[Federal Register: June 18, 2002 (Volume 67, Number 117)]
[Rules and Regulations]
[Page 41305-41307]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr18jn02-1]
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Rules and Regulations
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains regulatory documents
having general applicability and legal effect, most of which are keyed
to and codified in the Code of Federal Regulations, which is published
under 50 titles pursuant to 44 U.S.C. 1510.
The Code of Federal Regulations is sold by the Superintendent of Documents.
Prices of new books are listed in the first FEDERAL REGISTER issue of each
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[[Page 41305]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
RIN 3206-AJ36
Suspension of CHAMPVA or TRICARE or TRICARE-for-Life Eligibles'
Enrollment in the Federal Employees Health Benefits (FEHB) Program
AGENCY: Office of Personnel Management.
ACTION: Final rule.
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SUMMARY: The Office of Personnel Management is issuing a final rule to
allow CHAMPVA or TRICARE or TRICARE-for-Life eligible FEHB Program
annuitants, survivors, and former spouses to suspend their FEHB
enrollments, and then return to the FEHB Program during the Open
Season, or return to FEHB coverage immediately, if they involuntarily
lose CHAMPVA or TRICARE or TRICARE-for-Life coverage. The intent of
this rule is to allow these beneficiaries to avoid the expense of
continuing to pay FEHB Program premiums while they are using TRICARE or
TRICARE-for-Life or CHAMPVA coverage, without endangering their ability
to return to the FEHB Program in the future.
EFFECTIVE DATE: Effective July 18, 2002.
FOR FURTHER INFORMATION CONTACT: Michael W. Kaszynski, Policy Analyst,
Insurance Policy and Information Division, OPM, Room 3425, 1900 E
Street, NW., Washington, DC 20415-0001. Phone: (202) 606-0004.
SUPPLEMENTARY INFORMATION: Effective October 1, 2001, the National
Defense Authorization Act for 2001 reinstated TRICARE coverage for
Medicare-eligible uniformed services retirees, their survivors and
eligible dependents under the new TRICARE-for-Life program. TRICARE or
TRICARE-for-Life coverage can be advantageous to many uniformed
services beneficiaries who now are covered under the FEHB Program as
Federal civilian annuitants, survivors, or former spouses.
Also, recent legislation, Public Law 107-14, provides beneficiaries
over age 65 of the Department of Veterans Affairs (VA) with coverage
secondary to Medicare under the Civilian Health and Medical Program of
the Department of Veterans Affairs (CHAMPVA). CHAMPVA provides
similarly attractive benefits to VA eligible beneficiaries as those
benefits provided to uniformed services beneficiaries under the TRICARE
or new TRICARE-for-Life programs.
Under previous FEHB regulations, however, an annuitant, survivor,
or former spouse who canceled his or her FEHB coverage to use CHAMPVA
or TRICARE would not be allowed to return to FEHB coverage. Therefore,
OPM is issuing these final regulations to allow these FEHB participants
to suspend, rather than cancel, their FEHB coverage to use CHAMPVA or
TRICARE or the new TRICARE-for-Life coverage. Under this rule, eligible
individuals are allowed to return to FEHB coverage immediately if they
involuntarily lose CHAMPVA or TRICARE or TRICARE-for-Life coverage or
during a future FEHB Open Season.
We are also amending our regulations to clarify a similar situation
involving FEHB-covered annuitants, survivors, and former spouses. The
regulations allow an individual who drops FEHB coverage when he or she
enrolls in a Medicare-sponsored plan, or in Medicaid or a similar
State-sponsored program of medical assistance for the needy, to return
to FEHB coverage during the annual Open Season or immediately upon
being involuntarily disenrolled from the non-FEHB coverage.
On September 26, 2001, OPM published an interim regulation in the
Federal Register (66 FR 49086). OPM received comments from a number of
individuals as well as the Department of Veterans Affairs on the
regulation. Three commenters were not sure if the regulation allowed
surviving spouses of Federal annuitants to suspend their FEHB coverage
to use TRICARE or TRICARE-for-Life. One commenter also wanted to know
if a surviving spouse could reenroll in the FEHB Program if the
annuitant passed away during the suspension period. The regulation
authorizes a surviving spouse, who is eligible for health benefits
coverage as a survivor annuitant, to suspend FEHB coverage while
maintaining the right to reenroll in the future. In order to qualify
for health benefit coverage as a survivor annuitant, a surviving spouse
must have been enrolled as a family member under the annuitant's Self
and Family enrollment and qualify to receive a portion of the
annuitant's annuity upon his/her death. The regulation also allows
individuals who become survivor annuitants during a period of suspended
FEHB coverage to reenroll even though the survivor didn't make the
original decision to suspend coverage. The survivor must have been
enrolled under the annuitant's Self and Family coverage immediately
preceding the annuitant's suspension of FEHB coverage and otherwise
qualify as a survivor annuitant.
