[Code of Federal Regulations] [Title 5, Volume 2] [Revised as of January 1, 2002] From the U.S. Government Printing Office via GPO Access [CITE: 5CFR890.806] [Page 460-463] 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 [[Page 461]] 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 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, may reenroll. (iii) A former spouse who suspended 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, may reenroll. (iv) A former spouse who suspended enrollment under this part for the purpose of using TRICARE coverage (including the Uniformed Services Family Health Plan) instead of FEHB coverage, may reenroll. (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 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 suspended enrollment to enroll in a Medicare sponsored plan or to use TRICARE coverage (including the Uniformed Services Family Health Plan) under title 10 U.S.C. 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 use the TRICARE program (including the Uniformed Services Family Health Plan) under title 10 U.S.C. 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 for this purpose, and who is subsequently involuntarily disenrolled from the Medicare sponsored plan or the TRICARE program (including the Uniformed Services Family 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) of this section takes effect on the date following the effective date of the disenrollment as shown on the documentation from the Medicare sponsored plan or TRICARE program (including the Uniformed Services Family Health Plan). (2) A former spouse who suspended coverage in the FEHB Program to enroll in a Medicare sponsored plan, or to use TRICARE (including the Uniformed Services Family Health Plan), 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). [[Page 462]] (i) Reenrollment of former spouses who suspended enrollment because of eligibility under Medicaid or a similar State-sponsored program of medical assistance for the needy. (1) A former spouse who had been enrolled for coverage under this part and suspended 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 (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 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) of this section takes effect on the date following the date of loss of Medicaid or similar State- sponsored coverage. (2) A former spouse who suspended enrollment in the FEHB Program 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 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, [[Page 463]] 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, as amended at 66 FR 49087, Sept. 26, 2001]