Effective October 16, 2014, the Postal Service™ is revising the Employee and Labor Relations Manual (ELM), subchapter 520, Health Benefits Program, to update policy and procedures in accordance with Office of Personnel Management regulations and the Patient Protection and Affordable Care Act as follows:
n 521.1 — Revised to update Reference Note.
n 521.2 — Revised to update Reference Note and to reflect changes in noncareer employees’ titles.
n 521.4 — Revised to update Reference Note and to reflect changes to Federal Employees Health Benefits (FEHB) policy in accordance with the Affordable Care Act, covering Children until Age 26. Includes policy change concerning eligible same-sex spouses and qualified step-children of same-sex domestic partners who live in states that do not allow same-sex marriage. Updates FEHB Certification for Foster Child to include coverage for Federal Employees’ Group Life Insurance Program, and Federal Employees’ Dental and Vision Insurance Program. Changes references to “employing office” to Human Resources Shared Service Center or HRSSC.
n 521.6 — Revised to update Reference Note and to align ELM guidance with OPM’s requirements that allow former spouses to enroll in FEHB, and to correct the address to which former spouses should mail their requests for determination. In addition, changes references to “employing office” to Human Resources Shared Service Center or HRSSC.
n 521.7 — Revised to update Reference Note and to change the age of eligible dependent children from 22 to 26 years of age and “employing office” references to Human Resources Shared Service Center or HRSSC.
n 522 — Revised to update Reference Note and plan descriptions and to add description of High Deductible and Consumer-Driven Health Plans.
n 523 — Title was revised from Registration to Election Procedures to reflect OPM’s FEHB Handbook language.
n 523.2, 523.33 and 523.342 — Updated in accordance with current processes. References to “employing office” were changed to Human Resources Shared Service Center or HRSSC.
n 523.6 — Revised to replace “employing office” or “personnel office” with Human Resources Shared Service Center or HRSSC, and to change the age for which a child’s disability must be documented from age 22 to age 26.
n 524 — Revised to:
n Update Dual Enrollment policy in accordance with regulation changes in dependent eligibility.
n Change employing office to Human Resources Shared Service Center and HRSSC.
n Include a direct link under the Table of Permissible Changes in FEHB Enrollment and Pre-Tax/After-Tax Premium Payment on OPM’s website.
n Align with OPM’s FEHB Handbook policy concerning change in marital status.
n Update policy concerning Change in Family Status, and changing reference to dependents from age 22 to age 26.
n Delete ELM 524.537, Employee Reaches Age 19, as it is no longer applicable and has been deleted from OPM’s FEHB Handbook.
n Clarify implications of pre-tax payment of FEHB premiums.
n Update APWU and NALC noncareer employees’ titles.
n Provide a direct link to FEHB Handbook for employees who need guidance concerning Spouse Equity and TCC enrollment for former spouses.
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Employee and Labor Relations Manuals (ELM)
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5 Employee Benefits
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520 Health Benefits Program
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521 Administration and Eligibility
521.1 General
[Revise the text of 521.1 Reference Note to read as follows:]
Reference Note:
For more material on the information in 521.1, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
* * * * *
521.2 Eligible Employees
[Revise the text of 521.2 Reference Note and 521.2a and g to read as follows:]
Reference Note:
For more material on the information in 521.2 through 521.3, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
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a. Officers in charge, except “off-the-street” officers in charge, as noted in 521.3a.
* * * * *
g. Noncareer employees (such as, Substitute Rural Carriers, Rural Carrier Associates, Postmaster Leave Replacements, Postal Support Employees, City Carrier Assistants, and Mail Handler Assistants) who meet the following criteria:
(1) Have completed 1 year of continuous employment, disregarding breaks in service of 5 days or less.
(2) Have a predetermined tour of duty.
(3) Have sufficient earnings to cover mandatory withholdings and premium deductions.
* * * * *
521.4 Family Member Eligibility
[Revise the text of 521.4 Reference Note to read as follows:]
Reference Note:
For more material about the information in 521.4 through 521.5, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
521.41 General
[Revise the title and text of 521.411 to read as follows:]
521.411 Responsibility of Human Resources Shared Service Center
The Human Resources Shared Service Center (HRSSC) is responsible for determining whether or not a person is a family member for health benefits purposes for an enrolled employee. It is that person’s relationship to the employee that is controlling. The HRSSC must satisfy itself that an event has occurred that permits enrollment or a change in enrollment under the Federal Employees Health Benefits (FEHB) Program.
Documentary evidence may be requested as appropriate (e.g., marriage certificate, birth certificate, or divorce decree). However, it is not necessary that such evidence be retained. The carrier is not notified at the time the original determination is made regarding the eligibility status of an enrollee’s family member, but the carrier may request evidence to verify the eligibility of the family member at the time benefits for that family member are claimed.
521.412 Family Members Eligible
[Revise the text of 521.412 to read as follows:]
The employee’s spouse, including a spouse in a valid common-law marriage, and children under age 26, including legally adopted children, recognized natural (born out of wedlock) children and stepchildren, are eligible for coverage. A child is eligible for coverage under an employee’s Self and Family enrollment, if a state-issued birth certificate lists the employee as a parent of that child.
A child over age 26 who is incapable of self-support because of mental or physical incapacity that existed before the child’s 26th birthday is eligible if the incapacity is established as explained in 526.
