[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2008]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR892.101]

[Page 539-541]
 
                    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 Benefits Program 
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

[[Page 540]]

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;
    (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

[[Page 541]]

    (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]