We received a comment from the VA stating that CHAMPVA provides the
same or similar benefits to VA eligible beneficiaries as those benefits
provided to TRICARE beneficiaries. Because of this, the VA believes
that individuals eligible for CHAMPVA should be permitted to suspend
FEHB coverage under the same conditions as those individuals eligible
for TRICARE or TRICARE-for-Life. We agree with the VA and have revised
the regulation to allow annuitants, survivors, and former spouses to
suspend FEHB coverage with the right to reenroll in the future.
One commenter requested that we make the regulation retroactive to
the effective date of the TRICARE-for-Life legislation. The commenter
stated that many eligible individuals canceled rather than suspended
their FEHB enrollments because that was the only option available at
the time. The actual date that the new TRICARE-for-Life program became
effective for medical, hospital, and surgical coverage was October 1,
2001. Our interim regulation was published and effective on September
26, 2001. Therefore, the authority to suspend, rather than cancel, was
available to annuitants and former spouses on the effective date of
TRICARE-for-Life coverage. We see no need to make further changes to
the regulation's effective date.
One commenter requested that OPM give spouses of living civilian
annuitants the opportunity to enroll in
[[Page 41306]]
Self-Only coverage under the FEHB Program while allowing annuitants the
opportunity to suspend FEHB coverage for TRICARE or TRICARE-for-Life.
Another commenter requested that OPM give spouses of living annuitants
the opportunity to suspend their FEHB enrollment with the right to
reenroll in the FEHB Program in the future. Existing FEHB law does not
authorize spouses of living employees or annuitants to enroll in the
FEHB Program on their own behalf. Therefore, we cannot create this
authority through regulation.
One commenter asked if active civil service employees could suspend
their FEHB coverage to use TRICARE or TRICARE-for-Life. The regulation
does not allow employees to suspend their coverage. This is because
employees have always had the option of canceling their coverage with
the right to reenroll in the FEHB Program during a future Open Season,
or immediately if they involuntarily lose TRICARE coverage. In the
past, annuitants, survivors, and former spouses never had the option to
reenroll in the FEHB Program after leaving for TRICARE. Our new
regulation creates this authority.
We have clarified the period for submitting suspension
documentation to OPM and the effective date of suspensions. In the case
of an involuntary disenrollment from non-FEHB coverage, if an eligible
individual does not request to reenroll in the FEHB Program within the
time period specified by the regulation, he or she must wait until the
next Open Season to reenroll.
Regulatory Flexibility Act
I certify that this regulation will not have a significant economic
impact on a substantial number of small entities because the regulation
only affects health insurance carriers under the Federal Employees
Health Benefits Program.
Executive Order 12866, Regulatory Review
This regulation has been reviewed by the Office of Management and
Budget in accordance with Executive Order 12866.
List of Subjects in 5 CFR Part 890
Administrative practice and procedure, Government employees, Health
facilities, Health insurance, Health professionals, Hostages, Iraq,
Kuwait, Lebanon, Reporting and record keeping requirements, Retirement.
U.S. Office of Personnel Management.
Kay Coles James,
Director.
For the reasons set forth in the preamble, OPM is amending 5 CFR
Part 890 as follows:
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
1. The authority citation for Part 890 continues to read as
follows:
Authority: 5 U.S.C. 8913; Sec. 890.803 also issued under 50
U.S.C. 403p, 22 U.S.C. 4069c and 4069c-1; subpart L also issued
under sec. 599C of Pub. L. 101-513, 104 Stat. 2064, as amended;
Sec. 890.102 also issued under sections 11202(f), 11232(e), 11246
(b) and (c) of Pub. L. 105-33, 111 Stat. 251; and section 721 of
Pub. L. 105-261, 112 Stat. 2061.
