[Federal Register Volume 59, Number 250 (Friday, December 30, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-32141]


[[Page Unknown]]

[Federal Register: December 30, 1994]


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OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890

RIN 3206-AG33

 

Federal Employees Health Benefits Program: Procedures for Direct 
Payment of Premiums

AGENCY: Office of Personnel Management.

ACTION: Interim regulations with request for comments.

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SUMMARY: The Office of Personnel Management (OPM) is issuing interim 
regulations to eliminate the requirement for the use of certified mail, 
return receipt requested, when notifying certain enrollees that their 
enrollment in the Federal Employees Health Benefits (FEHB) Program will 
be terminated due to nonpayment of premiums unless the payment is 
received within 15 days. The purpose of these interim regulations is to 
reduce the cost of administering the FEHB enrollments of enrollees who 
make payments directly rather than through payroll or annuity 
deductions.

DATES: These interim regulations are effective January 30, 1995. 
Comments must be received on or before February 28, 1995.

ADDRESSES: Send written comments to Lucretia F. Myers, Assistant 
Director for Insurance Programs, Retirement and Insurance Group, Office 
of Personnel Management, P.O. Box 57, Washington, DC 20044; or deliver 
to OPM, Room 4351, 1900 E Street NW., Washington, DC; or FAX to (202) 
606-0633.

FOR FURTHER INFORMATION CONTACT:
Margaret Sears (202) 606-0191.

SUPPLEMENTARY INFORMATION: Most individuals enrolled under the FEHB 
Program pay their share of the premiums through withholding from pay or 
annuity. However, in some cases enrollees may make direct payments. 
These include: (1) certain annuitants and compensationers (individuals 
who are entitled to compensation from the Office of Workers' 
Compensation Programs based on a job-related injury or disease) whose 
annuity or compensation has been waived or suspended; (2) former 
spouses whose enrollment is based on a qualifying court order under 
subpart H of 5 CFR part 890 governing FEHB; and (3) former employees, 
former spouses, and children enrolled under the Temporary Continuation 
of Coverage (TCC) provisions.
    The current regulations governing these direct pay situations 
require that if the employing office does not receive the payment by 
the due date, it must notify the enrollee by certified mail, return 
receipt requested, that continuation of coverage rests upon payment 
being made within 15 days after receipt of the notice. (The regulations 
affecting former spouses with qualifying court orders and TCC enrollees 
allow 45 days for enrollees living overseas.) The TCC regulations 
further provide that, if the return receipt is not received, 
termination occurs 60 days after the date of the notice (90 days for 
overseas enrollees). All terminations are retroactive to the last day 
for which the enrollee made payment. Enrollments terminated for 
nonpayment of premiums cannot be reinstated unless the enrollee shows 
that he or she was prevented by circumstances beyond his or her control 
from making the payment on time.
    The purpose of the return receipt was to make certain that the 
enrollee was aware that the employing office had not received the 
payment and the consequences of nonpayment. Because of the high cost of 
certified mail, return receipt requested, ($2.29 per notice) OPM has 
reevaluated the need for this requirement and has determined that the 
value of the return receipt does not justify the cost. The absence of 
subsequent payments during the 60- to 90-day delay before termination 
of the enrollment makes it clear that the initial failure to make the 
payment was not a simple oversight or loss of the payment in the mail.
    We believe that the interim regulations will be much more 
convenient for enrollees. Under current regulations someone must sign 
for the notice. If no one is at home when the letter carrier arrives to 
deliver the return-receipt-requested letter, the enrollee must go to 
the post office to sign for it. Under the interim regulations, the 
letter will be left in the enrollee's mailbox and the enrollee will 
have the necessary information without making a trip to the post 
office.
    Most enrollees who stop paying their premiums do so because they no 
longer need the coverage. In these cases, the current regulations allow 
the agency to terminate the enrollment as early as 15 days after the 
enrollee received the nonreceipt notice, but there is no real benefit 
to the enrollee, who no longer wants the coverage.
    For other enrollees, a missed payment does not reflect an intent to 
stop paying the premiums. They may have overlooked making the payment 
or their payment may have been lost in the mail. In these cases, the 
nonpayment notice serves as a reminder or lets them know that their 
check was lost. If they do not receive the nonpayment notice, their 
intent to continue their coverage will be shown when they make the 
following month's payment. In addition, there has been a high incidence 
of late receipt of payment, with the result that nonreceipt notices 
cross in the mail with the incoming check. In these cases, the return 
receipt notices serve neither as a benefit to the enrollee nor as a 
means of allowing prompt termination of an enrollment.
    Another group of enrollees stop making their payments because of 
the cost or out of neglect. Such enrollees generally continue to miss 
payments until their enrollment terminates retroactively. Some of them 
then find they need medical services, but they have no health coverage. 
Some continued to obtain medical services even though they were not 
paying their premiums and their carriers are now asking for repayment 
of claims paid or payment for services rendered. When this happens, the 
enrollee may ask to have their coverage reinstated. They may have their 
coverage reinstated if they can show that they were prevented from 
paying their premiums on time due to a cause beyond their control.
    Under current regulations, if the agency does not receive the 
signed return receipt, it must wait 60 to 90 days before terminating 
the enrollment. Under the interim regulations, agencies must, in all 
cases, wait 60 to 90 days before terminating the enrollment. This means 
that the enrollee must miss two or three more payments before the 
agency can act to terminate. While it is possible that a single 
instance of nonreceipt of the payment represents a check lost in the 
mail, it is unlikely that three or four consecutive payments would be 
similarly lost. Therefore, instead of allowing termination based on a 
single instance of nonpayment, the interim regulations allow 
termination only if there is a sequence of missing payments. A former 
enrollee who wants to have an enrollment reinstated after it has been 
terminated for nonpayment must show that the nonpayment was due to a 
cause beyond his or her control. If the former enrollee did not receive 
the notice and can show that the sequence of missing payments was due 
to a cause beyond his or her control, the employing agency can allow 
the reinstatement upon payment of all premiums due. Causes beyond an 
enrollee's control include physical or mental incapacity; disasters 
such as floods, hurricanes or fires; or circumstances causing the 
enrollee to be out of contact with his or her home for an extended 
period. Each request for reinstatement must be considered on its own 
merits.
    If the agency's initial decision is to deny the request, the agency 
must offer the enrollee the right to reconsideration of the initial 
decision at a higher level or by a different office than the one making 
the initial decision.
    The Department of Agriculture's National Finance Center (NFC) 
administers the TCC accounts and accounts of former spouses with 
qualifying court orders for most Federal agencies. NFC issues 2,500 to 
3,000 nonpayment notices each month. Therefore, these interim 
regulations will result in annual savings of $60,000 to $70,000 for the 
NFC accounts alone.
    The interim regulations eliminate the requirement for sending the 
nonpayment notice by certified mail, return receipt requested. In 
addition, they clarify that there must be a delay of 60 days (90 days 
for overseas enrollees) before employing offices take action to 
terminate enrollments for nonpayment of premiums. These interim 
regulations do not address similar requirements in Sec. 890.502 related 
to employees on leave without pay and annuitants because that section 
is being revised and published separately. The revision will include 
the elimination of the requirement for certified mail, return receipt 
requested.

