[Federal Register Volume 79, Number 232 (Wednesday, December 3, 2014)]
[Proposed Rules]
[Pages 71695-71703]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-28429]


 ========================================================================
 Proposed Rules
                                                 Federal Register
 ________________________________________________________________________
 
 This section of the FEDERAL REGISTER contains notices to the public of 
 the proposed issuance of rules and regulations. The purpose of these 
 notices is to give interested persons an opportunity to participate in 
 the rule making prior to the adoption of the final rules.
 
 ========================================================================
 

  Federal Register / Vol. 79, No. 232 / Wednesday, December 3, 2014 / 
Proposed Rules  

[[Page 71695]]



OFFICE OF PERSONNEL MANAGEMENT

5 CFR Parts 890 and 892

RIN 3206-AN08


Federal Employees Health Benefits Program Self Plus One 
Enrollment Type

AGENCY: Office of Personnel Management.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: The United States Office of Personnel Management (OPM) is 
issuing a proposed rule to amend the Federal Employees Health Benefits 
(FEHB) Program regulations to add an additional enrollment type called 
``self plus one'' for premium rating and family member eligibility 
purposes.

DATES: Comments are due on or before February 2, 2015.

ADDRESSES: Send written comments to Chelsea Ruediger, Policy Analyst, 
Planning and Policy Analysis, U.S. Office of Personnel Management, Room 
4312, 1900 E Street NW., Washington, DC; or FAX to (202) 606-4640 Attn: 
Chelsea Ruediger. You may also submit comments using the Federal 
eRulemaking Portal: http://www.regulations.gov. Follow the instructions 
for submitting comments.

FOR FURTHER INFORMATION CONTACT: Chelsea Ruediger at 
[email protected] or (202) 606-0004.

SUPPLEMENTARY INFORMATION: Section 706 of the Bipartisan Budget Act of 
2013 adds to chapter 89 of title 5 United States Code a self plus one 
enrollment type for Federal employees and retirees under the Federal 
Employees Health Benefits (FEHB) Program. This proposed regulation 
amends 5 CFR parts 890 and 892 to include a self plus one enrollment 
type.
    The self plus one enrollment type will be available starting in the 
2015 Open Season for the 2016 plan year. A self plus one enrollment 
will cover the enrollee and one eligible family member, designated by 
the enrollee. The proposed regulation does not alter current FEHB 
family member eligibility guidelines. Eligible family members under a 
self plus one enrollment will be a spouse or an eligible child as 
outlined in Sec.  890.302.
    The government contribution calculation, determined by statute in 5 
U.S.C. 8906, is based on the lesser of: (1) 72 percent of amounts OPM 
determines are the program-wide weighted average of premiums in effect 
each year, for self only, self plus one, and for self and family 
enrollments, respectively, or (2) capped at 75 percent of the total 
premium for the particular plan option an enrollee selects. This 
government contribution calculation will apply to the three tier 
enrollment structure. Because actual enrollment data for a new three 
tier structure will not be available in advance, OPM will determine the 
weighted average \1\ for use in calculating the Government contribution 
and the employee contribution for the first plan year in which the self 
plus one enrollment type is made available (5 U.S.C. 8906(a)(1)(B)).
---------------------------------------------------------------------------

    \1\ Pub. L 113-67 sec. 706(d) WEIGHTED AVERAGE FOR FIRST YEAR.--
For the first contract year for which an employee may enroll for 
self plus one coverage under chapter 89 of title 5, United States 
Code, the Office of Personnel Management shall determine the 
weighted average of the subscription charges that will be in effect 
for the contract year for enrollments for self plus one under such 
chapter based on an actuarial analysis.
---------------------------------------------------------------------------

    The proposed regulation provides definitions for a self only, self 
plus one, and self and family enrollment as follows:
     Self only enrollment means an enrollment that covers only 
the enrollee.
     Self plus one enrollment means an enrollment that covers 
the enrollee and one eligible family member.
     Self and family enrollment means an enrollment that covers 
the enrollee and all eligible family members.
    We also offer definitions for an increase and decrease in 
enrollment type as follows:
     Decrease enrollment type means a change in enrollment from 
self and family to self plus one or to self only or a change from self 
plus one to self only.
     Increase enrollment type means a change in enrollment from 
self only to self plus one or to self and family or a change from self 
plus one to self and family.
    This proposed regulation allows individuals with a self plus one 
enrollment to make enrollment changes during Open Season and consistent 
with the guidelines for current FEHB Qualifying Life Events. The 
following chart summarizes when enrollment changes will be allowed. 
Definitions for each of the event codes can be found on the SF2809 at 
http://www.opm.gov/forms/pdf_fill/sf2809.pdf.

