[Federal Register Volume 66, Number 187 (Wednesday, September 26, 2001)]
[Rules and Regulations]
[Pages 49086-49088]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-24108]


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OFFICE OF PERSONNEL MANAGEMENT

5 CFR Part 890

RIN: 3206-AJ36


Suspension of TRICARE-Eligible's Enrollment in the Federal 
Employees Health Benefits (FEHB) Program

AGENCY: Office of Personnel Management.

ACTION: Interim Rule.

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SUMMARY: The Office of Personnel Management is issuing an interim rule 
to allow TRICARE-eligible FEHB Program annuitants and former spouses to 
suspend their FEHB enrollments, and then return to the FEHB Program 
during the Open Season, or return to FEHB coverage immediately, if they 
involuntarily lose TRICARE coverage. The intent of this rule is to 
allow TRICARE-eligible beneficiaries to avoid the expense of continuing 
to pay FEHB Program premiums while they are using TRICARE coverage, 
without endangering their ability to return to the FEHB Program in the 
future.

DATES: Effective September 26, 2001. Comments received on or before 
November 26, 2001.

FOR FURTHER INFORMATION CONTACT: Michael W. Kaszynski, Policy Analyst, 
Insurance Policy and Information Division, OPM, Room 3425, 1900 E 
Street, NW., Washington, DC 20415-0001. He can also be reached at (202) 
606-0004 or by electronic mail (e-mail) at: [email protected]. 

SUPPLEMENTARY INFORMATION: Effective October 1, 2001, the National 
Defense Authorization Act for 2001 will reinstate TRICARE coverage for 
Medicare-eligible uniformed services retirees, their survivors and 
eligible dependents. TRICARE coverage will be advantageous to many 
Medicare-eligible military system beneficiaries who now are covered 
under the FEHB Program as Federal civilian retirees, family members, or 
former spouses.
    Under current FEHB regulations, however, an annuitant or former 
spouse who cancels his or her FEHB coverage to use TRICARE coverage 
would not be allowed to return to FEHB coverage. Therefore, OPM is 
issuing these interim regulations, with a request for comments, to 
allow these FEHB participants to suspend, rather than cancel, their 
FEHB coverage when they begin TRICARE coverage. Under this rule, they 
would be allowed to return to FEHB coverage immediately if they 
involuntarily lose TRICARE coverage or, if not, during the next annual 
FEHB Open Season.
    We are also amending our regulations to clarify a similar situation 
involving FEHB-covered annuitants and former spouses. The regulations 
allow an individual who drops FEHB coverage when he or she enrolls in a 
Medicare-sponsored plan, or in Medicaid or a similar State-sponsored 
program of medical assistance for the needy, to return to FEHB coverage 
during the annual Open Season or immediately upon being involuntarily 
disenrolled from the non-FEHB coverage.

Waiver of Notice of Proposed Rule Making

    Pursuant to section 553(b)(3)(B) of title 5 of the United States 
Code, I find that good cause exists for waiving the general notice of 
proposed rule making. The notice is being waived so that FEHB enrollees 
who are eligible for the new TRICARE benefits can suspend their FEHB 
coverage and use their new benefits at their first opportunity.

Regulatory Flexibility Act

    I certify that this regulation will not have a significant economic 
impact on a substantial number of small entities because the regulation 
will only affect health insurance carriers under the Federal Employees 
Health Benefits Program.

Executive Order 12866, Regulatory Review

    This regulation has been reviewed by the Office of Management and 
Budget in accordance with Executive Order 12866.

List of Subjects in 5 CFR Part 890

    Administrative practice and procedure, Government employees, Health 
facilities, Health insurance, Health professionals, Hostages, Iraq, 
Kuwait, Lebanon, Reporting and record keeping requirements, Retirement.

U.S. Office of Personnel Management.
Kay Coles James,
Director.

    For the reasons set forth in the preamble, 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; 
Sec. 890.102 also issued under sections 11202(f), 11232(e), 11246(b) 
and (c) of Pub. L. 105-33, 111 Stat. 251; and section 721 of Pub. L. 
105-261, 112 Stat. 2061.

PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM

    2. In Sec. 890.304, paragraph (d)(2) is revised to read as follows:


Sec. 890.304  Termination of enrollment.