Foster Children are included if they meet the requirements listed below:
a. The child must be under age 26 (if the child is age 26 or over, he/she must be incapable of self-support);
b. The child must currently live with the employee;
c. The parent-child relationship must be with the employee, not the child's biological parent;
d. The employee must currently be the primary source of financial support for the child; and
e. The employee must expect to raise the child to adulthood.
Note: Effective June 26, 2013, legally married same-sex spouses became eligible family members under a Self and Family enrollment. Coverage is available to any legally married same-sex spouse regardless of the employee’s state of residency. In addition, the children of same-sex marriages will be treated in the same manner as those of opposite-sex marriages and will be eligible family members according to the same eligibility guidelines. This includes coverage for children of same-sex spouses as stepchildren.
In accordance with Office of Personnel Management regulations dated October 30, 2013, qualified stepchildren of same-sex domestic partners are eligible family members effective January 1, 2014. This is only applicable to employees living in states that do not allow same-sex marriage.
521.42 Determining Family Membership Status of Children
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521.422 Stepchildren
[Revise the text of 521.422 to read as follows:]
If not contrary to state law, an employee’s spouse’s legitimate or adopted child, or natural child, is considered to be the employee’s stepchild. However, a stepchild by a previous marriage of the employee’s spouse is not the employee’s stepchild.
An employee’s stepchild remains a stepchild and an eligible family member after the employee’s divorce from, or the death of, the natural parent, provided that the stepchild continues to live with the employee in a regular parent-child relationship. If the stepchild stops living with the employee in a regular parent-child relationship, the child is eligible for coverage under Temporary Continuation of Coverage (TCC) provisions because he/she no longer meets the definition of an eligible child.
If the employee divorces and the former spouse is eligible to enroll under either the Spouse Equity or TCC provisions, only the natural or adopted children of both the employee and the former spouse are covered under the former spouse’s Self and Family enrollment. An employee’s stepchildren are not covered even though they may have been covered previously by the employee’s Self and Family enrollment. However, they may qualify for a TCC enrollment of their own.
521.423 Foster Children
[Revise the text of 521.423 first paragraph and 521.423a to read as follows:]
To be considered a foster child for health benefits purposes, the child must be under age 26, the child must be incapable of self-support, if the child is age 26 or over, the child must live with the employee in a regular parent-child relationship, and the employee must be rearing the child as his or her own. The employee need not be related to the child nor have taken steps to legally adopt the child, but there must be an expectation that the employee will continue to rear the child into adulthood.
a. The employee must currently be the primary source of financial support for the child. However, a foster parent-child relationship between the child and an employee may exist even though the child receives support from other than the employee (e.g., Social Security payments, support payments from a parent, etc.).
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521.424 Child’s Temporary Absence on “Living-With” Requirement
[Revise the text of 521.424 to read as follows:]
Periods of temporary absence while attending school or for other reasons do not affect the family member status of foster children otherwise considered to be living with the employee in a regular parent-child relationship. Also, an employee’s foster child, who lives with the employee at least 6 months a year under a court order directing shared custody may be considered living with the employee in a regular parent-child relationship.
521.425 Effect of Child’s Marriage on Family Member Status
[Revise the text of 521.425 to read as follows:]
An employee’s married child is covered under the employee’s Self and Family enrollment until the child reaches age 26. The child’s spouse and/or children are not covered and dual enrollment is prohibited.
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[Revise the title and text of Exhibit 521.423 to read as follows:]
Exhibit 521.423 Certification for Foster Children
Certification for Foster Children
I have been informed of the following requirements for coverage of a foster child under the Federal Employees Health Benefits (FEHB), Federal Employees’ Group Life Insurance (FEGLI), and the Federal Employees Dental and Vision Insurance (FEDVIP) Programs:
1. For FEHB, the child must be under age 26. If the child is age 26 or older, he/she can only be covered if he/she is incapable of self-support because of a disabling condition that began before age 26. I must provide documentation of this to the Human Resources Shared Service Center (HRSSC);
2. For FEGLI and FEDVIP coverage, the child must be unmarried and under age 22 to qualify for coverage unless he/she is incapable of self-support because of a disabling condition that began before age 22. I must provide documentation of this to the HRSSC;
3. The child must currently live with me;
4. I must currently be the primary source of financial support for the child;
5. The parent-child relationship must be with me and not with the biological parent. This means that I exercise parental authority, responsibility, and control. I care for, support, discipline, and guide the child. I make the decisions about the child’s education and health care; and
6. I must expect to raise the child into adulthood.
I understand that if the child moves out of my home to live with a biological parent, he/she loses coverage and cannot ever again be covered as a foster child unless the biological parent dies, is imprisoned, or becomes incapable of caring for the child due to a disability, or unless I obtain a court order taking parental responsibility away from the biological parent.
This is to certify that [__name of child__] lives with me; I am the primary source of financial support for this child; I have a regular parent-child relationship with this child, as described above; and I intend to raise this child into adulthood.
I have provided my employing agency proof of my regular and substantial support for ____________________________ [name of child].
I will immediately notify both the HRSSC and the health benefits carrier (if this child is covered by FEHB) and/or dental and/or vision insurance carrier (if this child is covered by FEDVIP) if this child moves out of my home, ceases to be financially dependent on me, or otherwise no longer qualifies as a foster child per any of the requirements shown above.