------------------------------------------------------------------------
                                      Permitted for the following event
              Change                                codes
------------------------------------------------------------------------
            For Enrollees Participating in Premium Conversion
------------------------------------------------------------------------
Increase enrollment...............  1B, 1C, 1E, 1F, 1I, 1J, 1K, 1M, 1N,
                                     1O, 1R.
Decrease enrollment...............  1B, 1C, 1E, 1F, 1G, 1H, 1J, 1M, 1N,
                                     1O, 1P, 1Q, 1R.
------------------------------------------------------------------------
  For Annuitants (decreases in enrollment type are allowed at any time)
------------------------------------------------------------------------
Increase enrollment...............  2A, 2B, 2F, 2G, 2H, 2I, 2J, 2K.
------------------------------------------------------------------------
   For Former Spouses Under the Spouse Equity Provision (decreases in
                enrollment type are allowed at any time)
------------------------------------------------------------------------
Increase enrollment...............  3B, 3C, 3F, 3G, 3H, 3I.
------------------------------------------------------------------------

[[Page 71696]]

 
    For Temporary Continuation of Coverage (TCC) for Eligible Former
  Employees, Former Spouses, and Children (decreases in enrollment type
                        are allowed at any time)
------------------------------------------------------------------------
Increase enrollment...............  4A (for eligible former employees
                                     only), 4B, 4C, 4D, 4F, 4G, 4H.
------------------------------------------------------------------------
   For Employees Not Participating in Premium Conversion (decreases in
                enrollment type are allowed at any time)
------------------------------------------------------------------------
Increase enrollment...............  5B, 5C, 5D, 5E, 5F, 5G, 5H, 5I, 5J,
                                     5N.
------------------------------------------------------------------------

    In addition, enrollees in self plus one are provided with an 
opportunity to switch their covered family member during the annual 
Open Season and outside of Open Season upon experiencing a change in 
family status, a change in coverage, or a change in eligibility. The 
following chart summarizes this. Definitions for each of the event 
codes can be found on the SF2809 at http://www.opm.gov/forms/pdf_fill/sf2809.pdf.

------------------------------------------------------------------------
                                      Permitted for the following event
              Change                                codes
------------------------------------------------------------------------
            For Enrollees Participating in Premium Conversion
------------------------------------------------------------------------
Switch covered family member under  1B, 1C, 1I, 1J, 1M, 1N, 1O, 1P, 1Q,
 a self plus one enrollment.         1R.
------------------------------------------------------------------------
  For Annuitants (decreases in enrollment type are allowed at any time)
------------------------------------------------------------------------
Switch covered family member under  2A, 2B, 2F, 2G, 2H, 2I, 2J.
 a self plus one enrollment.
------------------------------------------------------------------------
   For Former Spouses Under the Spouse Equity Provision (decreases in
                enrollment type are allowed at any time)
------------------------------------------------------------------------
Switch covered family member under  3B, 3C, 3F, 3G, 3H, 3I.
 a self plus one enrollment.
------------------------------------------------------------------------
    For Temporary Continuation of Coverage (TCC) for Eligible Former
  Employees, Former Spouses, and Children (decreases in enrollment type
                        are allowed at any time)
------------------------------------------------------------------------
Switch covered family member under  4B, 4C, 4D, 4F, 4G, 4H.
 a self plus one enrollment.
------------------------------------------------------------------------
   For Employees Not Participating in Premium Conversion (decreases in
                enrollment type are allowed at any time)
------------------------------------------------------------------------
Switch covered family member under  5B, 5C, 5F, 5G, 5H, 5I, 5J, 5N.
 a self plus one enrollment.
------------------------------------------------------------------------

    We are requesting comments on these amendments and on the 
implementation of the self plus one enrollment type.