2. The section heading in Sec. 890.304 and paragraph (d)(2) are
revised to read as follows:
Sec. 890.304 When do enrollments terminate, cancel or suspend?
* * * * *
(d) * * *
(2) An annuitant or survivor annuitant may suspend enrollment in
FEHB for the purpose of enrolling in a Medicare-sponsored plan under
sections 1833, 1876, or 1851 of the Social Security Act, or to enroll
in the Medicaid program or a similar State-sponsored program of medical
assistance for the needy, or to use CHAMPVA or TRICARE (including
coverage provided by the Uniformed Services Family Health Plan) or
TRICARE-for-Life instead of FEHB coverage. To suspend FEHB coverage,
documentation of eligibility for coverage under the non-FEHB program
must be submitted to the retirement system. If the documentation is
received within the period beginning 31 days before and ending 31 days
after the effective date of the enrollment in the Medicare-sponsored
plan, or the Medicaid or similar program, or within 31 days before or
after the day designated by the annuitant or survivor annuitant as the
day he or she wants to suspend FEHB coverage to use CHAMPVA or TRICARE
(including the Uniformed Services Family Health Plan) or TRICARE-for-
Life instead of FEHB coverage, then suspension will be effective at the
end of the day before the effective date of the enrollment or the end
of the day before the day designated. Otherwise, the suspension is
effective the first day of the first pay period that begins after the
date the retirement system receives the documentation.
* * * * *
3. The section heading in Sec. 890.306 and paragraph (f)(1)(ii) are
revised, paragraphs (f)(1)(iii) and (f)(1)(iv) are removed, paragraph
(h) is revised, and paragraph (i) is removed and reserved to read as
follows:
Sec. 890.306 When can annuitants or survivor annuitants change
enrollment or reenroll and what are the effective dates?
* * * * *
(f) * * *
(1) * * *
(ii) An annuitant or survivor annuitant who suspended enrollment
under this part to enroll in a Medicare-sponsored plan under sections
1833, 1876, or 1851 of the Social Security Act, or to enroll in a
Medicaid or similar State-sponsored program of medical assistance for
the needy, or to use CHAMPVA or TRICARE (including the Uniformed
Services Family Health Plan) or TRICARE-for-Life coverage instead of
FEHB coverage, may reenroll.
* * * * *
(h) Reenrollment of annuitants or survivor annuitants who suspended
enrollment to enroll in a Medicare-sponsored plan, or a Medicaid or
similar State-sponsored program; or to use CHAMPVA or TRICARE
(including the Uniformed Services Family Health Plan) or TRICARE-for-
Life coverage instead of FEHB coverage.
(1) An annuitant or survivor annuitant who had been enrolled (or
was eligible to enroll) for coverage under this part and suspended the
enrollment for the purpose of enrolling in a Medicare sponsored plan
under sections 1833, 1876, or 1851 of the Social Security Act, or to
enroll in the Medicaid program or a similar State-sponsored program of
medical assistance for the needy, or to use CHAMPVA or TRICARE
(including the Uniformed Services Family Health Plan) or TRICARE-for-
Life coverage instead of the FEHB Program (as provided by
Sec. 890.304(d)), and who subsequently involuntarily loses coverage
under one of these programs, may immediately reenroll in any available
FEHB plan under this part at any time beginning 31 days before and
ending 60 days after the loss of coverage. A reenrollment under this
paragraph (h) of this section takes effect on the date following the
effective date of the loss of coverage as shown on the documentation
from the non-FEHB coverage. If the request to reenroll is not received
by the retirement system within the time period specified, the
annuitant must wait until the next available Open Season to reenroll.
(2) An annuitant or survivor annuitant who suspended enrollment in
the FEHB Program to enroll in a Medicare sponsored plan or the Medicaid
or similar State-sponsored program of
[[Page 41307]]
medical assistance for the needy, or to use CHAMPVA or TRICARE
(including the Uniformed Services Family Health Plan) or TRICARE-for-
Life, but now wants to reenroll in the FEHB Program for any reason
other than an involuntary loss of coverage, may do so during the next
available Open Season (as provided by paragraph (f) of this section).