_________________________________________________ ________________________________________
Print Name of Employee Employee Identification Number
________________________________________________ ________________________
Employee Signature Date
Privacy Act Statement: Your information will be used to certify that you intend to raise a “foster” child until adulthood for the purposes of coverage under the Federal Employees Health Benefit (FEHB), Federal Employees Group Life Insurance (FEGLI), and Federal Employees Dental and Vision Insurance (FEDVIP) Programs. Collection is authorized by 39 U.S.C. 410, 1001, 1005, and 1206. Providing the information is voluntary, but if not provided, we may be unable to process your request. We may disclose your information as follows: in relevant legal proceedings; to law enforcement when the U.S. Postal Service (USPS) or requesting agency becomes aware of a violation of law; to a congressional office at your request; to entities or individuals under contract with USPS; to entities authorized to perform audits; to labor organizations as required by law; to federal, state, local, or foreign government agencies regarding personnel matters; to the Equal Employment Opportunity Commission; to the Merit Systems Protection Board or Office of Special Counsel; the Selective Service System, records pertaining to supervisors and Postmasters may be disclosed to supervisory and other managerial organizations recognized by USPS; and to financial entities regarding financial transaction issues.
Benefits and Compensation
PO Box 970400
Greensboro NC 27497-0400
USPS 30
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521.6 Former Spouses
[Revise the text of 521.6 Reference Note to read as follows:]
Reference Note:
For more material about the information in 521.6, see:
n Office of Personnel Management’s Federal Employees Health Benefits Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
521.61 Eligibility Determination
521.611 Requirements
[Revise the text of 521.611 to read as follows:]
Former spouses of employees are eligible to enroll for health benefits coverage under the Federal Employees Health Benefits (FEHB) Program if they meet all of the following requirements:
a. Based on a qualifying court order or divorce decree, the OPM has granted the former spouse a portion of the employee’s annuity or a survivor benefit.
b. The former spouse, if under the age of 55, has not remarried.
c. The former spouse was covered as a family member in an FEHB plan at any time during the 18 months before the date of the dissolution of marriage.
d. The application for coverage is filed within 60 days after:
(1) The marriage is dissolved;
(2) The date of OPM’s notice to the former spouse of his/her eligibility to enroll based on a qualifying court order awarding entitlement to a portion of the employee’s future annuity; or
(3) The date of the notice of the former spouse’s eligibility to enroll based on entitlement to a former spouse’s annuity under another retirement system for government employees.
If the application is mailed, the postmark is used in determining the 60-day time limit.
521.612 Office of Personnel Management Responsibility
[Revise the text of 521.612 to read as follows:]
OPM is responsible for determining whether a former spouse is entitled to receive a survivor annuity or a portion of the employee’s retirement annuity as a prerequisite to the former spouse’s eligibility to enroll in the FEHB Program.
The former spouse forwards the request for determination to:
U.S. OFFICE OF PERSONNEL MANAGEMENT
COURT ORDERED BENEFITS BRANCH
PO BOX 17
WASHINGTON, DC 20044–0017
The request must contain as much information as possible, including the employee’s name, date of birth, Social Security number, and HRSSC address, and a certified copy of the court order or divorce decree.
OPM sends the former spouse a written decision once it has reviewed all the information provided by the former spouse.
[Revise the title and text of 521.613 to read as follows:]
521.613 Human Resources Shared Service Center Responsibility
The Human Resources Shared Service Center (HRSSC) 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, Employee Health Benefits Election Form, a letter, or a written statement to the HRSSC. The application preserves the former spouse’s FEHB enrollment right until the eligibility determination is made.
After the former spouse provides the HRSSC with a copy of OPM’s decision as required by 521.612, the HRSSC makes its determination regarding the former spouse’s eligibility to enroll under the FEHB Program by verifying whether the requirements stated in 521.611b and 521.611c have been met. To make this determination, the HRSSC:
a. Reviews the SFs 2809, the SFs 2810, Notice of Change in Health Benefit Enrollment, and the PostalEASE FEHB Worksheets in the employee’s electronic official personnel folder (eOPF) to determine if the former spouse was covered as a family member in an FEHB enrollment at any time during the 18 months before the date of the dissolution of marriage.
b. Verifies the former spouse’s age and, if under age 55, verifies that the former spouse has not remarried.
521.62 Documentation of Eligibility
521.621 Eligible for Coverage
[Revise the text of 521.621 to read as follows:]
If the former spouse meets all the requirements stated in 521.61, and is, therefore, eligible for coverage, the HRSSC notifies the former spouse in writing of its determination. The notification of eligibility acknowledges the documents on which the HRSSC based its decision, i.e., proof that the former spouse has not remarried before age 55 and that the former spouse was enrolled under the FEHB Program at some point during the 18 months before a divorce. An RI 70–5, Guide to Federal Benefits for TCC and Former Spouse Enrollees, and a statement of the requirements for continued enrollment (Exhibit 523.62) are forwarded to the former spouse with the notification. See 523.6 for enrollment procedures.
521.622 Ineligible for Coverage
[Revise the text of 521.622 to read as follows:]
If the HRSSC determines, after its review, that the former spouse has not met the eligibility requirements for health benefits coverage stated in 521.61, it notifies the former spouse of its determination in writing. The notification of ineligibility must provide the former spouse the right to request reconsideration of its decision in accordance with 521.63. It must also state the reason for the denial, specify the time limit for making the reconsideration request, and include the address for forwarding the request (see 521.63).
521.63 Request for Reconsideration
[Revise the text of 521.63 to read as follows:]
A former spouse denied health benefits coverage by the HRSSC may request reconsideration of the HRSSC’s refusal to permit him or her to enroll. The request is made in writing and sent within 30 days of the HRSSC’s letter of denial to the area Human Resources address identified in the denial letter. Requests must include the employee’s name and date of birth, reasons for the request, and a copy of the denial letter. The decision rendered by the area office is final.
