[Federal Register Volume 73, Number 166 (Tuesday, August 26, 2008)]
[Rules and Regulations]
[Pages 50183-50188]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-19761]


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OFFICE OF PERSONNEL MANAGEMENT

5 CFR Part 894

RIN 3206-AL03


Federal Employees Dental and Vision Insurance Program

AGENCY: Office of Personnel Management.

ACTION: Final rule.

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SUMMARY: The Office of Personnel Management (OPM) is issuing final 
regulations to administer the Federal Employee Dental and Vision 
Benefits Enhancement Act of 2004, signed into law December 23, 2004. 
This law establishes dental and vision benefits programs for Federal 
employees, annuitants, and their eligible family members.

DATES: September 25, 2008.

FOR FURTHER INFORMATION CONTACT: Nataya Battle, (202) 606-1874, or e-
mail at [email protected].

SUPPLEMENTARY INFORMATION:

Background

    On December 23, 2004, Public Law 108-496, 118 Stat. 4001, was 
signed into law. This law established a dental benefits and vision 
benefits program for Federal employees, annuitants, and their eligible 
family members. The first effective date of coverage was December 31, 
2006.
    On October 15, 2007, OPM published interim regulations in the 
Federal Register (72 FR 58243-58248) to administer the Federal 
Employees Dental and Vision Insurance Program (FEDVIP). Comments were 
requested by December 15, 2007. OPM received comments from an employee 
union, a participating health plan in the FEHB Program, and an 
independent organization.
    One comment addressed the role of the carriers and the 
Administrator in the handling of the enrollment process. OPM contracts 
with the Administrator which has agreed to handle all aspects of the 
enrollment process on behalf of the carriers. Therefore the regulations 
have been revised to substitute ``Administrator'' for ``carrier'' 
wherever there is a reference to the enrollment process.
    Another comment addressed concerns that OPM does not review appeals 
for denial of a claim. The dental and vision carriers conduct their own 
disputed claims process and are required to use an independent third 
party to conduct a final analysis of any dispute, upon appeal. This 
process was established to ensure an independent evaluation is 
conducted, but at minimal cost to Program enrollees.
    A comment indicated that it was not clear whether enrollment or 
coverage would be denied for preexisting dental conditions. Under this 
Program, neither enrollment nor benefits coverage is denied due to a 
preexisting dental condition. However, since the dental program was 
established in order to provide benefits for dental services for teeth 
and their surrounding tissues, a carrier may determine that coverage 
does not extend to replacements for teeth missing before the effective 
date of enrollment in the Program.
    Another comment suggested revising the language in Sec.  894.601(a) 
to remove the reference to coverage ending at the end of the pay period 
``in which you were last eligible'' and in Sec.  894.601(b) to remove 
the reference to coverage ending at the end of the pay period for which 
the last premium allotment was made;

[[Page 50184]]

and replace them each with coverage ending ``at the end of the period 
covered by your last premium payment.'' It is not our intention to 
terminate an enrollment prior to the end of an enrollees' eligibility 
for coverage. Therefore, we did not adopt this suggestion.
    The regulations have also been revised at Sec.  894.602 to provide 
for a Qualifying Life Event that allows cancellation of enrollment when 
an enrollee or his or her spouse is called to active military service, 
and at Sec.  894.704(d) to advise an annuitant if his or her 
reemployment terminates, he or she must notify the Administrator within 
30 days to have his or her FEDVIP allotments withheld from his or her 
annuity payments. Otherwise, their FEDVIP coverage will terminate due 
to non-payment of premiums.

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 
only affects dental and vision benefits of Federal employees and 
annuitants.

Executive Order 12866, Regulatory Review

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

Federalism

    We have examined this rule in accordance with Executive Order 
13132, Federalism, and have determined that this rule will not have any 
negative impact on the rights, roles, and responsibilities of State, 
local, or Tribal governments.

List of Subjects in 5 CFR Part 894

    Administrative practice and procedure, Employee benefit plans, 
Government employees, Reporting and recordkeeping requirements, 
Retirement.