Regulatory Impact Analysis

    OPM has examined the impact of this proposed rule as required by 
Executive Order 12866 and Executive Order 13563, which directs agencies 
to assess all costs and benefits of available regulatory alternatives 
and, if regulation is necessary, to select regulatory approaches that 
maximize net benefits (including potential economic, environmental, 
public, health, and safety effects, distributive impacts, and equity). 
A regulatory impact analysis must be prepared for major rules that may 
have economically significant effects (i.e., effects of $100 million or 
more in at least one year). Given that there are approximately 8.2 
million members participating in the FEHB Program and participation 
involves hundreds of dollars per member per month, we cannot rule out 
the possibility that this proposed rule's changes to the FEHB Program 
will have effects that meet the threshold for economic significance. 
However, we do expect the overall federal budget impact of this 
proposed rule to be net neutral.
    The new enrollment tier will align the FEHB Program with the 
commercial market and serve to spread costs across different enrollment 
types; in other words, it will shift costs among program participants. 
Under OPM's policies, current enrollees with Self and Family coverage 
who only have one dependent are expected to have lower premiums under 
the new enrollment tier, while those with more than one dependent are 
expected to have higher premiums. A large percentage of annuitants who 
currently have Self and Family coverage would likely benefit from a 
Self-Plus One premium tier, resulting in mandatory savings to the 
government because the government share of annuitant premiums will 
decrease. As enrollees shift from Self and Family enrollments, OPM will 
closely monitor the effect on premiums for those remaining in that 
enrollment type. If premiums for active employees with more than one 
covered family member rise, there will be increasing costs to the 
government (assuming appropriation of necessary funds).\2\
---------------------------------------------------------------------------

    \2\ United States Office of Personnel Management, Congressional 
Budget Justification Performance Budget, Fiscal Year 2014, Submitted 
April 2013, available at https://www.opm.gov/about-us/budget-performance/budgets/congressional-budget-justification-fy2014.pdf. 
See also Congressional Budget Office, Cost Estimate, Bipartisan 
Budget Act of 2013, dated December 11, 2013, available at http://www.cbo.gov/sites/default/files/cbofiles/attachments/Bipartisan%20Budget%20Act% 20of%202013.pdf.
---------------------------------------------------------------------------

    The impact of this proposed rule hinges upon the relative premiums 
for self plus one and self and family insurance options. Because the 
self and family option includes coverage for a larger number of people, 
a natural assumption would be that premiums (both the portion paid by 
the

[[Page 71697]]

government and the portion paid by the federal employee or annuitant) 
would be lower with self plus one enrollment than with self and family 
enrollment. In that case, several rule-induced outcomes are likely:
     Federal employees and annuitants who, in the absence of 
the rule, would choose self and family enrollment for themselves and 
either a spouse or a child would switch to self-plus-one enrollment, 
resulting in lower premium payments for both the employees and 
annuitants and the federal government.
     Federal employees and annuitants choosing self and family 
enrollment for themselves and at least two family members would 
experience an increase in premiums and therefore, in some cases, may 
choose to switch from FEHB to an alternative health insurance option. 
If all such families continued with FEHB participation, the government 
would experience an increase in premium payments that would (in theory) 
exactly offset the decreases associated with two-person families 
switching from self and family to self plus one enrollment; however, 
any switching away from FEHB would mitigate the premium increases 
experienced by the federal government, instead potentially leading to 
payment increases by any contributors to the newly-chosen insurance 
options (an obvious example would be the employer of a federal 
employee's or annuitant's spouse if that employer sponsors the newly-
chosen insurance).
     Federal employees and annuitants who, in the absence of 
the rule, would choose self only enrollment in spite of having a spouse 
or child who would be eligible for coverage under self and family 
enrollment may choose self plus one enrollment. For example, this 
outcome might occur if a self and family premium is greater than the 
combined premiums for a federal employee's self only enrollment and a 
spouse's self only enrollment in health insurance through his or her 
own employer, but the relevant FEHB self plus one premium is less than 
the combined premiums.\3\ In this type of scenario in which the federal 
employee's or annuitant's enrollment increases, the federal government 
would pay more in premiums (relative to a baseline in which this rule 
is not finalized) but the federal employee's or annuitant's family 
would pay less. Any contributors to the insurance in which the family 
member would be enrolled in the absence of the rule--such as the 
employer of the federal employee's spouse in the preceding example--
would also pay less.
---------------------------------------------------------------------------

    \3\ Similarly, federal employees and annuitants who, in the 
absence of the rule, would choose not to participate in the FEHB 
Program may choose self plus one enrollment. For example, this 
outcome might occur if a federal employee's spouse has access to 
health insurance with a family or plus-one premium that is less than 
the combined premiums for the federal employee's self only 
enrollment and the spouse's self only enrollment, but the relevant 
FEHB self plus one premium is even further below the combined 
premiums than the family or plus-one premium through the spouse's 
employer.
---------------------------------------------------------------------------

    The premium payments newly made by the entities listed above are 
appropriately categorized as costs to society if rule-induced changes 
in health insurance enrollment would be associated with providing 
additional or higher-quality medical services to affected individuals. 
These costs would presumably be associated with health and longevity 
benefits. Analogously, overall reductions in premium payments are 
appropriately categorized as cost savings for society if rule-induced 
changes in health insurance enrollment would be associated with 
providing lower amounts or quality of medical services. These cost 
savings would presumably be associated with reductions in health and 
longevity. To the extent that new patterns of enrollment do not change 
how society uses its resources, then effects described above would be 
transfers between members of society, rather than social costs or 
benefits.
    We lack data with which to quantify rule-induced costs, transfers 
or public health benefits. We therefore request comments on any of this 
proposed rule's impacts.