521.7 Temporary Continuation of Coverage
[Revise the text of 521.7 Reference Note to read as follows:]
Reference Note:
For more materials about the information in 521.7, see:
n Management Instruction EL-520-91-2, FEHB: Temporary Continuation of Coverage, March 27, 1991.
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
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521.71 Eligibility
521.711 Eligible for Coverage
[Revise the text of 521.711 first sentence and 521.711c to read as follows:]
Individuals identified below are eligible to enroll in TCC beyond the 31-day extension period allowed following termination of coverage:
* * * * *
c. Children who have been covered under an employee or annuitant’s enrollment because they met the requirements for dependent children and no longer meet these requirements. This group includes children who:
(1) Lose coverage because they reach age 26.
(2) Lose their status as stepchildren or foster children.
(3) Are disabled, age 26 and older, and recover from their disability or become able to support themselves.
(4) Lose coverage upon the death of an employee because he/she does not qualify for a survivor annuity.
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521.72 Agency Responsibilities
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[Revise the title of 521.723 and text of the first and last sentence of 521.723 to read as follows:]
521.723 Human Resources Shared Service Center’s Responsibility
The Human Resources Shared Service Center (HRSSC):
* * * * *
The HRSSC must collect, review, and approve all SF 2809 forms before forwarding the appropriate copies to the National Finance Center (NFC) for processing.
521.73 Time Limitations for Enrollment
[Revise the text of 521.73 to read as follows:]
SF 2809 forms to enroll in the TCC program must be received by the HRSSC within the specific timeframes noted below:
a. Former Employees. Forms must be received within 60 days after the date of separation or within 65 days after the date the SF 2810, Notice of Change in Health Benefits Enrollment, is received from the Postal Service, whichever is later.
b. Children. Forms must be received either:
(1) within 60 days after the qualifying event, if the employee did not notify the HRSSC within the required 60-day notification period (even if someone else provided notification); or
(2) 65 days after the date the notice is received from the Postal Service, if the employee notified the HRSSC within the required 60-day notification period.
c. Former Spouses. Forms must be received either:
(1) within 60 days after the date of divorce or annulment, if the employee or the former spouse did not notify the HRSSC within the required 60-day notification period (even if someone else provided notification); or,
(2) 65 days after the date of the HRSSC’s notice, if the employee or the former spouse notified the HRSSC within the required 60-day notification period; or
(3) 60 days after the date the former spouse lost coverage under Spouse Equity provisions (because of remarriage before age 55 or loss of the qualifying court order), if the loss of coverage is within the 36-month period of TCC eligibility.
If the employee or the former spouse does not notify the HRSSC within the 60-day period, the former spouse’s opportunity to elect TCC ends 60 days after the divorce or annulment.
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522 Health Insurance Plans Available
[Revise the text of 522 Reference Note to read as follows:]
Reference Note:
For more material about the information in 522, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
522.1 Types of Participating Plans
[Revise the title and text of 522.11 to read as follows:]
522.11 Fee-for-Service Plans with a Preferred Provider Organization
Nationwide plans are available to all eligible Postal Service employees no matter where they reside. Employees may use medical providers of choice; however, medical providers who have contracted with the PPO network or health plan may offer discounted charges. Plans will either pay medical providers directly or reimburse employees for covered services after claims are filed. The amount the plan pays may depend on whether the provider has a participation agreement with the PPO network or health plan.
[Add new 522.12 to read as follows:]
522.12 Fee-for-Service PPO Only Plans
PPO Only plans provide medical services only through medical providers who have contracts with the plan. With few exceptions, there is no medical coverage if employees or their family members receive care from providers not contracted with the plan.
[Renumber 522.12 to 522.13 and revise the title and text to read as follows:]
522.13 Fee-for-Service Employee Organization Plans
Employee organization plans are sponsored by an employee organization or union and are available only to employees who are, or who become members of the particular sponsoring organization. Generally, these plans provide benefits by cash reimbursement to either the employee or, at the employee’s request, directly to doctors and hospitals. Information concerning membership is obtained from the local representative or directly from the headquarters office of the employee organization or union.
[Renumber 522.13 to 522.14 and revise the title and text to read as follows:]
522.14 Health Maintenance Organization and Point-of-Service Plans
Health Maintenance Organization (HMO) and Point-of-Service (POS) plans are available to employees in certain geographic localities only. These plans are either:
a. A group-practice plan that provides benefits in the form of medical services by teams of doctors and technicians practicing in their own medical centers;
b. An individual-practice plan that provides direct payments to doctors with whom the plan has an agreement; or
c. A mixed model plan that is a combination of a group practice and an individual practice plan.
These plans also provide hospital benefits. The enrollment area for each plan is stated in its brochure.
[Add new 522.15 to read as follows:]
522.15 High Deductible and Consumer-Driven Health Plans
High Deductible Health Plans (HDHPs) provide comprehensive coverage with higher annual deductibles and annual out-of-pocket limits than other insurance plans. HDHPs can have first-dollar coverage (no deductible) for preventive care. HDHPs offered by the FEHB Program establish and partially fund Health Savings Accounts (HSAs) for all eligible enrollees and provide comparable Health Reimbursement Arrangements (HRAs) for enrollees who are not eligible for HSAs.
With Consumer-Driven Health Plans, eligible in-network preventive care is covered in full and employees use their designated health care funds for any other covered care. If employees use up their health care funds, traditional medical coverage begins after their deductibles are satisfied.