Office of Personnel Management.
Howard Weizmann,
Deputy Director.

0
For the reasons stated in the Preamble, OPM is revising part 894 to 
title 5, Code of Federal Regulations, to read as follows:

PART 894--FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM

Subpart A--Administration and General Provisions
Sec.
894.101 Definitions.
894.102 If I have a preexisting dental or vision condition, may I 
join FEDVIP?
894.103 How do I enroll?
894.104 Who makes enrollment decisions?
894.105 Who may correct an error in my enrollment?
Subpart B--Coverage and Types of Enrollment
894.201 What types of enrollments are available under FEDVIP?
894.202 If I enroll for self plus one, may I decide which family 
member to cover?
894.203 If I have a self plus one enrollment, when may I change 
which family member I want to cover or change to self only?
894.204 May I be enrolled in more than one dental or vision plan at 
a time?
Subpart C--Eligibility
894.301 Am I eligible to enroll in FEDVIP?
894.302 What is an excluded position?
894.303 What happens to my enrollment if I transfer to an excluded 
position?
894.304 Am I eligible to enroll if I'm retired or receiving workers' 
compensation?
894.305 Am I eligible to enroll if I am a former spouse receiving an 
apportionment of annuity?
894.306 Are foster children eligible as family members?
894.307 Are disabled children age 22 or over eligible as family 
members?
Subpart D--Cost of Coverage
894.401 How do I pay premiums?
894.402 Do the premiums I pay reflect the cost of providing 
benefits?
894.403 Are FEDVIP premiums paid on a pre-tax basis?
894.404 May I opt out of premium conversion?
894.405 What happens if I go into nonpay status or if my pay/annuity 
is insufficient to cover the allotments?
Subpart E--Enrolling and Changing Enrollment
894.501 When may I enroll?
894.502 What are the Qualifying Life Events (QLEs) that allow me to 
enroll?
894.503 Are belated enrollments or changes allowed?
894.504 When is my enrollment effective?
894.505 Are retroactive premiums paid with pre-tax dollars (premium 
conversion)?
894.506 How often will there be open seasons?
894.507 After I'm enrolled, may I change from one dental or vision 
plan or plan option to another?
894.508 When may I increase my type of enrollment?
894.509 What are the QLEs that are consistent with increasing my 
type of enrollment?
894.510 When may I decrease my type of enrollment?
894.511 What are the QLEs that are consistent with decreasing my 
type of enrollment?
894.512 What happens if I leave Government and then return?
Subpart F--Termination or Cancellation of Coverage
894.601 When does my FEDVIP coverage stop?
894.602 May I cancel my enrollment at any time?
894.603 Is there an extension of coverage and right to convert when 
my coverage stops or when a covered family member loses eligibility?
Subpart G--Annuitants and Compensationers
894.701 May I keep my dental and/or vision coverage when I retire or 
if I start receiving workers' compensation?
894.702 May I participate in open seasons and make changes to my 
enrollment as an annuitant or compensationer?
894.703 How long does my coverage as an annuitant or compensationer 
last?
894.704 What happens if I retire and then come back to work for the 
Federal Government?
Subpart H--Benefits in Underserved Areas
894.801 Will benefits be available in underserved areas?

    Authority: 5 U.S.C. 8962; 5 U.S.C. 8992.

Subpart A--Administration and General Provisions


Sec.  894.101  Definitions.