Regulatory Flexibility Act

    I propose to certify that this regulation will not have a 
significant economic impact on a substantial number of small entities 
because the regulation only adds a self plus one enrollment tier to the 
current self only and self and family enrollment tiers under FEHB.

Executive Orders 13563 and 12866, Regulatory Review

    This rule has been reviewed by the Office of Management and Budget 
in accordance with Executive Orders 13563 and 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 890 and 892

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

U.S. Office of Personnel Management.
Katherine Archuleta,
Director.
    Accordingly, OPM proposes to amend 5 CFR parts 890 and 892 as 
follows:

PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM

0
1. The authority citation for part 890 continues to read as follows:

    Authority: 5 U.S.C. 8913; Sec. 890.301 also issued under sec. 
311 of Pub. L. 111-03, 123 Stat. 64; Sec. 890.111 also issued under 
section 1622(b) of Pub. L. 104-106, 110 Stat. 521; Sec. 890.112 also 
issued under section 1 of Pub. L. 110-279, 122 Stat. 2604; 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; Pub. 
L. 111-148, as amended by Pub. L. 111-152.

0
2. Amend Sec.  890.101 by:
0
a. Revising the definitions of ``Change the enrollment'' and ``Covered 
family member''; and
0
b. Adding the definitions of ``Decrease enrollment type,'' ``Increase 
enrollment type,'' ``Self and family enrollment,'' ``Self only 
enrollment,'' and ``Self plus one enrollment'' in alphabetical order.
    The revisions and additions read as follows:


Sec.  890.101  Definitions; time computations.

* * * * *
    Change the enrollment means to submit to the employing office an 
appropriate request electing a change of enrollment to a different plan 
or option, or to a different type of coverage (self only, self plus 
one, or self and family).
* * * * *
    Covered family member means a member of the family of an enrollee 
with a self plus one or self and family enrollment who meets the 
requirements of Sec.  890.302, Sec.  890.804, or Sec.  890.1106(a), as 
appropriate to the type of enrollee.
    Decrease enrollment type means a change in enrollment from self and 
family to self plus one or to self only or a change from self plus one 
to self only.
* * * * *
    Increase enrollment type means a change in enrollment from self 
only to

[[Page 71698]]

self plus one or to self and family or a change from self plus one to 
self and family.
* * * * *
    Self and family enrollment means an enrollment that covers the 
enrollee and all eligible family members.
    Self only enrollment means an enrollment that covers only the 
enrollee.
    Self plus one enrollment means an enrollment that covers the 
enrollee and one eligible family member.
* * * * *
0
3. Amend Sec.  890.201 by revising (a)(6) to read as follows:


Sec.  890.201  Minimum standards for health benefits plans.

    (a) * * *
    (6) Provide a standard rate structure that contains, for each 
option, one standard self only rate, one standard self plus one rate 
and one standard self and family rate.
* * * * *
0
4. Amend Sec.  890.301 by revising paragraphs (e), (f)(3), (g)(1) and 
(3), (h) introductory text, (i) introductory text and (i)(1), and (m) 
to read as follows:


Sec.  890.301  Opportunities for employees who are not participants in 
premium conversion to enroll or change enrollment; effective dates.