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[Revise the title of 523 and the text of 523 Reference Note to read as follows:]
523 Election Procedures
Reference Note:
For more material about information in 523 through 523.33, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url-FEHB-Handbook.
523.1 Initial
[Revise the text of 523.1 to read as follows:]
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
[Revise the text of 523.2 to read as follows:]
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:
a. Enroll in FEHB via PostalEASE, or
b. 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
[Revise the text of 523.31 to read as follows:]
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
[Revise the text of 523.32b and c to read as follows:]
* * * * *
b. The HRSSC failed to give new employee information concerning health benefits coverage.
c. The HRSSC officials previously advised the employee that he or she was not eligible to enroll.
* * * * *
523.33 Procedures for Documenting Late Enrollment
[Revise the text of 523.33 to read as follows:]
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
[Revise the text of 523.34 Reference Note to read as follows:]
Reference Note:
For additional material concerning the subject matter found in 523.34, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
* * * * *
523.342 Late Enrollment Other Than FEHB Open Season
[Revise the text of 523.342 to read as follows:]
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
[Revise the text of 523.4 to read as follows:]
Reference Note:
For additional material concerning the subject matter found in 523.4 through 523.4, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
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
[Revise the text of 523.5 to read as follows:]
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
[Revise the text of 523.6 Reference Note to read as follows:]
Reference Note:
For more material about the information in 523.6, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
523.61 Enrollment Form
[Revise the text of 523.61 first and second paragraphs as follows:]
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.
* * * * *
523.62 Statement Signed by Former Spouse
[Revise the text of 523.62 to read as follows:]
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.
[Revise the title of 523.63 to read as follows:]
523.63 Human Resources Shared Service Center Records on Former Spouse
523.631 Establishing File
[Revise the first sentence of 523.631 to read as follows:]
The Human Resources Shared Service Center (HRSSC) establishes and maintains a health benefits file for the former spouse.***
523.632 Contents of File
[Revise the text of 523.632 to read as follows:]
The following documents are kept in the former spouse’s file:
a. The former spouse’s letter (the application) to the HRSSC requesting enrollment.
b. A copy of the court order or divorce decree used by OPM to determine eligibility.
c. A copy of the OPM’s written notification to the former spouse verifying the acceptability of the court order.
d. The HRSSC‘s copy of the SF 2809 or PostalEASE FEHB Worksheet documenting the former spouse’s enrollment, enrollment changes, or cancellation.
e. The HRSSC’s copy of the SF 2810 terminating or transferring the enrollment.
f. 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.
* * * * *
523.634 Disposition of File
[Revise the text of 523.634 to read as follows:]
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:
a. The former spouse cancels the enrollment.
b. The HRSSC terminates the enrollment.
c. 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.
* * * * *
524 Enrollment
[Revise the text of 524 Reference Note to read as follows:]
Reference Note:
For more material about the information in 524 through 523.4, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
524.1 Types of Enrollment
* * * * *
524.12 Self and Family
[Revise the text of 524.12c to read as follows:]
c. On the FEHB Worksheet, if an employee lists a person who is not an eligible family member, the Human Resources Shared Service Center 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
524.31 General
[Revise the text of 524.31 to read as follows:]
The law prohibits an individual from being enrolled under his or her own name while covered as a family member of another person enrolled as an employee or as a retiree under the Federal Employees Health Benefits Program.
[Revise the title and text of 524.32 to read as follows:]
524.32 Procedures to Be Followed by the Human Resources Shared Service Center
If there is a dual enrollment, arrangements are made to terminate one of the enrollments as soon as possible. If the employees involved cannot agree on which enrollment will continue, the Human Resources Shared Service Center (HRSSC) makes the decision in accordance with the following principles:
a. Coverage of any children who are eligible family members is protected.
b. A family enrollment takes precedence over a Self Only enrollment.
If the person whose enrollment must be terminated in order to avoid or eliminate dual coverage refuses to cancel, the HRSSC cancels the enrollment, identifying the action on the PostalEASE FEHB Worksheet as an agency action, and explains the reason for the cancellation.
When an enrollment is voided or cancelled in order to eliminate illegal dual coverage, the health benefits premiums deducted from the employee’s pay during the illegal enrollment are refunded.
[Add new 524.33 to read as follows:]
524.33 Dual Enrollment Exceptions
Dual enrollment must be authorized by the HRSSC and will only be allowed when the employee or an eligible family member would otherwise lose coverage. Some examples of allowable dual enrollment include when:
a. The employee and the employee’s spouse legally separate and their children would lose full health benefits coverage. See the following examples:
(1) The employee moves outside of the HMO’s service area and the employee’s spouse refuses to change health plans;
(2) The spouse refuses to pass along reimbursements for health benefits claims filed;
b. The employee divorces;
c. The employee is under age 26, is covered by a parent’s FEHB enrollment, and has a family of his or her own (spouse/children) and chose to cover them;
d. The employee is under age 26, is covered by his/her parent’s enrollment, and lives outside the coverage area of his/her parent’s HMO plan;
e. The employee and his/her spouse each have Self Only enrollments and one of them changes to a family enrollment and the other cancels an enrollment. A brief overlap of coverage is allowed to avoid a gap in coverage.
No employee or family member may receive benefits under more than one FEHB enrollment. The employee must inform the carriers involved of which family members will be covered and receive benefits under which enrollment. If an employee and family member will receive benefits under more than one plan, it is considered fraud and the employee is subject to disciplinary action.