    This part is written as if the reader were an applicant or 
enrollee. Accordingly, the terms ``you,'' ``your,'' etc., refer, as 
appropriate, to the applicant or enrollee.
    Acquiring an eligible child means one of the following:
    (1) Birth of a child;
    (2) Adoption of a child;
    (3) Acquisition of a foster child as described in Sec.  
890.101(a)(8) of this chapter;
    (4) Residence change of the enrollee's stepchild or recognized 
natural child who moves in with the enrollee;
    (5) Establishment of dependency of a recognized natural child as 
described in Sec.  890.302(b) of this chapter; and
    (6) An otherwise eligible child's loss of spouse due to divorce or 
annulment of marriage, or death.
    Administrator means the entity with which the Office of Personnel 
Management contracts to manage the enrollment and premium payment 
process for the Federal Employees Dental and Vision Insurance Program 
(FEDVIP).
    Annuitant means an individual defined at 5 U.S.C. 8901(3). 
Generally, the term means a former employee who is entitled to an 
immediate annuity or a disability annuity under a retirement system 
established for employees. The term also generally includes those 
receiving a survivor annuity due to the death of a Federal employee or

[[Page 50185]]

annuitant (survivor annuitants) and those receiving compensation from 
the Office of Workers' Compensation Programs (compensationers). The 
term does not include former employees who retire with a deferred 
annuity under 5 U.S.C. 8413, or former spouses of annuitants.
    Carrier means a company with which the Office of Personnel 
Management contracts to provide dental and/or vision benefits.
    Child means one of the following:
    (1)(i) A child born within marriage;
    (ii) An adopted child;
    (iii) A stepchild or foster child who lives with the enrollee in a 
regular parent-child relationship; or
    (iv) A recognized natural child.
    (2) This definition does not include a grandchild (unless the 
grandchild meets all the requirements of a foster child as stated in 
Sec.  890.101(a)(8) of this chapter).
    (3) The child must be unmarried and under age 22. A child age 22 or 
over is eligible if the child is incapable of self-support because of a 
physical or mental disability that existed before the child reached age 
22.
    Compensation has the same meaning as found under subchapter I of 
chapter 81 of title 5, United States Code, which is payable because of 
an on-the-job injury or disease.
    Compensationer means an individual who is receiving compensation 
and who the Department of Labor determines is unable to return to duty.
    Covered position means a position in which an employee is not 
excluded from FEDVIP eligibility by law or regulation.
    Days means calendar days.
    Dependent means an unmarried child who is living with or receiving 
regular and substantial support from the enrollee.
    Employee means an individual defined in 5 U.S.C. 8901. For the 
purposes of this subpart, the term employee additionally means an 
employee of the United States Postal Service and an employee of the 
District of Columbia courts.
    Enrollment reconsideration means the Administrator's review of its 
initial enrollment decision to determine if it followed the law and 
regulations correctly in making the initial decision concerning FEDVIP 
eligibility.
    Family member means a spouse (including a spouse under a valid 
common law marriage) and/or unmarried dependent child(ren).
    OPM means the Office of Personnel Management.
    OWCP means the Office of Workers' Compensation Programs, U.S. 
Department of Labor.
    Premium conversion means the payment of FEDVIP premiums using pre-
tax dollars. See Sec.  892.102 of this chapter for a discussion of how 
premium conversion works.
    QLE means a qualifying life event.
    Recognized natural child means a biological child born outside of 
marriage. A recognized natural child is an eligible family member if 
the child lives with the enrollee or receives financial support from 
the enrollee.
    Regular parent-child relationship means that the enrollee is 
exercising parental authority, responsibility, and control over the 
child; is caring for, supporting the child; and is making the decisions 
about the child's education and medical care.
    Type of enrollment means one of the following:
    (1) Self only;
    (2) Self plus one; or
    (3) Self and family.


Sec.  894.102  If I have a pre-existing dental or vision condition, may 
I join FEDVIP?

    Yes. Pre-existing conditions do not exclude you from coverage under 
FEDVIP. The Administrator may not deny an individual the right to 
enroll solely because of a preexisting dental or vision condition.


Sec.  894.103  How do I enroll?

    You may enroll through an Administrator contracted by OPM to 
facilitate the enrollment process. Your Federal agency, retirement 
system, or OWCP office will advise you of the enrollment process 
available to you.


Sec.  894.104  Who makes enrollment decisions and reconsiderations?