* * * * *
    (e) Decreasing enrollment type. (1) Subject to two exceptions, an 
employee may decrease enrollment type at any time. Exceptions:
    (i) An employee participating in health insurance premium 
conversion may decrease enrollment type during an open season or 
because of and consistent with a qualifying life event as defined in 
part 892 of this chapter.
    (ii) An employee who is subject to a court or administrative order 
as discussed in Sec.  890.301(g)(3) may not decrease enrollment type in 
a way that eliminates coverage of a child identified in the order as 
long as the court or administrative order is still in effect and the 
employee has at least one child identified in the order who is still 
eligible under the FEHB Program, unless the employee provides 
documentation to the agency that he or she has other coverage for the 
child(ren). The employee may not elect self only as long as he or she 
has one child identified as covered, but may elect self plus one.
    (2) A decrease in enrollment type takes effect on the first day of 
the first pay period that begins after the date the employing office 
receives an appropriate request to change the enrollment, except that 
at the request of the enrollee and upon a showing satisfactory to the 
employing office that there was no family member eligible for coverage 
under the self plus one or self and family enrollment, or only one 
family member eligible for coverage under the self and family 
enrollment, as appropriate, the employing office may make the change 
effective on the first day of the pay period following the one in which 
there was, in the case of a self plus one enrollment, no family member 
or, in the case of a self only enrollment, only one or no family 
member.
    (f) * * *
    (3) With one exception, during an open season, an eligible employee 
may enroll and an enrolled employee may decrease or increase enrollment 
type, may change from one plan or option to another, or may make any 
combination of these changes. Exception: An employee who is subject to 
a court or administrative order as discussed in Sec.  890.301(g)(3) may 
not cancel his or her enrollment, decrease enrollment type, or change 
to a comprehensive medical plan that does not serve the area where his 
or her child or children live as long as the court or administrative 
order is still in effect, and the employee has at least one child 
identified in the order who is still eligible under the FEHB Program, 
unless the employee provides documentation to the agency that he or she 
has other coverage for the child(ren). The employee may not elect self 
only as long as he or she has one child identified as covered, but may 
elect self plus one.
* * * * *
    (g) Change in family status. (1) An eligible employee may enroll 
and an enrolled employee may decrease or increase enrollment type, 
change from one plan or option to another, or make any combination of 
these changes when the employee's family status changes, including a 
change in marital status or any other change in family status. The 
employee must enroll or change the enrollment within the period 
beginning 31 days before the date of the change in family status, and 
ending 60 days after the date of the change in family status.
* * * * *
    (3)(i) If an employing office receives a court or administrative 
order on or after October 30, 2000, requiring an employee to provide 
health benefits for his or her child or children, the employing office 
will determine if the employee has a self plus one or self and family 
enrollment, as appropriate, in a health benefits plan that provides 
full benefits in the area where the child or children live. If the 
employee does not have the required enrollment, the agency must notify 
him or her that it has received the court or administrative order and 
give the employee until the end of the following pay period to change 
his or her enrollment or provide documentation to the employing office 
that he or she has other coverage for the child or children. If the 
employee does not comply within these time frames, the employing office 
must enroll the employee involuntarily as stated in paragraph 
(g)(3)(ii) of this section.
    (ii) If the employee is not enrolled or does not enroll, the agency 
must enroll him or her for self plus one or self and family coverage, 
as appropriate, in the option that provides the lower level of coverage 
in the Service Benefit Plan. If the employee is enrolled but does not 
increase the enrollment type in a way that is sufficient to cover the 
child or children, the employing office must change the enrollment to 
self plus one or self and family, as appropriate, in the same option 
and plan, as long as the plan provides full benefits in the area where 
the child or children live. If the employee is enrolled in a 
comprehensive medical plan that does not serve the area in which the 
child or children live, the employing office must change the enrollment 
to self plus one or self and family, as appropriate, in the option that 
provides the lower level of coverage in the Service Benefit Plan.
* * * * *
    (h) Change in employment status. An eligible employee may enroll 
and an enrolled employee may decrease or increase enrollment type, 
change from one plan or option to another, or make any combination of 
these changes when the employee's employment status changes. Except as 
otherwise provided, an employee must enroll or change the enrollment 
within 60 days after the change in employment status. Employment status 
changes include, but are not limited to--
* * * * *
    (i) Loss of coverage under this part or under another group 
insurance plan. An eligible employee may enroll and an enrolled 
employee may decrease or increase enrollment type, change from one plan 
or option to another, or make any combination of these changes when the 
employee or an eligible family member of the employee loses coverage 
under this part or another group health benefits plan. Except as 
otherwise provided, an employee must enroll or change the enrollment 
within the period beginning 31 days before the date of loss of 
coverage, and ending 60 days after the date of loss of coverage. Losses 
of coverage include, but are not limited to--
    (1) Loss of coverage under another FEHB enrollment due to the

[[Page 71699]]

termination, cancellation, or a change to self plus one or to self 
only, of the covering enrollment.
* * * * *
    (m) An employee or eligible family member becomes eligible for 
premium assistance under Medicaid or a State Children's Health 
Insurance Program (CHIP). An eligible employee may enroll and an 
enrolled employee may decrease or increase enrollment type, change from 
one plan or option to another, or make any combination of these changes 
when the employee or an eligible family member of the employee becomes 
eligible for premium assistance under a Medicaid plan or CHIP. An 
employee must enroll or change his or her enrollment within 60 days 
after the date the employee or family member is determined to be 
eligible for assistance.
0
5. Amend Sec.  890.302 by revising paragraphs (a)(1), (a)(2)(ii), and 
(c) introductory text and adding paragraph (f) to read as follows:


Sec.  890.302  Coverage of family members.

