[Code of Federal Regulations]
[Title 5, Volume 2, Parts 700 to 1199]
[Revised as of January 1, 2001]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR890.806]

[Page 443-445]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (Continued)
 
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
                 Subpart H--Benefits for Former Spouses
 
Sec. 890.806  Opportunities for former spouses to enroll and change enrollment; effective dates of enrollment.

    (a) Initial opportunity to enroll. A former spouse who has met the 
eligibility requirements of Sec. 890.803 and the application time 
limitation requirements of Sec. 890.805 may enroll at any time after the 
employing office establishes that these requirements have been met.
    (b) Effective date--generally. (1) Except as otherwise provided, an 
enrollment takes effect on the first day of the first pay period that 
begins after the date the employing office receives an appropriate 
request and satisfactory proof of eligibility as required by paragraph 
(a) of this section. If a former spouse requests immediate coverage, and 
the employing office receives an appropriate request and satisfactory 
proof of eligibility within 60 days after the date of divorce, the 
enrollment may be made effective on the same day that temporary 
continuation of coverage under subpart K of this part would otherwise 
take effect.
    (2) A change of enrollment takes effect on the first day of the 
first pay period that begins after the date the employing office 
receives the appropriate request.
    (c) Belated enrollment. When an employing office determines that a 
former spouse was unable, for cause beyond his or her control, to enroll 
or change the enrollment within the time limits prescribed by this 
section, the former spouse may do so within 60 days after the employing 
office advises the former spouse of its determination.
    (d) Enrollment by proxy. Subject to the discretion of the employing 
office, a former spouse's representative, having written authorization 
to do so, may enroll or change the enrollment for the former spouse.
    (e) Change to self only. (1) A former spouse may change the 
enrollment from self and family to self only at any time.
    (2) A change of enrollment to self only takes effect on the first 
day of the first pay period that begins after the date the employing 
office receives an appropriate request to change the enrollment, except 
that at the request of the former spouse and upon a showing satisfactory 
to the employing office that there was no family member eligible for 
coverage under the family enrollment, the employing office may make the 
change take effect on the first day of the pay period following the one 
in which there was no family member.
    (f) Open season. (1) During an open season as provided by 
Sec. 890.301(f)--
    (i) An enrolled former spouse may change the enrollment from self 
only to self and family provided the family member(s) is eligible for 
coverage under Sec. 890.804, from one plan or option to another, or make 
any combination of these changes.
    (ii) A former spouse who cancelled the enrollment under this part 
for the purpose of enrolling in a prepaid health plan under section 1833 
or 1876 of the Social Security Act, and who subsequently voluntarily 
disenrolls from the prepaid health plan, may reenroll.
    (iii) A former spouse who cancelled the enrollment under this part 
because he or she furnished proof of eligibility for coverage under the 
Medicaid program or a similar State-sponsored program of medical 
assistance for the needy, and who wishes to reenroll in a plan under 
that part for reasons other than an involuntary loss of that coverage, 
may do so.
    (2) An open season reenrollment or change of enrollment takes effect 
on the first day of the first pay period that begins in January of the 
next following year.
    (3) When a belated open season reenrollment or change of enrollment 
is accepted by the employing office under paragraph (c) of this section, 
it takes effect as required by paragraph (f)(2) of this section.
    (g) Change in family status. (1) An enrolled former spouse may 
change the enrollment from self only to self and family, from one plan 
or option to another, or make any combination of

[[Page 444]]