    The Administrator makes enrollment decisions and the Administrator 
reviews requests for reconsideration of an enrollment decision. The 
Administrator's initial enrollment decision denying enrollment or an 
opportunity to change coverage must be in writing and must inform you 
about your right to reconsideration.


Sec.  894.105  Who may correct an error in my enrollment?

    (a) The Administrator may correct administrative errors about the 
processing of your enrollment or changes in enrollment.
    (b) OPM may order correction of an administrative error if it 
receives evidence that it would be against equity (fairness) and good 
conscience not to order the correction. This decision is made at the 
discretion of OPM and is not subject to review.
    (c) If the correction gives you retroactive coverage, you must pay 
the premiums for all periods of the retroactive coverage. These 
premiums will not be on a pre-tax basis (they are not subject to 
premium conversion).

Subpart B--Coverage and Types of Enrollment


Sec.  894.201  What types of enrollments are available under FEDVIP?

    FEDVIP has three types of enrollment:
    (a) Self only, which covers only the enrolled employee or 
annuitant;
    (b) Self plus one, which covers the enrolled employee or annuitant 
plus one eligible family member; and
    (c) Self and family, which covers the enrolled employee or 
annuitant and all eligible family members.


Sec.  894.202  If I enroll for self plus one, may I decide which family 
member to cover?

    Yes, if you enroll for self plus one, you must state at the time 
you enroll which eligible family member you want to cover under your 
enrollment.


Sec.  894.203  If I have a self plus one enrollment, when may I change 
which family member I want to cover or change to self only?

    You may change your covered family member under a self plus one 
enrollment or change to self only coverage in the following situations:
    (a) During the annual open season;
    (b) If your covered family member dies during the year; or
    (c) If your covered family member loses eligibility during the 
year.


Sec.  894.204  May I be enrolled in more than one dental or vision plan 
at a time?

    You may be enrolled in a FEDVIP dental plan and a separate FEDVIP 
vision plan at the same time. But no one may enroll or be covered as a 
family member in a FEDVIP dental or vision plan if he or she is covered 
under another person's FEDVIP dental or vision self plus one or self 
and family enrollment, except as provided under Sec.  890.302 (a)(2) 
through (4) of this chapter, with respect to dual enrollments.

Subpart C--Eligibility


Sec.  894.301  Am I eligible to enroll in the FEDVIP?

    You are eligible if you meet the definition of employee in 5 U.S.C. 
8901(1), unless you are in an excluded position. You are eligible if 
you are an employee of the United States Postal Service or the District 
of Columbia courts.


Sec.  894.302  What is an excluded position?

    Excluded positions are described in 5 U.S.C. 8901 (1)(I) and 5 CFR 
890.102 (c), except that employees of the United

[[Page 50186]]

States Postal Service and District of Columbia courts are not excluded 
positions.
    You are in an excluded position if you are:
    (a) An employee of a corporation supervised by the Farm Credit 
Administration, if private interests elect or appoint a member of the 
board of directors.
    (b) An employee who is not a citizen or national of the United 
States and your permanent duty station is outside the United States. 
Exception: You are eligible if you met the definition of employee on 
September 30, 1979, by service in an Executive agency, the United 
States Postal Service, or the Smithsonian Institution in the area that 
was then known as the Canal Zone.
    (c) An employee of the Tennessee Valley Authority.
    (d) An individual first employed by the Government of the District 
of Columbia on or after October 1, 1987, except employees of the 
District of Columbia Courts and those employees defined at Sec.  
890.102 (c)(8) of this chapter.
    (e) Serving under an appointment limited to 1 year or less. 
Exceptions: You are eligible if:
    (1) You are an acting postmaster;
    (2) You are a Presidential appointee appointed to fill an unexpired 
term;
    (3) You are an employee with a provisional appointment, as defined 
in Sec.  316.401 and Sec.  316.403 of this chapter; or
    (4) You have completed 1 year of current continuous employment, 
excluding any break in service of 5 days or less.
    (f) You are expected to work fewer than 6 months in each year. 
Exception: You are eligible if you are employed under an OPM-approved 
career-related work-study program under Schedule B. To qualify, your 
work-study program must last at least 1 year, and you must be expected 
to be in pay status for at least one-third of the total period of time 
from the date of your first appointment to the date you complete the 
work-study program.
    (g) An intermittent employee (a non-full-time employee without a 
prearranged regular tour of duty).
    (h) A beneficiary or patient employee in a Government hospital or 
home.
    (i) Paid on a contract or fee basis. Exception: You are eligible if 
you are a United States citizen, and you are appointed by a contract 
between you and the Federal employing authority. To qualify, your 
contract must require your personal service, and you must be paid on 
the basis of units of time.
    (j) Paid on a piecework basis. Exception: You are eligible if your 
work schedule provides for full-time or part-time service, and you have 
a regularly scheduled tour of duty.
    (k) The following positions are not excluded positions:
    (1) An employee appointed to perform ``part-time career 
employment,'' as defined in section 3401 (2) of title 5, U.S.C., and 5 
CFR part 430, subpart B; or
    (2) An employee serving under an interim appointment established 
under Sec.  772.102 of this chapter.