    (a)(1) An enrollment for self plus one includes the enrollee and 
one eligible family member. An enrollment for self and family includes 
all family members who are eligible to be covered by the enrollment. 
Except as provided in paragraph (a)(2) of this section, no employee, 
former employee, annuitant, child, or former spouse may enroll or be 
covered as a family member if he or she is already covered under 
another person's self plus one or self and family enrollment in the 
FEHB Program.
    (2) * * *
    (ii) Exception. An individual described in paragraph (a)(2)(i) of 
this section may enroll if he or she or his or her eligible family 
members would otherwise not have access to coverage, in which case the 
individual may enroll in his or her own right for self only, self plus 
one, or self and family coverage, as appropriate. However, an eligible 
individual is entitled to receive benefits under only one enrollment 
regardless of whether he or she qualifies as a family member under a 
spouse's or parent's enrollment. To ensure that no person receives 
benefits under more than one enrollment, each enrollee must promptly 
notify the insurance carrier as to which person(s) will be covered 
under his or her enrollment. These individuals are not covered under 
the other enrollment. Examples include but are not limited to:
    (A) To protect the interests of married or legally separated 
Federal employees, annuitants, and their children, an employee or 
annuitant may enroll in his or her own right in a self only, self plus 
one, or self and family enrollment, as appropriate, even though his or 
her spouse also has a self plus one or self and family enrollment if 
the employee, annuitant, or his or her children live apart from the 
spouse and would otherwise not have access to coverage due to a service 
area restriction and the spouse refuses to change health plans.
    (B) When an employee who is under age 26 and covered under a 
parent's self plus one or self and family enrollment acquires an 
eligible family member, the employee may elect to enroll for self plus 
one or self and family coverage.
* * * * *
    (c) Child incapable of self-support. When an individual's 
enrollment for self plus one or self and family includes a child who 
has become 26 years of age and is incapable of self-support, the 
employing office must require such enrollee to submit a physician's 
certificate verifying the child's disability. The certificate must--
* * * * *
    (f) Switching a covered family member. An enrollee with a self plus 
one enrollment may switch his or her covered family member during the 
annual Open Season, upon a change in family status, upon a change in 
coverage, or upon a change in eligibility, so long as switching a 
covered family member is consistent with the event that has taken 
place.
0
6. Amend Sec.  890.303 by revising paragraphs (c), (d)(2)(ii), and the 
paragraph heading to (d)(3) to read as follows:


Sec.  890.303  Continuation of enrollment.

* * * * *
    (c) On death. (1) The enrollment of a deceased employee or 
annuitant who is enrolled for self plus one or self and family (as 
opposed to self only) is transferred automatically to his or her 
eligible survivor annuitant(s) covered by the enrollment, as 
applicable. For self and family, the enrollment is considered to be 
that of:
    (i) The survivor annuitant from whose annuity all or the greatest 
portion of the withholding for health benefits is made; or
    (ii) The surviving spouse entitled to a basic employee death 
benefit.
    (2) The enrollment covers members of the family of the deceased 
employee or annuitant. In those instances in which the annuity is split 
among surviving family members, multiple enrollments are allowed. A 
remarried spouse is not a member of the family of the deceased employee 
or annuitant unless annuity under section 8341 or 8442 of title 5, 
United States Code, continues after remarriage.
    (d) * * *
    (2) * * *
    (ii) If the surviving spouse of a deceased employee or annuitant is 
enrolled as an employee with a self plus one or self and family 
enrollment (or, if both the decedent and the surviving spouse were 
enrolled in a self only or self plus one enrollment) at the time the 
surviving spouse becomes a survivor annuitant and the surviving spouse 
is thereafter separated without entitlement to continued enrollment as 
a retiree, the surviving spouse is entitled to enroll as a survivor 
annuitant. The change from coverage as an employee to coverage as a 
survivor annuitant must be made within 30 days of separation from 
service.
* * * * *
    (3) Insurable interest survivor annuity.
* * * * *
0
7. Amend Sec.  890.306 by revising paragraphs (e), (f)(1)(i), (g)(1), 
(l) introductory text, (l)(1), (n), and (r) as follows:


Sec.  890.306  When can annuitants or survivor annuitants change 
enrollment or reenroll and what are the effective dates?