these changes within the period beginning 31 days before and ending 60 
days after the birth or acquisition of a child who meets the eligibility 
requirements of Sec. 890.804.
    (2) A change in enrollment under paragraph (g)(1) of this section 
takes effect on the first day of the pay period in which the child is 
born or becomes an eligible family member.
    (h) Reenrollment of former spouses who cancelled enrollment to 
enroll in a Medicare-sponsored Coordinated Care Plan. (1) A former 
spouse who had been enrolled for coverage under this part and cancelled 
enrollment for the purpose of enrolling in a prepaid health plan under 
section 1833 or 1876 of the Social Security Act, or who meets the 
eligibility requirements of Sec. 890.803 and the application time 
limitation requirements of Sec. 890.805, but postponed enrollment for 
this purpose, and who is subsequently involuntarily disenrolled from the 
prepaid health plan, may immediately reenroll in any available plan 
under this part at any time beginning 31 days before and ending 60 days 
after the disenrollment. A reenrollment under this paragraph (h) takes 
effect on the date following the effective date of the disenrollment as 
shown on the documentation from the prepaid health plan.
    (2) A former spouse who voluntarily disenrolls from the prepaid 
health plan must do so in conjunction with reenrolling in a plan under 
this part during the next available open season (as provided by 
paragraph (f) of this section) to assure continuing uninterrupted health 
plan coverage.
    (i) Reenrollment of former spouses who cancelled enrollment because 
of eligibility under Medicaid or similar State-sponsored program of 
medical assistance for the needy. (1) A former spouse who had been 
enrolled for coverage under this part and cancelled the enrollment 
because he or she furnished proof of eligibility for coverage under the 
Medicaid program or a similar State-sponsored program of medical 
assistance for the needy, or who meets the eligibility requirements of 
Sec. 890.803 and the application time limitation requirements of 
Sec. 890.805, but postponed enrollment for this reason, and who 
involuntarily loses that coverage, may reenroll in any available plan 
under this part at any time beginning 31 days before and ending 60 days 
after the loss of Medicaid or similar State-sponsored coverage. A 
reenrollment under this paragraph (i)(1) takes effect on the date 
following the date of loss of Medicaid or similar State-sponsored 
coverage.
    (2) A former spouse who cancelled his or her enrollment because he 
or she furnished proof of eligibility for coverage under the Medicaid 
program or a similar State-sponsored program of medical assistance for 
the needy, and who wishes to reenroll in a plan under this part for 
reasons other than an involuntary loss of that coverage, may do so 
during the next available open season as provided by paragraph (f) of 
this section.
    (j) Loss of coverage under this part or under another group 
insurance plan. An enrolled former spouse may change the enrollment from 
self only to self and family, from one plan or option to another or make 
any combination of these changes when the former spouse or a child who 
meets the eligibility requirements under Sec. 890.804 loses coverage 
under another enrollment under this part or under another group health 
benefits plan. Except as otherwise provided, the former spouse must 
change the enrollment within the period beginning 31 days before the 
date of loss of coverage and ending 60 days after the date of loss of 
coverage, provided he or she continues to meet the eligibility 
requirements under Sec. 890.803. Losses of coverage include but are not 
limited to--
    (1) Loss of coverage under another FEHB enrollment due to the 
termination, cancellation, or a change to self only, of the covering 
enrollment;
    (2) Loss of coverage under another federally-sponsored health 
benefits program;
    (3) Loss of coverage due to the termination of membership in an 
employee organization sponsoring or underwriting an FEHB plan;
    (4) Loss of coverage due to the discontinuance of an FEHB plan in 
whole or in part. For a former spouse who loses coverage under this 
paragraph (j)(4)--
    (i) If the discontinuance is at the end of a contract year, the 
former spouse

[[Page 445]]

must change the enrollment during the open season, unless OPM 
establishes a different time. If the discontinuance is at a time other 
than the end of the contract year, OPM must establish a time and 
effective date for the former spouse to change the enrollment;
    (ii) If the whole plan is discontinued, a former spouse who does not 
change the enrollment within the time set is considered to have 
cancelled the plan in which enrolled.
    (iii) If one option of a plan that has two options is discontinued, 
a former spouse who does not change the enrollment is considered to be 
enrolled in the remaining option of the plan.
    (5) Loss of coverage under the Medicaid program or similar State-
sponsored program of Medical assistance for the needy.
    (6) Loss of coverage under a non-Federal health plan.
    (k) Move from comprehensive medical plan's area. A former spouse in 
a comprehensive medical plan who moves or becomes employed outside the 
geographic area from which the plan accepts enrollments, or, if already 
outside this area, moves or becomes employed further from this area, may 
change the enrollment upon notifying the employing office of the move or 
change of place of employment. Similarly, a former spouse whose covered 
family member moves outside the geographic area from which the plan 
accepts enrollments, or if already outside this area, moves further from 
this area, may change the enrollment upon notifying the employing office 
of the family member's move. The change of enrollment takes effect on 
the first day of the pay period that begins after the employing office 
receives an appropriate request.
    (l) On becoming eligible for Medicare. A former spouse may change 
the enrollment from one plan or option to another at any time beginning 
on the 30th day before becoming eligible for coverage under title XVIII 
of the Social Security Act (Medicare). A change of enrollment based on 
becoming eligible for Medicare may be made only once.
    (m) Annuity insufficient to pay withholdings. (1) If the annuity of 
a former spouse is insufficient to pay the full subscription charge for 
the plan in which he or she is enrolled, the retirement system must 
provide the former spouse with information regarding the available plans 
and written notification of the opportunity to either--
    (i) Pay the premium directly to the retirement system in accordance 
with Sec. 890.808(d); or
    (ii) Enroll in any plan with a full premium that is less than the 
amount of annuity. If the former spouse elects to change to a lower cost 
enrollment, the change takes effect immediately upon loss of coverage 
under the prior enrollment.
    (2) If the former spouse is enrolled in the high option of a plan 
that has two options, and does not elect a plan with a full premium that 
is less than the annuity or does not elect to pay premiums directly, he 
or she is deemed to have enrolled in the standard option of the same 
plan unless the annuity is insufficient to pay the full subscription 
charge for the standard option.
    (3) A former spouse who is enrolled in a plan with only one option, 
who fails to make the election required by this paragraph (m)(3) will be 
subject to the provisions of Sec. 890.807(c).

[62 FR 38440, July 18, 1997; 62 FR 49557, Sept. 22, 1997]