Sec.  894.303  What happens to my enrollment if I transfer to an 
excluded position?

    (a) If you have FEDVIP coverage and you transfer to a position 
excluded under Sec.  894.302(a) through (d), your enrollment stops.
    (b) If you have FEDVIP coverage and you transfer to a position 
excluded under Sec.  894.302(e) through (j) with no break in service of 
more than 3 days, your enrollment is not affected. If you have a break 
in service of more than 3 days, your enrollment stops.
    (c) If you did not elect to enroll in FEDVIP and then transfer to 
an excluded position, you lose all rights to enroll at that time.


Sec.  894.304  Am I eligible to enroll if I'm retired or receiving 
workers' compensation?

    If you are retired, receiving workers' compensation, or are a 
survivor annuitant, you are eligible if you meet the definition of 
annuitant in 5 U.S.C. 8901(3).


Sec.  894.305  Am I eligible to enroll if I am a former spouse 
receiving an apportionment of annuity?

    No. Former spouses receiving an apportionment of annuity are not 
eligible to enroll in FEDVIP.


Sec.  894.306  Are foster children eligible as family members?

    Yes, foster children may be eligible for coverage as family members 
under FEDVIP.


Sec.  894.307  Are disabled children age 22 or over eligible as family 
members?

    A child age 22 or over is an eligible family member if the child is 
incapable of self-support because of a physical or mental disability 
that existed before the child reached age 22.

Subpart D--Cost of Coverage


Sec.  894.401  How do I pay premiums?

    (a) Employees pay premiums through payroll allotments.
    (b) Annuitants and survivor annuitants pay premiums through annuity 
allotments.
    (c) Compensationers pay premiums through allotments from 
compensation payments.
    (d) In limited circumstances, individuals may make direct premium 
payments. See Sec.  894.405.


Sec.  894.402  Do the premiums I pay reflect the cost of providing 
benefits?

    The premiums you pay shall reasonably and equitably reflect the 
cost of the benefits provided.


Sec.  894.403  Are FEDVIP premiums paid on a pre-tax basis?

    (a) Your FEDVIP premiums are paid on a pre-tax basis (called 
premium conversion) if you are an active employee, your salary is 
sufficient to make the premium allotments, and your agency is able to 
make pre-tax allotments.
    (b) Your FEDVIP premiums are not paid on a pre-tax basis if:
    (1) You are an employee in nonpay status or an employee whose 
salary is not high enough to make premium allotments, or your agency is 
unable to make pre-tax allotments;
    (2) You are an annuitant, a survivor annuitant, or a 
compensationer;
    (3) Your enrollment change was made effective retroactively which 
resulted in additional premium withholdings, unless it is as a result 
of birth or adoption of a child.
    (4) You have been approved to pay premiums directly to the 
Administrator.


Sec.  894.404  May I opt out of premium conversion?