* * * * *
    (e) Decreasing enrollment type. (1) With one exception, an 
annuitant may decrease enrollment type at any time. Exception: An 
annuitant who, as an employee, was subject to a court or administrative 
order as discussed in Sec.  890.301(g)(3) at the time he or she retired 
may not, after retirement, decrease enrollment type in a way that 
eliminates coverage of a child identified in the order as long as the 
court or administrative order is still in effect and the annuitant has 
at least one child identified in the order who is still eligible under 
the FEHB Program, unless the annuitant provides documentation to the 
retirement system that he or she has other coverage for the child or 
children. The annuitant may not elect self only as long as he or she 
has one child identified as covered, but may elect self plus one.
    (2) A decrease in enrollment type takes effect on the first day of 
the first pay period that begins after the date the employing office 
receives an appropriate request to change the enrollment, except that 
at the request of the annuitant and upon a showing satisfactory to the 
employing office that there was no family member eligible for coverage 
under the self plus one or self and family enrollment, or only one 
family member eligible for coverage under the self and family 
enrollment, as appropriate, the employing office may make the change 
effective on the first day of the pay period following the one

[[Page 71700]]

in which there was, in the case of a self plus one enrollment, no 
family member or, in the case of a self and family enrollment, only one 
or no family member.
    (f) * * *
    (1) * * *
    (i) With one exception, an enrolled annuitant may decrease or 
increase enrollment type, may change from one plan or option to 
another, or may make any combination of these changes. Exception: An 
annuitant who, as an employee, was subject to a court or administrative 
order as discussed in Sec.  890.301(g)(3) at the time he or she retired 
may not cancel or suspend his or her enrollment, decrease enrollment 
type, in a way that eliminates coverage of a child identified in the 
order or change to a comprehensive medical plan that does not serve the 
area where his or her child or children live after retirement as long 
as the court or administrative order is still in effect and the 
annuitant has at least one child identified in the order who is still 
eligible under the FEHB Program, unless the annuitant provides 
documentation to the retirement system that he or she has other 
coverage for the child or children. The annuitant may not elect self 
only as long as he or she has one child identified as covered, but may 
elect self plus one.
* * * * *
    (g) Change in family status. (1) An enrolled former employee in 
receipt of an annuity may decrease or increase enrollment type, change 
from one plan or option to another, or make any combination of these 
changes when the annuitant's family status changes, including a change 
in marital status or any other change in family status. In the case of 
an enrolled survivor annuitant, a change in family status based on 
additional family members occurs only if the additional family members 
are family members of the deceased employee or annuitant. The annuitant 
must change the enrollment within the period beginning 31 days before 
the date of the change in family status, and ending 60 days after the 
date of the change in family status.
* * * * *
    (l) Loss of coverage under this part or under another group 
insurance plan. An annuitant who meets the requirements of paragraph 
(a) of this section, and who is not enrolled but is covered by another 
enrollment under this part may continue coverage by enrolling in his or 
her own name when the annuitant loses coverage under the other 
enrollment under this part. An enrolled annuitant may decrease or 
increase enrollment type, change from one plan or option to another, or 
make any combination of these changes when the annuitant or an eligible 
family member of the annuitant loses coverage under this part or under 
another group health benefits plan. Except as otherwise provided, an 
annuitant must enroll or change the enrollment within the period 
beginning 31 days before the date of loss of coverage and ending 60 
days after the date of loss of coverage. Losses of coverage include, 
but are not limited to--
    (1) Loss of coverage under another FEHB enrollment due to the 
termination, cancellation, or a change to self plus one or self only, 
of the covering enrollment;
* * * * *
    (n) Overseas post of duty. An annuitant may decrease or increase 
enrollment type, change from one plan or option to another, or make any 
combination of these changes within 60 days after the retirement or 
death of the employee on whose service title to annuity is based, if 
the employee was stationed at a post of duty outside a State of the 
United States or the District of Columbia at the time of retirement or 
death.
* * * * *
    (r) Sole survivor. When an employee or annuitant enrolled for self 
plus one or self and family dies, leaving a survivor annuitant who is 
entitled to continue the enrollment, and it is apparent from available 
records that the survivor annuitant is the sole survivor entitled to 
continue the enrollment, the office of the retirement system which is 
acting as employing office must change the enrollment from self plus 
one or self and family to self only, effective on the commencing date 
of the survivor annuity. On request of the survivor annuitant made 
within 31 days after the first installment of annuity is paid, the 
office of the retirement system which is acting as employing office 
must rescind the action retroactive to the effective date of the change 
to self only, with corresponding adjustment in withholdings and 
contributions.
* * * * *
0
8. Amend Sec.  890.401 by revising paragraph (a)(1) to read as follows:


Sec.  890.401  Temporary extension of coverage and conversion.