524.4 Correction of Erroneous Enrollment
[Revise the first paragraph of 524.4 to read as follows:]
The enrollment of a person who is excluded from participation in the health benefits program because of the nature of employment, but who was permitted to enroll through error, is terminated or voided (as appropriate) by the HRSSC as soon as the error is discovered. The HRSSC makes sure that all employees, whose erroneous enrollments are so terminated or voided, understand what action has been taken regarding their enrollments, the reasons for, and effect of, such action, as the following:***
524.5 Enrollment or Change in Enrollment
[Revise the text of 524.5 Reference Note to read as follows:]
Reference Note:
For additional material concerning the subject matter found in 524.5 through 524.537, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
524.51 General
[Revise the text of 524.51 to read as follows:]
An employee is given the opportunity to enroll or to make changes in enrollment only as specified herein. The determination of an employee’s eligibility to enroll or change enrollment under the FEHB Program is made by the Human Resources Shared Service Center (HRSSC). Therefore, employees are required to provide the HRSSC with sufficient evidence to justify a request to enroll or change enrollment under the Program.
524.52 Events Permitting
[Revise the text of 524.52 to read as follows:]
The complete list of Qualifying Life Events can be found in each Guide to Benefits for U.S. Postal Service Employees in the Table of Permissible Changes in FEHB Enrollment and Pre-Tax/After-Tax Premium Payment at https://liteblue.usps.gov/humanresources/benefits/insurance/benefits_insurance_fehb.shtml?.
* * * * *
524.529 Change to Self Only
[Revise the text of 524.529 to read as follows:]
The option to change from Self and Family to Self Only at any time during the year is available only to those employees whose health premiums are being paid on an after-tax basis. For those employees with health benefit premiums being paid on a pre-tax basis, a change to Self Only may only be processed during FEHB Open Season or following a qualifying life event. Requests due to qualifying life events must be received by the Human Resources Shared Service Center (HRSSC) from the employee within 60 days of the qualifying event. See 524.52 for more information on qualifying life events. For more information on effective dates, see 524.6.
524.53 Family Changes Affecting Enrollment
524.531 Change in Marital Status
[Revise the text of 524.531 to read as follows:]
The following provisions apply for a new spouse:
a. Options. As a result of a change in marital status, an employee may enroll or, if already enrolled, may change the enrollment from Self Only to Self and Family, or from one plan or option to another, or both, during the period beginning 31 days before a change in marital status and ending 60 days after the change. If an enrollment or change of enrollment becomes effective before the anticipated date of change in marital status and the change in marital status does not occur, the action taken is voided.
b. 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.
The following provisions apply for a divorce or separation:
a. If an employee is legally separated, the spouse is still considered a family member and eligible for coverage under the employee’s Self and Family enrollment.
b. To continue to provide health benefits coverage for their children, employees must continue their Self and Family enrollments.
c. Once a final divorce decree is issued, an employee’s spouse is no longer an eligible family member and is not covered under the employee’s enrollment.
524.532 Change in Family Status
[Revise the text of 524.532 to read as follows:]
The following provisions apply:
a. Criteria. Generally, a change in family status is an event that adds or decreases the number of family members. However, a change in family status is not limited to these two events. The following events are considered a change in family status for health benefits purposes:
(1) Marriage, including a valid common law marriage (in accordance with applicable state law).
(2) Birth of a child (but not a stillborn child).
(3) Legal adoption by the enrollee of a child under age 26 or the acquisition of a foster child under age 26.
(4) Submission of a Declaration of Domestic Partnership to the HRSSC or retirement system.
(5) Entry into, or discharge from, military service of a spouse or of a child under age 26.
(6) Issuance or termination of a court order granting to the enrollee or spouse final divorce, interlocutory divorce, limited divorce, legal separation, or separate maintenance.
(7) Issuance of a court decree of annulment, or in the case of a marriage void from its beginning (ab initio), also a declaratory judgment, or conviction of the spouse of bigamy.
(8) Issuance of a court order specifically requiring an employee to enroll for his or her children or to provide health benefits protections for them.
(9) The death of an employee’s spouse, including a declaration by a court that the employee’s missing spouse is presumed dead.
b. Options. An enrolled employee who has a change in family status, including a change in marital status, may enroll, change enrollment from Self Only to Self and Family, or from one plan or option to another, or both, during the period beginning 31 days before a change in family status and ending 60 days after the change. If husband and wife are each enrolled for Self Only and wish to have a Self and Family enrollment because of a change in family status, one may change to a Self and Family enrollment if the other cancels the Self Only enrollment.
* * * * *
524.534 Employee Loses Coverage as Family Member
[Revise the text of 524.534b and c to read as follows:]
b. Other Than Change to Self Only or Cancellation. If an employee loses coverage as a family member for any reason other than cancellation or change in the covering enrollment to Self Only, the employee may enroll for Self Only, or for Self and Family, in either option of any plan available beginning 31 days before and ending 60 days after termination of the covering enrollment. This may occur when (1) enrolled spouse or parents enter military service or separate from federal or Postal Service rolls, or (2) employee covered by parent’s enrollment reaches age 26.
c. Death. If the covering enrollment terminates because of the death of the enrolled spouse or parent, the surviving employee has 60 days in which to enroll. If the employee also becomes a survivor annuitant, the enrollment may continue as that of a survivor annuitant, or the employee may enroll in any plan for which eligible as an employee whose marital status has changed. If the employee elects to enroll as an employee and later is separated, or the employee status otherwise changes so that enrollment must be terminated, the employee may continue the enrollment as a survivor annuitant. In this event, the Human Resources Shared Service Center terminates the enrollment on SF 2810 and advises the survivor annuitant to apply to the Office of Personnel Management for continuation of enrollment as an annuitant.