    No, all enrolled employees whose salary is sufficient to make 
premium allotments and whose agency is able to make pre-tax allotments 
must participate in premium conversion.


Sec.  894.405  What happens if I go into nonpay status or if my pay/
annuity is insufficient to cover the allotments?

    (a) If your pay, annuity, or compensation is too low to cover the 
premium allotments, or if you go into a nonpay status, contact the 
Administrator to arrange to pay your premiums directly to the 
Administrator.
    (b) If you do not make the premium payments, your FEDVIP coverage 
will stop. You will not be able to reenroll until the next open season 
after:
    (1) You are in pay status; or
    (2) Your pay is sufficient to make the premium allotments.

[[Page 50187]]

Subpart E--Enrollment and Changing Enrollment


Sec.  894.501  When may I enroll?

    You may enroll:
    (a) During the annual open season;
    (b) Within 60 days after you first become eligible as:
    (1) A new employee;
    (2) A previously ineligible employee who transfers to a covered 
position; or
    (3) A new survivor annuitant, if not already covered under FEDVIP.
    (c) Within 60 days of when you return to service following a break 
in service of at least 30 days; or
    (d) Within 60 days of a QLE that allows you to enroll.


Sec.  894.502  What are the Qualifying Life Events (QLEs) that allow me 
to enroll?

    (a) You or an eligible family member lose other dental/vision 
coverage;
    (b) Your annuity or compensation is restored after having been 
terminated; or
    (c) You return to pay status after being on leave without pay due 
to deployment to active military duty.


Sec.  894.503  Are belated enrollments or changes allowed?

    (a) The time limit for enrolling or changing your enrollment may be 
extended up to 3 months after the date you became newly eligible or had 
a QLE or after the end of an open season. To qualify, you must 
demonstrate to the Administrator that you were not able to enroll or 
change your enrollment on time for reasons beyond your control.
    (b) If the Administrator allows you to make a belated enrollment or 
enrollment change, you must enroll or change within 30 days after the 
Administrator notifies you of its determination.


Sec.  894.504  When is my enrollment effective?

    (a) Open season enrollments are effective on the date set by OPM.
    (b) If you enroll when you first become eligible your enrollment is 
effective the 1st day of the pay period following the one in which the 
Administrator receives your enrollment, but no earlier than December 
31, 2006.
    (c)(1) A belated open season enrollment is effective retroactive to 
the date it would have been effective if you had made a timely 
enrollment or request for a change.
    (2) Any other belated enrollment or change is effective retroactive 
to the 1st day of the pay period following the one in which you became 
newly eligible or the date of your QLE.
    (3) You are responsible for any retroactive premiums due to a 
belated enrollment or request for a change.


Sec.  894.505  Are retroactive premiums paid with pre-tax dollars 
(premium conversion)?

    Retroactive premiums are not paid under premium conversion, except 
when you are changing your enrollment retroactively as a result of 
birth or adoption of a child. Any additional withholdings for 
retroactive premiums that are due must be made with after-tax dollars. 
The Administrator will bill you directly for any retroactive premiums 
that must be paid with after-tax dollars.


Sec.  894.506  How often will there be open seasons?

    There will be an annual open season for FEDVIP at the same time as 
the annual Federal Benefits Open Season.


Sec.  894.507  After I'm enrolled, may I change from one dental or 
vision plan or plan option to another?

    (a) You may change from one dental and/or vision plan to another 
plan or one plan option to another option in that same plan during the 
annual open season.
    (b)(1) If you are enrolled in a dental or vision plan with a 
geographically restricted service area, and you or a covered eligible 
family member move out of the service area, you may change to a 
different dental or vision plan that serves that area.
    (2) You may make this change at any time before or after the move, 
once you or a covered eligible family member has a new address.
    (3) The enrollment change is effective the first day of the pay 
period following the pay period in which you make the change.
    (4) You may not change your type of enrollment unless you also have 
a QLE that allows you to change your type of enrollment.


Sec.  894.508  When may I increase my type of enrollment?