* * * * *
    (d) * * *
    (2) An annuitant may suspend enrollment in FEHB for the purpose of 
enrolling in a Medicare-sponsored plan under sections 1833, 1876, or 
1851 of the Social Security Act, or to enroll in the Medicaid program 
or a similar State-sponsored program of medical assistance for the 
needy, or for the purpose of using TRICARE coverage (including coverage 
provided by the Uniformed Services Family Health Plan) under title 10 
U.S.C. instead of FEHB coverage. To suspend FEHB coverage, 
documentation must be submitted to the employing office or retirement 
system within the period beginning 31 days before and ending 31 days 
after the effective date of the enrollment in the Medicare-sponsored 
plan, or the Medicaid or similar program, or the first day of using 
TRICARE (including the Uniformed Services Family Health Plan) instead 
of FEHB coverage. The suspension becomes effective on the day before 
the effective date of the enrollment in the Medicare-sponsored plan, or 
Medicaid or a similar program, or the day before the day designated by 
the annuitant as the first day of using TRICARE (including the 
Uniformed Services Family Health Plan) instead of FEHB coverage.
* * * * *

    3. In Sec. 890.306 paragraphs (f)(1)(ii) and (f)(1)(iii) are 
revised, paragraph (f)(1)(iv) is added and paragraphs (h) and (i) are 
revised to read as follows:

[[Page 49087]]

890.306 Opportunities for annuitants to change enrollment or to 
reenroll; effective dates.
* * * * *
    (f) * * *
    (1) * * *
    (ii) An annuitant who suspended 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)An annuitant who suspended the enrollment under this part 
because he or she furnished proof of eligibility for coverage under the 
Medicaid program or similar State-sponsored program of medical 
assistance for the needy, may reenroll.
    (iv) An annuitant who suspended enrollment under this part for the 
purpose of using TRICARE (including the Uniformed Services Family 
Health Plan) coverage instead of FEHB coverage, may reenroll.
* * * * *
    (h) Reenrollment of annuitants who suspended enrollment to enroll 
in a Medicare-sponsored plan or to use TRICARE (including the Uniformed 
Services Family Health Plan) coverage under title 10 U.S.C. instead of 
FEHB coverage. 
    (1) An annuitant who had been enrolled (or was otherwise eligible 
to enroll) for coverage under this part and suspended the 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 the FEHB Program (as provided by 
Sec. 890.304(d)), 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 the TRICARE program (including the 
Uniformed Services Family Health Plan).
    (2) An annuitant who voluntarily suspended enrollment 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).
    (i) Reenrollment of annuitants who suspended enrollment because of 
eligibility under Medicaid or a similar State-sponsored program of 
medical assistance for the needy. 
    (1) An annuitant who had been enrolled (or was otherwise eligible 
to enroll) 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 by Sec. 890.304(d)), 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) An annuitant who suspended 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 any 
reason, may do so during the next available Open Season as provided by 
paragraph (f) of this section.

    4. In Sec. 890.806 paragraphs (f)(1)(ii) and (f)(1)(iii) are 
revised and (f)(1)(iv) is added and paragraphs (h) and (i) are revised 
to read as follows:


Sec. 890.806  Opportunities for former spouses to enroll and change 
enrollment; effective dates of enrollment.

* * * * *
    (f) * * *
    (1) * * *
    (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.
* * * * *
    (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).
    (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

[[Page 49088]]

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.

    5. In Sec. 890.807 paragraphs (e)(2) and (e)(4) are revised to read 
as follows:


Sec. 890.807  Termination of enrollment.

* * * * *
    (e) * * *
    (2) A former spouse may suspend enrollment in FEHB for the purpose 
of enrolling in Medicare sponsored plan under sections 1833, 1876, or 
1851 of the Social Security Act, or to enroll in the Medicaid program 
or a similar State-sponsored program of medical assistance for the 
needy, or for the purpose of using TRICARE coverage (including the 
Uniformed Services Family Health Plan) under title 10 U.S.C. instead of 
FEHB coverage. To suspend FEHB coverage, documentation must be 
submitted to the employing office or retirement system within the 
period beginning 31 days before and ending 31 days after the effective 
date of the enrollment in the Medicare sponsored plan, or the Medicaid 
or similar program, or the first day of using TRICARE (including the 
Uniformed Services Family Health Plan) instead of FEHB coverage. The 
suspension becomes effective on the day before the effective date of 
the enrollment in the Medicare sponsored plan, or the Medicaid or 
similar program, or the day before the day designated by the former 
spouse as the first day of using TRICARE (including the Uniformed 
Services Family Health Plan) instead of FEHB coverage.
* * * * *
    (4) A former spouse who cancels his or her enrollment for any 
reason may not later reenroll in the FEHB Program.

[FR Doc. 01-24108 Filed 9-25-01; 8:45 am]
BILLING CODE 6325-50-P