524.535 Loss of Coverage Under Parent’s Nonfederal Plan
[Revise the text of 524.535 to read as follows:]
An employee who loses coverage under a parent’s nonfederal health plan may enroll under the FEHB Program within 31 days before and ending 60 days after losing coverage under the parent’s nonfederal plan for any reason.
* * * * *
[Delete 524.537 in its entirety.]
524.54 Family Changes Not Affecting Enrollment
[Revise the text of 524.54 Reference Note to read as follows:]
Reference Note:
For more material about the information in 524.54, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url-FEHB-Handbook.
524.541 General
[Revise the first sentence of 524.541 and 524.541c to read as follows:]
If a change in the employee’s family does not affect enrollment, it is not necessary to report such change to the Human Resources Shared Service Center (HRSSC) for health benefits purposes.
* * * * *
c. Attainment of age 26 of a child of an employee when there are other children or a spouse still covered under the family enrollment.
524.542 Name Change
[Revise the text of 524.542 to read as follows:]
If an employee’s name changes for any reason, the HRSSC reports the change to the health benefits plan.
An employee legally changes names or an employee enrolled for Self Only marries but retains a Self Only enrollment. If no other changes are involved, the HRSSC reports the name change on SF 2810.
If an employee with a Self Only enrollment reports a name change due to marriage, the HRSSC reminds the employee of the opportunity to change his or her enrollment. If the employee decides to change the enrollment, no SF 2810 is required, but a PostalEASE Worksheet is submitted in accordance with 524.531d.
542.6 Effective Date of Enrollment or Enrollment Change
[Revise the text of 524.6 Reference Note to read as follows:]
Reference Note:
For additional material concerning the subject matter found in 524.6, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
* * * * *
524.62 Change to Self Only
[Revise the text of 524.62 a and b 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 Human Resources Shared Service Center (HRSSC). 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 HRSSC with documentation showing that he or she had a qualifying life event 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 at the HRSSC.
* * * * *
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 HRSSC and that follows a pay period during any part of which the employee is in pay status.
524.7 Termination of Enrollment
[Revise the text of 524.7 Reference Note to read as follows:]
Reference Notice:
For more material about the information in 524.7, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
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 qualifying life event as identified in 524.529. Requests due to qualifying life events must be received by the Human Resources Shared Service Center (HRSSC) within 60 days of the qualifying life event. The PostalEASE FEHB Worksheet used to cancel enrollment due to a qualifying life event becomes effective the last day of the pay period in which the FEHB Worksheet is received. For information on effective dates, see 524.6.
524.72 Discontinuance of Plan or Part
* * * * *
524.722 Because of Leave Without Pay
[Revise the text of 524.722 to read as follows:]
The health benefits enrollment of an employee who completes 365 days LWOP (26 pay periods) is terminated by the Eagan ASC. The Eagan ASC issues an SF 2810, terminating the coverage, retains Eagan ASC and carrier copies, and forwards employee and agency copies to the HRSSC. If it is determined a termination was improper, the HRSSC must promptly take corrective action.
524.73 Membership Termination in Employee Organization
[Revise the first sentence of 524.73 and 524.73 a and b to read as follows:]
If an employee who is enrolled in an employee organization plan ceased to be a member of the organization, the plan may instruct the HRSSC to terminate the enrollment, subject to a 31-day temporary extension of coverage.***
* * * * *
a. On the basis of either the original or the copy of the notice, the HRSSC terminated the enrollment on SF 2810 with a note in Remarks similar to the following:
b. The date in Item 8A is the last day of the pay period in which the plan’s notice of termination is received by the HRSSC.
* * * * *
524.75 Effective Termination Dates of Family Member Coverage
[Revise the text of 524.75 Example to read as follows:]
Coverage of an employee’s child terminates on the day the child reaches age 26.
* * * * *
524.77 Conversion Rights
* * * * *
[Revise the title and text of 524.772 to read as follows:]
524.772 Human Resources Shared Service Center Responsibility
If an employee’s coverage is terminated, the Human Resources Shared Service Center (HRSSC) issues SF 2810 as promptly as possible, but no later than 60 days after the date the enrollment terminates due to the limited time allotted for conversion. The HRSSC is not expected to monitor conversion rights of family members. It is the responsibility of an employee (or the person who loses status as a family member) to apply in a timely manner for a conversion contract. However, from time to time, the HRSSC should publish reminders of a family member’s right to convert. These reminders can be in the form of bulletins, letters, memos, etc.
* * * * *
524.774 Late Conversion
[Revise the text of 524.774a and b to read as follows:]
a. Documentation that the enrollment has terminated (for example, an SF 50 showing separation from service).
b. Proof that the employee was not notified of the enrollment termination and the right to convert (for example, a letter from the HRSSC confirming that it did not provide timely notice of the conversion option), and that he or she was not otherwise aware of it.
* * * * *
524.8 Cost of Enrollment
[Revise the text of 524.8 Reference Note to read as follows:]
Reference Note:
For more material about the information in 524.8 through 524.966, see:
n Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
* * * * *
524.83 Pre-Tax and After-Tax Premiums
524.831 Tax Benefits
[Revise the text of 524.831 to read as follows:]
The Postal Service has established the pre-tax payment of health insurance premium contributions as a tax-saving benefit feature for its employees. FEHB premiums paid on a pre-tax basis are not included in an employee’s gross income. This practice reduces the taxable income figure reported and reduces income taxes. However, employees may also receive slightly lower Social Security benefits, upon eligibility, because paying FEHB premiums pre-tax reduces the earning reported to the Social Security Administration.