    (a) You may increase your type of enrollment:
    (1) during the annual open season; or
    (2) If you have a QLE that is consistent with increasing your type 
of enrollment.
    (b) Increasing your type of enrollment means going from:
    (1) Self only to self plus one;
    (2) Self only to self and family; or
    (3) Self plus one to self and family.
    (c) You may increase your type of enrollment during the time period 
beginning 31 days before the QLE and ending 60 days after the QLE.
    (d) Your new type of enrollment is effective the 1st day of the pay 
period following the pay period in which you make the change.
    (e) You may not change from one dental or vision plan to another, 
except as stated in Sec.  894.507(b).


Sec.  894.509  What are the QLEs that are consistent with increasing my 
type of enrollment?

    (a) Marriage;
    (b) Acquiring an eligible child; or
    (c) Loss of other dental or vision coverage by an eligible family 
member.


Sec.  894.510  When may I decrease my type of enrollment?

    (a) You may decrease your type of enrollment
    (1) during the annual open season; or
    (2) If you have a QLE that is consistent with decreasing your type 
of enrollment,
    (b) Decreasing your type of enrollment means going from:
    (1) Self and family to self plus one;
    (2) Self and family to self only; or
    (3) Self plus one to self only.
    (c) You may decrease your type of enrollment during the time period 
beginning 31 days before your QLE and ending 60 days after your QLE.
    (d) Your new type of enrollment is effective the 1st day of the pay 
period following the one in which you make the change.
    (e) You may not change from one dental or vision plan or option to 
another, except as stated in Sec.  894.507(b).


Sec.  894.511  What are the QLEs that are consistent with decreasing my 
type of enrollment?

    (a) Loss of an eligible family member due to:
    (1) Divorce;
    (2) Death; or
    (3) Loss of eligibility of a previously enrolled child.
    (b) Your spouse deploys to active military service.


Sec.  894.512  What happens if I leave Federal Government and then 
return?

    (a) Your FEDVIP coverage terminates at the end of the pay period in 
which you separate from government service. Exception: If you separate 
for retirement or while in receipt of workers' compensation as defined 
in Sec.  894.701, your FEDVIP coverage continues.
    (b)(1) If you return to Federal service after a break in service of 
fewer than 30 days, and you were not previously enrolled in FEDVIP, you 
may not enroll until the next open season or unless you have a QLE that 
allows you to enroll.
    (2) If you return to Federal service after a break in service of 
fewer than 30 days, and you were previously enrolled in FEDVIP, you may 
reenroll in the same plan(s) and plan option and with the same type of 
enrollment you had before you separated. Exceptions:
    (i) If you were enrolled in a dental or vision plan with a 
restricted geographic service area, and you have since moved out of the 
plan's service area, you may

[[Page 50188]]

change to a different dental or vision plan that serves that area.
    (ii) If you have since gained or lost an eligible family member, 
you may change your type of enrollment consistent with the change in 
the number of eligible family members.
    (3) If you return to Federal service as a new hire after a break in 
service of 30 days or more, you may enroll if you were not previously 
enrolled, change your dental or vision plan, and/or change your type of 
enrollment.

Subpart F--Termination or Cancellation of Coverage


Sec.  894.601  When does my FEDVIP coverage stop?

    (a) If you no longer meet the definition of an eligible employee or 
annuitant, your FEDVIP coverage stops at the end of the pay period in 
which you were last eligible.
    (b) If you go into a period of nonpay or insufficient pay, and you 
do not make direct premium payments, your FEDVIP coverage stops at the 
end of the pay period for which your agency, retirement system, or OWCP 
last made a premium allotment from your pay.
    (c) If you are making direct premium payments, and you stop making 
the payments, your FEDVIP coverage stops at the end of the pay period 
for which you last made a payment.
    (d) If you cancel your enrollment during an open season, your 
FEDVIP coverage stops at midnight of the day before the effective date 
of an open season change as set by OPM.
    (e) If you are enrolled with a combination dental and vision 
carrier with a restricted service area, and you move outside the 
carrier's service area to a service area that does not offer a 
combination carrier and you change to a dental only or vision only 
carrier, your existing combination plan coverage will stop at midnight 
of the day before the effective date of your new plan coverage.
    (f) If your FEDVIP carrier discontinues participation in the 
program at the end of the contract year, then you must change to 
another carrier 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 will establish a time and effective date for 
you to change your carrier. If you do not change your carrier within 
the time set by OPM, your coverage will stop at midnight of the day 
before the effective date set by OPM for coverage with another carrier.


