[Code of Federal Regulations] [Title 5, Volume 2] [Revised as of January 1, 2004] From the U.S. Government Printing Office via GPO Access [CITE: 5CFR892.101] [Page 519-520] TITLE 5--ADMINISTRATIVE PERSONNEL CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) PART 892_FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS--Table of Contents Subpart A_Administration and General Provisions Sec. 892.101 Definitions. Days mean calendar days. Dependent means a family member who is both eligible for coverage under the FEHB Program and a dependent as defined in section 152 of the Internal Revenue Code. FEHB Program means the Federal Employees Health BenefitsProgram described in 5 U.S.C. 8901. Open Season means the period of time each year as described in Sec. 890.301(f) of this chapter when all individuals eligible for FEHB coverage have the opportunity to enroll or change their enrollment. These changes become effective with the first pay period that begins in the following year. For additional open seasons authorized by OPM, the effective date is specified. OPM means the Office of Personnel Management. Qualifying life event means an event that may permit changes to your FEHB enrollment as well as changes to your premium conversion election as described in Treasury regulations at 26 CFR 1.125-4 and includes the following: (1) Change in family status that results in an increase or decrease in the number of eligible family members as follows: (i) Marriage, divorce, annulment, legal separation; (ii) Birth, adoption, acquiring a foster child that meets the definition in Sec. 890.101(a) or a stepchild, issuance of a court order requiring an employee to provide coverage for a child; (iii) Last dependent child loses coverage, for example, the child reaches age 22 or marries, stepchild moves out of employee's home, disabled child becomes capable of self support, child acquires other coverage by court order; and (iv) Death of a spouse or dependent. (2) Any change in employment status that could result in entitlement to coverage; for example: (i) Reemployment after a break in service of more than 3 days; (ii) Return to pay status from non-pay status if employee previously elected to terminate coverage (if employee did not elect to terminate see Sec. 892.101 (5); (iii) Return to receiving pay sufficient to cover premium withholdings if coverage terminated; [[Page 520]] (iv) Your spouse or dependent changes hours from either full-time to part-time status, or the reverse, which significantly affects their eligibility for coverage; (v) Start or end of a period of unpaid leave of absence (leave without pay [LWOP], or other non-pay status) by you or your spouse. A period of unpaid leave is a continuous unpaid leave of absence of more than one pay period; and (vi) Start or end of your spouse's employment that affects you or your spouse's eligibility for coverage. (3) Any change in employment status that could affect the cost of insurance, including: (i) Change from temporary appointment with eligibility for coverage under 5 U.S.C. 8906a to an appointment that permits receipt of government contribution; and (ii) Change from full-time to part-time status or the reverse. (4) An employee is restored to a civilian position after serving in uniformed services as described in Sec. 890.304 (a)(vi)(vii). (5) Start of non-pay status and end of non-pay status if employee did not terminate coverage (if coverage terminated see Sec. 892.101 (2)(ii)). (6) An employee enrolled in a health maintenance organization (HMO) or a covered family member moves or becomes employed outside the geographic area from which the carrier accepts enrollments, or if already lives or works outside the area, moves further from this area. (7) Transfer from a post of duty within the United States to a post of duty outside the United States, or the reverse. (8) Separation from Federal employment when the employee or employee's spouse is pregnant. (9) An employee becomes entitled to Medicare. (For change to self only, cancellation, or change in premium conversion status see Sec. 892.101 (11)). (10) An employee or eligible family member loses coverage under FEHB or another group insurance coverage including the following: (i) Loss of coverage due to termination of membership in an employee organization sponsoring the FEHB plan; (ii) Loss of coverage of employee or eligible family member due to discontinuance in whole or part of FEHB plan; (iii) Loss of coverage under another Federally-sponsored health benefits program, including, TRICARE, Medicare, or Indian Health Service; (iv) Loss of coverage under Medicaid or similar State-sponsored program of medical assistance for the needy; and (v) Loss of coverage under a non-Federal health plan, including foreign, State or local government, or private sector group health plan as described in Sec. 890.301 (i)(6). (11) An employee or eligible family member gains coverage under FEHB or another group insurance plan, including the following: (i) Another Federally-sponsored health benefits program, including, TRICARE, Medicare, or Indian Health Service; (ii) Medicaid or similar State-sponsored program of medical assistance for the needy; and (iii) A non-Federal health plan, including foreign, State or local government, or private sector group plan. (12) A change in an employee's spouse or dependent's coverage options, for example: (i) Employer starts offering a different type of coverage; (ii) Employer stops offering the type of coverage that the employee's spouse or dependent has (if no other coverage is available); (iii) A health maintenance organization (HMO) adds a geographic service area that now makes the employee's spouse eligible to enroll in that HMO; (iv) Employee's spouse is enrolled in an HMO that removes a geographic area that makes the spouse ineligible for coverage under that HMO, but other health plans or options are available (if no other coverage is available see Sec. 892.101 (10); and (v) Change in the cost of coverage. [65 FR 44646, July 19, 2000, as amended at 68 FR 56527, Oct. 1, 2003] [[Page 521]]