524.832 Career Employees
[Revise the text of 524.832 to read as follows:]
Career employees have their portion of health benefit premiums automatically paid on a pre-tax basis unless a waiver is submitted by the employee. PS Form 8201, Pre-Tax Health Insurance Premium Waiver/Restoration Form for Career Employees, is accepted during an employee’s first opportunity to enroll in health benefits, during the annual FEHB Open Season period, or upon the occurrence of a qualifying life event (see 524.529). Once a waiver is processed and deductions are being made on an after-tax basis, a return to a pre-tax basis requires the completion of a second PS Form 8201 to cancel the waiver and restore the pre-tax status. Requests to cancel pre-tax waivers are accepted during FEHB Open Season periods or upon the occurrence of a qualifying life event (see 524.529).
524.833 Certain Noncareer and Transitional Employees
[Revise the text of 524.833 to read as follows:]
Generally, noncareer employee health benefit premiums are withheld on an after-tax basis. However, noncareer employees in the Rural Carrier craft, NALC City Carrier Assistant employees, Postal Support Employees covered by the APWU contract, and other employees as specified in collective bargaining agreements may elect to have premiums paid on a pre-tax basis by completing PS Form 8202, Application to Elect or Waive Pretax FEHB Premiums (for Noncareer Employees), at their first opportunity to enroll in health benefits, during the annual FEHB Open Season periods, or upon the occurrence of a qualifying life event (see ELM 524.529).
524.834 Further Information
[Revise the text of 524.834 to read as follows:]
Complete information on pre-tax and after-tax premiums is available from the Human Resources Shared Service Center (HRSSC).
* * * * *
524.9 Enrollments for Former Spouses
[Add new text to 524.9 to read as follows:]
For detailed information concerning Spouse Equity and Temporary Continuation of Coverage (TCC) enrollment for former spouses, go to http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/former-spouses/#eligibility.
524.91 Type of Enrollment
[Revise the text of 524.91 to read as follows:]
A former spouse eligible to enroll in the FEHB Program may elect coverage for Self Only or for Self and Family. A family enrollment covers the former spouse only and any child of the former spouse and the employee provided the child is not also covered by another FEHB enrollment. A child must be under age 26 or incapable of self-support because of a mental or physical disability that existed before age 26 (see 526).
524.92 Effective Date of Enrollment
524.921 New Enrollment
[Revise the first paragraph of 524.921 to read as follows:]
The effective date of a new enrollment for a former spouse is the first day of the pay period after the Human Resources Shared Service Center received the properly completed SF 2809 and OPM’s approval of eligibility or at a future date (at the beginning of a pay period) requested by the former spouse.
* * * * *
524.95 Cancellation of Enrollment
[Revise the text of 524.95 to read as follows:]
A former spouse may cancel enrollment at any time by filing a properly completed SF 2809 with the NFC. If a former spouse cancels enrollment, the cancellation becomes effective the last day of the pay period that the health benefits form canceling the enrollment is received by the NFC. The former spouse and family members, if any, are not entitled to the temporary extension of coverage or the right to convert to an individual contract. A former spouse who cancels an enrollment may not later re-enroll unless Spouse Equity enrollment is suspended to enroll in a Medicare managed care plan or Medicaid (or a similar State-sponsored program of medical assistance for the needy).
If a former spouse submits documentation that the cancellation is for the purpose of enrolling in a Medicare managed care plan or Medicaid, the suspension becomes effective the day before the enrollment under the Medicare managed care plan takes effect. Documentation must be submitted to the Human Resources Shared Service Center during the period beginning 31 days before and ending 31 days after the enrollment takes effect.
A former spouse who cancels his or her Spouse Equity enrollment for this purpose may re-enroll, if still qualified for a Souse Equity enrollment, in any available plan at any time during the period beginning 31 days before and ending 60 days after involuntary disenrollment from the Medicare managed care plan. A former spouse who voluntarily disenrolls from the Medicare managed care plan or Medicaid may re-enroll under the Spouse Equity provisions during the following Open Season.
524.96 Termination of Enrollment
524.961 Events Terminating Coverage
[Revise the text of 524.961a to read as follows:]
* * * * *
a. Qualifying court order ceases to provide entitlement to former spouse survivor annuity or portion of retirement annuity under a retirement system for federal or Postal Service employees.
* * * * *
524.962 Temporary Extension of Coverage
[Revise the text of 524.962b to read as follows:]
* * * * *
b. The separated employee on whose service the benefits are based died before the requirements for deferred annuity were met. In such cases, the right of conversion may be exercised up to 31 days after the HRSSC’s notice of termination (SF 2810). During that time, the former spouse may convert to individual coverage. The former spouse must pay the full premium (employee and employer share) during the extended period exclusive of the 31-day period following the notice.
* * * * *
We will incorporate these revisions into the next online update of the ELM, which is available on the Postal Service PolicyNet website:
n Go to http://blue.usps.gov.
n In the left-hand column under “Essential Links”, click PolicyNet.
n Click Manuals.
The direct URL for the Postal Service PolicyNet website is http://blue.usps.gov/cpim.
— Compensation and Benefits,
Human Resources, 10-16-14
