsored by an employee organization if they promptly take steps to become members. The HRSSC need not ascertain whether or not an employee is a member of an organization when accepting the enrollment form to enroll in the organization plan. The organization verifies membership. However, the HRSSC ascertains that the employee understands that membership in the organization that sponsors the plan is required.

523.6 Enrollment by a Former Spouse

 

Reference Note:

For more material about the information in 523.6, see:

523.61 Enrollment Form

Former spouses eligible to enroll for health benefits coverage under the FEHB Program must enroll for coverage by completing SF 2809. Former spouses complete Part A of the form using their own name, date of birth, and Social Security number.

The Human Resources Shared Service Center (HRSSC) enters the name, date of birth, and employee identification number of the employee in the Remarks section of the SF 2809. The following statement is also included in the Remarks section: “Former spouse is eligible to enroll by authority of the CSR Spouse Equity Act (Public Law 98-615).” An event number is not required in Part C.

All SFs 2809 for former spouses are forwarded to the NFC at the following address:

DPRS BILLING UNIT
NATIONAL FINANCE CENTER
PO BOX 61760
NEW ORLEANS LA 70161–1760

523.62 Statement Signed by Former Spouse

Former spouses enrolling for health benefits coverage are required to sign a statement certifying that the HRSSC will be notified within 31 days of any event that will terminate eligibility for health benefits coverage. Exhibit 523.62 is used for this purpose.

523.63 Human Resources Shared Service Center Records on Former Spouse
523.631 Establishing File

The Human Resources Shared Service Center (HRSSC) establishes and maintains a health benefits file for the former spouse. The file is kept separate from the personnel records of the employee. The file is established in the name of the former spouse. The name and date of birth of the employee on whose service the former spouse’s benefits are based are also noted on the front cover of the file established for the former spouse.

523.632 Contents of File

The following documents are kept in the former spouse’s file:

  1. The former spouse’s letter (the application) to the HRSSC requesting enrollment.
  2. A copy of the court order or divorce decree used by OPM to determine eligibility.
  3. A copy of the OPM’s written notification to the former spouse verifying the acceptability of the court order.
  4. The HRSSC‘s copy of the SF 2809 or PostalEASE FEHB Worksheet documenting the former spouse’s enrollment, enrollment changes, or cancellation.
  5. The HRSSC’s copy of the SF 2810 terminating or transferring the enrollment.
  6. Copies of all correspondence relating to the former spouse’s enrollment, e.g.:
    1. The HRSSC’s letter approving or denying eligibility for health benefits coverage along with documents on which the agency’s eligibility decision is based.
    2. The former spouse’s agreement (Exhibit 523.62) to notify the HRSSC within 31 days of an event that terminates eligibility.
    3. The National Finance Center (NFC) letter requesting payment of overdue premiums prior to terminating coverage.
    4. Documents pertaining to a child’s physical disability before age 26.
    5. Court order terminating entitlement to survivor annuity or a portion of a retirement annuity.
    6. Letter from the former spouse canceling the enrollment; and OPM’s notice that a refund has been made to a former employee or that the former employee has died and no survivor annuity is payable.
523.633 Access to File

Disclosure of the contents of the former spouse’s file must be consistent with the provisions of the Privacy Act.

523.634 Disposition of File

The HRSSC maintains the former spouse’s health benefits file for as long as the NFC maintains the enrollment. The file is transferred to OPM upon the occurrence of one of the following events:

  1. The former spouse cancels the enrollment.
  2. The HRSSC terminates the enrollment.
  3. The former spouse begins receiving an annuity payment (a portion of the employee’s retirement annuity or a survivor annuity).

If the former spouse does not qualify for coverage under the Souse Equity Act provisions, the HRSSC must keep a file containing the records for at least 1 year from the date of notice stating that he or she did not qualify. Then the contents of the file may either be destroyed or returned to the former spouse.

Exhibit 523.62

Statement by Former Spouse Regarding FEHB Coverage Under the Spouse Equity Act

Exhibit 523.62 Statement by Former Spouse..