Waiver of Notice of Proposed Rulemaking

    Pursuant to section 553(b)(3)(B) of title 5 of the U.S. Code, I 
find that good cause exists for waiving the general notice of 
rulemaking because these interim regulations will result in immediate 
cost savings without adversely affecting FEHB enrollees.

Regulatory Flexibility Act

    I certify that these regulations will not have a significant 
economic impact on a substantial number of small entities because they 
primarily affect individuals enrolled under the Federal Employees 
Health Benefits Program.

List of Subjects in 5 CFR Part 890

    Administrative practice and procedure, Government employees, Health 
facilities, Health insurance, Health professions, Hostages, Iraq, 
Kuwait, Lebanon, Reporting and recordkeeping requirements, Retirement.

U.S. Office of Personnel Management.
Lorraine A. Green,
Deputy Director.

    Accordingly, 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.

    2. In Sec. 890.307 paragraph (b) is revised to read as follows:


Sec. 890.307  Waiver or suspension of annuity or compensation.

* * * * *
    (b) If the annuitant elects to pay premiums directly, he or she 
must send to the employing office his or her share of the subscription 
charge for the enrollment for every pay period during which the 
enrollment continues, exclusive of the 31-day temporary extension of 
coverage for conversion provided in Sec. 890.401. The annuitant must 
pay after each pay period he or she is covered in accordance with a 
schedule established by the employing office. If the employing office 
does not receive payment by the date due, the employing office must 
notify the annuitant in writing that continuation of coverage depends 
upon payment being made within 15 days (45 days for annuitants residing 
overseas) after receipt of the notice. If no further payments are made, 
the employing office terminates the enrollment 60 days after the date 
of the notice (90 days for annuitants residing overseas). The employing 
office automatically reinstates enrollment on a prospective basis when 
payment of annuity or compensation resumes.
* * * * *
    3. In Sec. 890.808 paragraph (d)(1) is revised to read as follows:


Sec. 890.808  Employing office responsibilities.

* * * * *
    (d) * * * (1) The former spouse must remit to the employing office 
the full subscription charge for the enrollment for every pay period 
during which the enrollment continues, exclusive of the 31-day 
temporary extension of coverage for conversion provided in 
Secs. 890.401 and 890.807(a)(2). Payment must be made after the pay 
period in which the former spouse is covered in accordance with a 
schedule established by the employing office (see definition of pay 
period under Sec. 890.101(a)). If the employing office does not receive 
payment by the due date the employing office must notify the former 
spouse in writing that continuation of coverage depends upon payment 
being made within 15 days (45 days for enrollees residing overseas) 
after receipt of the notice. If no subsequent payments are made, the 
employing office terminates the enrollment 60 days (90 days for 
enrollees residing overseas) after the date of the notice. Termination 
for nonpayment of premium is considered a voluntary cancellation under 
Sec. 890.807(d). A former spouse whose enrollment is terminated because 
of nonpayment of premium may not reenroll or reinstate coverage except 
as provided in paragraph (d)(2) of this section.
 * * * * *
    4. In Sec. 890.1109, paragraph (c) is revised to read as follow:


Sec. 890.1109  Premium payments.

 * * * * *
    (c) The enrollee must make the payment after the pay period during 
which he or she is covered in accordance with a schedule established by 
the employing office. If the employing office does not receive the 
payment by the date due, the employing office must notify the enrollee 
in writing that continuation of coverage depends upon payment being 
made within 15 days (45 days for enrollees residing overseas) after 
receipt of the notice. If no subsequent payments are made, the 
employing office terminates the enrollment 60 days (90 days for 
enrollees residing overseas) after the date of the notice. An enrollee 
whose coverage terminates because of nonpayment may not reenroll or 
reinstate coverage except as provided under paragraph (d) of this 
section.
 * * * * *
[FR Doc. 94-32141 Filed 12-29-94; 2:16 pm]
BILLING CODE 6325-01-M