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ELM REVISION
Using PostalEASE FEHB Worksheet
Effective September 15, 2004, Employee and Labor
Relations (ELM) 520, Health Benefits Program, is updated to reflect
the adoption of the PostalEASE Federal Employees Health Benefits
(FEHB) Worksheet for health benefits elections.
Since the development of PostalEASE to
administer certain employee benefits, the PostalEASE FEHB Worksheet
rather than Standard Form (SF) 2809, Health Benefits Election Form,
has been used to document election of participation in health benefits
except (1) when the person electing benefits is a family member applying
for Temporary Continuation of Coverage or a former spouse seeking spouse
equity and (2) when an employee is transferring to another agency.
Accordingly, where appropriate:
• References to SF 2809 are replaced by references
to the PostalEASE FEHB Worksheet.
• References to the PostalEASE FEHB
History Report for the employee are added.
• The PostalEASE FEHB Worksheet is
added to lists of documents being examined or stored.
Other revisions include the following:
• References to the Social Security number
are replaced by references to the employee identification number where
appropriate.
• The title of PS Form 3111, Federal Employees
Health Benefits (FEHB) Coverage or Termination While in Leave Without
Pay (LWOP) Status, is corrected.
• PS Form 3111 is shown to be available on
the Postal ServiceTM Intranet.
• Minor editorial changes are made for consistency
of presentation.
The changes made to ELM 520 do not alter health
benefits available to employees, family members, or former spouses.
We will incorporate these revisions into the next
printed version of the ELM and also into the online update, available
on the Postal Service PolicyNet Web site:
• Go to http://blue.usps.gov.
• Under "Essential Links" in the
left-hand column, click on References.
• Under "References" in the right-hand
column, under "Policies," click on PolicyNet.
• Click on Manuals.
(The direct URL for the Postal Service PolicyNet
Web site is http://blue.usps.gov/cpim.)
It is also available on the Postal Service Internet:
• Go to www.usps.com.
• Click on About USPS & News,
then Forms & Publications, then Postal Periodicals and
Publications, and then Manuals.
Employee and Labor Relations Manual (ELM)
* * * * *
Chapter 5 Employee Benefits
* * * * *
520 Health Benefits Program
* * * * *
521 Administration and Eligibility
* * * * *
521.6 Former Spouses
521.61 Eligibility Determination
* * * * *
521.613 Employing Office Responsibility
[Revise the text of the first paragraph of 521.613
to read as follows:]
The employing office for which the employee worked
at the time the marriage dissolved is responsible for accepting the former
spouse's application for health benefits coverage under the FEHB program.
The former spouse's application for health benefits may be in the form
of an SF 2809, Health Benefits Election Form, letter, or a written
statement to the employing office. The application preserves the former
spouse's FEHB enrollment right until the eligibility determination is
made.
* * * * *
[Revise the text of 521.613a to read as follows:]
a. Reviews the SFs 2809, the SFs 2810,
Notice of Change in Health Benefit Enrollment, and the PostalEASE
Federal Employees Health Benefits (FEHB) Worksheets in the employee's
official personnel folder (OPF) to determine if the former spouse was
covered as a family member in an FEHB enrollment at any time during the
18 months preceding the date of the dissolution of marriage.
* * * * *
523 Registration
* * * * *
523.1 Initial
[Revise the text of 523.1 to read as follows:]
All employees who initially become eligible must
register either to enroll or not to enroll in a plan by completing a PostalEASE
FEHB Worksheet. An employee registering 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. Each installation has a follow-up
system to remind employees of the 60-day deadline for enrolling and to
insure that all employees register on a timely basis. See 524.64 for effective
date of coverage.
523.2 Employee Declines to
Enroll
[Revise the text of 523.2 to read as follows:]
When an employee declines to register or waives
enrollment, the employing installation contacts the employee and verifies
the employee's intentions within the 60-day enrollment period, if practicable.
If the employee refuses to enroll, the employing installation fills out
a PostalEASE FEHB Worksheet with the employee's name, employee
identification number, etc. A notation is made in the Remarks section
that the employee was contacted but declined to enroll.
523.3 Late Enrollment or Change
in Enrollment
* * * * *
523.33 Procedures for Documenting
Late Enrollment
[Revise the text of 523.33 to read as follows:]
When an employing office 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
FEHB Worksheet for purposes of meeting the "enrolled from first opportunity
or last 5 years" 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 attached
to the OPF copy of the form.
When enrolling for an employee, the representative
signs his or her own name on the FEHB Worksheet and adds after it "For
[__name of employee__]." The employing office attaches the written
authorization to the official personnel folder copy of the FEHB Worksheet
and writes "Authorization attached" in the Remarks section of
the form.
* * * * *
523.6 Enrollment by a Former
Spouse
* * * * *
523.61 Enrollment Form
* * * * *
[Revise the text of the second paragraph of
523.61 to read as follows:]
The employing office 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.