(i) [Reserved]
* * * * *
4. The section heading in Sec. 890.806 and paragraphs (f)(1)(ii)
are revised, paragraphs (f)(1)(iii) and (f)(1)(iv) are removed,
paragraph (h) is revised, and paragraph (i) is removed and reserved to
read as follows:
Sec. 890.806 When can former spouses change enrollment or reenroll and
what are the effective dates?
* * * * *
(f) * * *
(1) * * *
(ii) A former spouse who suspended the enrollment under this part
for the purpose of enrolling in a Medicare sponsored plan under
sections 1833, 1876, or 1851 of the Social Security Act, or to enroll
in the Medicaid program or a similar State-sponsored program of medical
assistance for the needy, or to use CHAMPVA or TRICARE (including the
Uniformed Services Family Health Plan) or TRICARE-for-Life coverage
instead of FEHB coverage, may reenroll.
* * * * *
(h) Reenrollment of former spouses who suspended enrollment to
enroll in a Medicare sponsored plan, or the Medicaid or similar State-
sponsored program, or to use CHAMPVA or TRICARE (including the
Uniformed Services Family Health Plan) or TRICARE-for-Life coverage
instead of FEHB coverage.
(1) A former spouse who had been enrolled for coverage under this
part and suspended enrollment for the purpose of enrolling in a
Medicare sponsored plan under sections 1833, 1876, or 1851 of the
Social Security Act, or to enroll in Medicaid or similar State-
sponsored program of medical assistance for the needy, or to use
CHAMPVA or TRICARE (including the Uniformed Services Family Health
Plan) or TRICARE-for-Life coverage instead of FEHB (as provided in
Sec. 890.807(e)), or who meets the eligibility requirements of
Sec. 890.803 and the application time limitation requirements of
Sec. 890.805, but postponed enrollment in the FEHB Program for the
purpose of enrolling in one of these non-FEHB programs, and who
subsequently involuntarily loses coverage under one of these programs,
may immediately reenroll in any available FEHB plan under this part at
any time beginning 31 days before and ending 60 days after the loss of
coverage. A reenrollment under this paragraph (h) of this section takes
effect on the date following the effective date of the loss of coverage
as shown on the documentation from the non-FEHB coverage. If the
request to reenroll is not received by the employing office or
retirement system within the time period specified, the former spouse
must wait until the next available Open Season to reenroll.
(2) A former spouse who suspended enrollment in the FEHB Program to
enroll in a Medicare sponsored plan, or the Medicaid program or a
similar State-sponsored program of medical assistance for the needy, or
to use CHAMPVA or TRICARE (including the Uniformed Services Family
Health Plan) or the TRICARE-for-Life program, but now wants to reenroll
in the FEHB Program for any reason other than an involuntary loss of
coverage, may do so during the next available Open Season (as provided
by paragraph (f) of this section).
(i) [Reserved]
* * * * *
5. The section heading in Sec. 890.807 and paragraphs (e)(2) and
(e)(4) are revised to read as follows:
Sec. 890.807 When do enrollments terminate, cancel or suspend?
* * * * *
(e) * * *
(2) A former spouse may suspend enrollment in FEHB for the purpose
of enrolling in a Medicare sponsored plan under sections 1833, 1876, or
1851 of the Social Security Act, or to enroll in the Medicaid program
or a similar State-sponsored program of medical assistance for the
needy, or to use CHAMPVA or TRICARE (including the Uniformed Services
Family Health Plan) or TRICARE-for-Life coverage instead of FEHB
coverage. To suspend FEHB coverage, documentation of eligibility for
coverage under the non-FEHB Program must be submitted to the employing
office or retirement system. If the documentation is received within
the period beginning 31 days before and ending 31 days after the
effective date of the enrollment in the Medicare sponsored plan, or the
Medicaid or similar program, or within 31 days before or after the day
designated by the former spouse as the day he or she wants to suspend
FEHB coverage to use CHAMPVA or TRICARE (including the Uniformed
Services Family Health Plan) or TRICARE-for-Life coverage instead of
FEHB coverage, then the suspension will be effective at the end of the
day before the effective date of the enrollment or the end of the day
before the day designated. Otherwise, the suspension is effective the
first day of the first pay period that begins after the date the
employing office or retirement system receives the documentation.
* * * * *
(4) A former spouse who cancels his or her enrollment for any
reason may not later reenroll in the FEHB Program.
[FR Doc. 02-15275 Filed 6-17-02; 8:45 am]
BILLING CODE 6325-50-P