Sec.  894.602  May I cancel my enrollment at any time?

    No. You may only cancel your enrollment during an open season. 
Exceptions: You may cancel your dental and/or vision enrollment if you 
transfer to an eligible position with a Federal agency that provides 
dental and/or vision coverage with 50 percent or more employer-paid 
premiums. You may also cancel upon your deployment or your spouse's 
deployment to active military duty. These cancellations will become 
effective at the end of the pay period that you submit your request.


Sec.  894.603  Is there an extension of coverage and right to convert 
when my coverage stops or when a covered family member loses 
eligibility?

    No. There is no extension of coverage or right to convert to an 
individual policy or Temporary Continuation of Coverage (TCC) when your 
FEDVIP coverage stops or when a family member loses eligibility under 
the Program.

Subpart G--Annuitants and Compensationers


Sec.  894.701  May I keep my dental and/or vision coverage when I 
retire or start receiving workers' compensation?

    (a) Your FEDVIP coverage continues if you retire on an immediate 
annuity or on a disability annuity, or start receiving compensation 
from OWCP.
    (b) If you retire on a Minimum Retirement Age +10 annuity that you 
elect to postpone in accordance with 5 U.S.C. 8412(g), your FEDVIP 
coverage will stop when you separate from service. However, you may 
enroll again within 60 days of when your annuity starts.
    (c) If you retire on a deferred annuity in accordance with 5 U.S.C. 
8413, your FEDVIP coverage stops and you are not eligible to enroll.


Sec.  894.702  May I participate in open season and make changes to my 
enrollment as an annuitant or compensationer?

    Yes. Annuitants and compensationers may participate in open season 
and make enrollment changes under the same circumstances as active 
employees.


Sec.  894.703  How long does my coverage as an annuitant or 
compensationer last?

    Your coverage as an annuitant or compensationer continues as long 
as you continue receiving an annuity or compensation and pay your 
premiums, unless you cancel your coverage during an open season or 
terminate coverage due to insufficient annuity or compensation.


Sec.  894.704  What happens if I retire and then come back to work for 
the Federal Government?

    (a) If you have FEDVIP coverage as an annuitant, and you become 
reemployed in an eligible position in Federal service, you must contact 
the Administrator so it can send the request for allotments to your 
agency so your agency can start making the allotments from your pay.
    (b) If you did not enroll in FEDVIP coverage as an annuitant and 
become reemployed in an eligible Federal position, you have 60 days to 
enroll in FEDVIP.
    (c) If you enroll as an employee the Administrator will stop 
sending requests for allotments from your annuity.
    (d) If your reemployment terminates, you must notify the 
Administrator within 30 days to have your allotments withheld from your 
annuity payments. Otherwise, your FEDVIP coverage will terminate due to 
non-payment of premiums.

Subpart H--Benefits in Underserved Areas


Sec.  894.801  Will benefits be available in underserved areas?

    (a) Dental and vision plans under FEDVIP will include underserved 
areas in their service areas and provide benefits to enrollees in 
underserved areas.
    (b) In any area where a FEDVIP dental or vision plan does not meet 
OPM access standards, including underserved areas, enrollees may 
receive services from non-network providers.
    (c) Contracts under FEDVIP shall include access standards as 
defined by OPM and payment levels for services to non-network providers 
in areas that do not meet access standards.

[FR Doc. E8-19761 Filed 8-25-08; 8:45 am]
BILLING CODE 6325-39-P