* * * * *
523.63 Employing Office Records
on Former Spouse
* * * * *
523.632 Contents of File
* * * * *
[Revise the text of 523.632d to read as follows:]
d. The employing office's copy of the
SF 2809 or PostalEASE FEHB Worksheet documenting the former spouse's
enrollment, enrollment changes, or cancellation.
* * * * *
524 Enrollment
* * * * *
524.1 Types of Enrollment
* * * * *
524.12 Self and Family
[Revise the introductory text of 524.12 to read
as follows:]
A Self and Family enrollment provides benefits for
the enrolled employee and eligible family members. It automatically covers
all eligible family members even if they are not listed on the PostalEASE
FEHB Worksheet and even if the enrolled employee may wish to exclude some
of them. An employee's failure to list an eligible family member does
not deprive the member of the right to benefits under a family enrollment.
* * * * *
[Revise the text of notes b and c to read as
follows:]
b. The listing on the FEHB Worksheet
of a person who is not a family member does not entitle that person to
benefits.
c. If an employee lists on the FEHB
Worksheet a person who is not an eligible family member, the employing
office explains to the employee that the person is not eligible for coverage.
The ineligible person's name is deleted from the FEHB Worksheet.
* * * * *
524.3 Dual Coverage Restriction
* * * * *
524.32 Procedures to Be Followed
by Employing Office
* * * * *
[Revise the text of the second paragraph of
524.32 to read as follows:]
If the person whose enrollment must be terminated
in order to avoid or eliminate dual coverage refuses to cancel, the employing
office cancels the enrollment, identifying the action on the PostalEASE
FEHB Worksheet as an agency action, and explains the reason for the cancellation.
* * * * *
524.5 Enrollment or Change
in Enrollment
* * * * *
524.53 Family Changes Affecting
Enrollment
524.531 Change in Marital Status
* * * * *
[Revise the text of 524.531c and 524.531d to
read as follows:]
c. Coverage for New Spouse.
An employee may provide immediate coverage for the new spouse by filing
a PostalEASE FEHB Worksheet during the pay period before the
anticipated date of the marriage. If the effective date of the change
is before the marriage, the new spouse is not eligible for coverage until
the actual day of the marriage.
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d. Name Change. A female employee
who enrolls on this basis before the date of her marriage enters her name
on an FEHB Worksheet as "Now: [__former name__] will be: [__married
name__]." An enrolled female employee who changes her enrollment
also enters her former name and her new married name. The reason for the
change and the date of the marriage is given in the Remarks section of
the FEHB Worksheet.
* * * * *
524.54 Family Changes Not Affecting
Enrollment
* * * * *
524.542 Name Change
* * * * *
[Revise the text of the second paragraph of
the example in 524.542 to read as follows:]
If a female employee with a Self Only enrollment
reports a name change due to marriage, the employing office reminds her
of the opportunity to change her enrollment. If she decides to change
her enrollment, no SF 2810 is required, but a PostalEASE FEHB
Worksheet is submitted in accordance with 524.531d.
* * * * *
524.6 Effective Date of Enrollment
or Enrollment Change
* * * * *
524.62 Change to Self Only
* * * * *
[Revise the text of 524.62a and 524.62b to read
as follows:]
a. If health premiums are paid on an
after-tax basis, a change to Self Only may be made at any time. The effective
date of the change is the first day of the pay period that begins after
the completed PostalEASE FEHB Worksheet is received in the employing
office. However, a retroactive change may be approved to the first day
of the pay period following the one in which there were no family members
eligible for coverage if the employee is able to satisfy the agency of
that fact.
b. If health premiums are paid on a
pre-tax basis, the employee must provide the local personnel office with
documentation showing that he or she had a qualified life status change
occur within the past 60 days. The effective date of the change is the
first day of the pay period that begins after the completed FEHB Worksheet
is received in the employing office.
* * * * *
524.64 All Other Enrollments
or Changes in Enrollment
[Revise the text of 524.64 to read as follows:]
All other enrollments or changes in enrollment become
effective the first day of the first pay period that begins after the
PostalEASE FEHB Worksheet is received by the employing office
and that follows a pay period during any part of which the employee is
in pay status.
524.7 Termination of Enrollment
* * * * *
524.71 Cancellation by Employee
[Revise the text of 524.71 to read as follows:]
The option to cancel enrollment at any time during
the year is available only to those employees whose health benefit premiums
are paid on an after-tax basis. For those employees with health premiums
paid on a pre-tax basis, a cancellation of coverage may only be processed
during FEHB Open Season or following a qualified life status change as
identified in 524.529. Requests due to qualified life status changes must
be received in the local personnel office within 60 days of the life status
change. The PostalEASE FEHB Worksheet used to cancel enrollment
due to a life status change becomes effective the last day of the pay
period in which the FEHB Worksheet is received. For information on effective
dates, see 524.6.
* * * * *
525 Special Circumstances Affecting
Health Insurance Coverage
* * * * *
525.1 Office of Workers' Compensation
Programs
* * * * *
525.14 Procedures for Continuation
of Enrollment
* * * * *
525.142 Eligibility for Transfer
* * * * *
Exhibit 525.142 Transfer of
FEHB Enrollment to OWCP
* * * * *
[Revise the text of the second paragraph of
Exhibit 525.142 to read as follows:]
Attached are the employee's health benefits enrollment
documents that this agency is forwarding to OWCP as specified in the Federal
Employees' Health Benefits Handbook (formerly Supplement 890-1 of the
Federal Employees Personnel Manual). The documents include the copies
of every SF 2809 and SF 2810 in the employee's official personnel folder,
beginning with the date of his or her initial enrollment in the FEHB Program,
together with any related documentation (such as medical documentation
for a disabled child over age 22) and the PostalEASE FEHB History
Report for the employee. As of the effective date shown above, OWCP is
the employing office for this employee.
* * * * *
525.2 Employees in Nonpay Status
* * * * *
525.22 Payment Required for
Periods of Nonpay Status
* * * * *
525.222 Procedures to Be Followed
by Employing Office
* * * * *
[Revise the text of 525.222a to read as follows:]
a. As soon as it is determined that
an employee will be in a nonpay status, the employing office notifies
the employee of the option to continue or terminate the FEHB coverage.
PS Form 3111, Federal Employees Health Benefits (FEHB) Coverage
or Termination While in Leave Without Pay (LWOP) Status, is used
for this purpose. This form may be found on the Postal Service Intranet.
* * * * *
525.3 Military Service
* * * * *
525.32 Return From Military
Service
* * * * *
525.322 Return in Exercise
of Reemployment Rights
* * * * *
[Revise the text of 525.322b to read as follows:]
b. Also, if the employee was not enrolled
upon entering military duty, the employee may enroll within 31 days after
returning to civilian service. The enrollment becomes effective the first
day of the pay period that begins after the completed PostalEASE
FEHB Worksheet is received in the employing office and that follows a
pay period during any part of which the employee was in pay status.
* * * * *
525.4 Coverage Into Retirement
* * * * *
525.42 Procedures to Be Followed
by Employing Office
* * * * *
525.422 Transferring Enrollment
to OPM
* * * * *
[Revise the text of the third paragraph of 525.422
to read as follows:]
All SFs 2809 and SFs 2810 in the employee's official
personnel folder together with the PostalEASE FEHB History Report
are sent to the Eagan Accounting Service Center (ASC) with the completed
memorandum and any related medical certificates for submission to OPM.
* * * * *
Exhibit 525.422 Memorandum
About FEHB Enrollment
* * * * *
[Revise the text of the second paragraph of
Exhibit 525.422 to read as follows:]
As specified in the Federal Employees Health
Benefits Handbook (formerly Supplement 890-1 of the Federal Employees
Personnel Manual), attached are copies of every SF 2809 and SF 2810
kept in the employee's official personnel folder, beginning with the date
of his or her initial enrollment in the FEHB Program together with any
related documentation (such as medical documentation for a disabled child
over age 22) and the PostalEASE FEHB History Report for the employee.
The Remarks section at the end of this memorandum shows pertinent information
about the enrollment that is not readily apparent in the FEHB forms documentation.
* * * * *
525.7 Move Outside Service
Area of a Comprehensive Plan
[Revise the text of 525.7 to read as follows:]
An employee enrolled in a comprehensive plan (group
or individual practice prepayment plan) that moves outside the service
area of that plan may change to any other plan available in the area to
which he or she is moving and may change options from Self Only to Self
and Family. An employee already living outside the service area of the
plan that moves farther from the nearest office of the plan in which enrolled
may similarly change enrollment. Such a change may be made at any time
after the move. The change takes effect on the first day of the pay period
after the PostalEASE FEHB Worksheet is received by the employing
office.
* * * * *
526 Self-Support Determinations
* * * * *
526.3 Medical Requirement
* * * * *
526.32 Medical Certificate
* * * * *
526.322 Time Limitation
[Revise the text of 526.322 to read as follows:]
The medical certificate for each individual case
may be approved for a limited period of time, e.g., 1 year, or it may
be approved without time limitation. The health benefits plan is advised
of the duration of the approval in the letter to the health benefits plan
(see 526.5).
* * * * *
526.5 Procedures for Notifying
the Health Benefits Plan
* * * * *
526.51 Employing Office
* * * * *
526.512 New Enrollment
[Revise the text of 526.512 to read as follows:]
For a new enrollment, the medical officer's determination
of incapacity is entered in the Remarks section of the PostalEASE
FEHB Worksheet.
* * * * *
— Compensation,
Employee Resource Management, 9-15-05
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