    (a) Thirty-one day extension and conversion. (1) An enrollee whose 
enrollment is terminated other than by cancellation of the enrollment 
or discontinuance of the plan, in whole or part, and a covered family 
member whose coverage is terminated other than by cancellation of the 
enrollment or discontinuance of the plan, in whole or in part, is 
entitled to a 31-day extension of coverage for self only, self plus 
one, or self and family, as the case may be, without contributions by 
the enrollee or the Government, during which period he or she is 
entitled to exercise the right of conversion provided for by this part. 
The 31-day extension of coverage and the right of conversion for any 
person ends on the effective date of a new enrollment under this part 
covering the person.
* * * * *
0
9. Amend Sec.  890.501 by revising paragraph (b) introductory text, 
(b)(2)(i), and (b)(3) to read as follows:


Sec.  890.501  Government contributions.

* * * * *
    (b) In accordance with the provisions of 5 U.S.C. 8906(a) which 
take effect with the contract year that begins in January 1999, OPM 
will determine the amounts representing the weighted average of 
subscription charges in effect for each contract year, for self only, 
self plus one, and self and family enrollments, as follows:
* * * * *
    (2)* * *
    (i) When a subscription charge for an upcoming contract year 
applies to a plan that is the result of a merger of two or more plans 
which contract separately with OPM during the determination year, or 
applies to a plan which will cease to offer two benefits options, OPM 
will combine the self only enrollments, the self plus one enrollments, 
and the self and family enrollments from the merging plans, or from a 
plan's benefits options, for purposes of weighting subscription charges 
in effect for the successor plan for the upcoming contract year.
* * * * *
    (3) After OPM weights each subscription charge as provided in 
paragraph (b)(2) of this section, OPM will compute the total of 
subscription charges associated with self only enrollments, self plus 
one enrollments, and self and family enrollments, respectively. OPM 
will divide each subscription charge total by the total number of 
enrollments such amount represents to obtain the program-wide weighted 
average subscription charges for self only and for self plus one and 
self and family enrollments, respectively.
* * * * *
0
10. Amend Sec.  890.804 by revising paragraph (a) to read as follows:

[[Page 71701]]

Sec.  890.804  Coverage.

    (a) Type of enrollment. A former spouse who meets the requirements 
of Sec.  890.803 may elect coverage for self only, self plus one, or 
self and family. A self and family enrollment covers only the former 
spouse and all eligible children of both the former spouse and the 
employee, former employee, or employee annuitant, provided such 
children are not otherwise covered by a health plan under this part. A 
self plus one enrollment covers only the former spouse and one eligible 
child of both the former spouse and the employee, former employee, or 
employee annuitant, provided the child is not otherwise covered by a 
health plan under this part. A child must be under age 26 or incapable 
of self-support because of a mental or physical disability existing 
before age 26. No person may be covered by two enrollments.
* * * * *
0
11. Amend Sec.  890.806 by revising paragraphs (e), (f)(1)(i), (g)(1), 
(j) introductory text, and (j)(1) to read as follows:


Sec.  890.806  When can former spouses change enrollment or reenroll 
and what are the effective dates?

* * * * *
    (e) Decreasing enrollment type. (1) A former spouse may decrease 
enrollment type at any time.
    (2) A decrease in enrollment type takes effect on the first day of 
the first pay period that begins after the date the employing office 
receives an appropriate request to change the enrollment, except that 
at the request of the former spouse and upon a showing satisfactory to 
the employing office that there was no family member eligible for 
coverage under the self plus one or self and family enrollment, or only 
one family member eligible for coverage under the self and family 
enrollment, as appropriate, the employing office may make the change 
effective on the first day of the pay period following the one in which 
there was, in the case of a self plus one enrollment, no family member 
or, in the case of a self and family enrollment, only one or no family 
member.
    (f) * * *
    (i) An enrolled former spouse may decrease enrollment type, 
increase enrollment type provided the family member(s) to be covered 
under the enrollment is eligible for coverage under Sec.  890.804, 
change from one plan or option to another, or make any combination of 
these changes.
* * * * *
    (g) Change in family status. (1) An enrolled former spouse may 
increase enrollment type, change from one plan or option to another, or 
make any combination of these changes within the period beginning 31 
days before and ending 60 days after the birth or acquisition of a 
child who meets the eligibility requirements of Sec.  890.804.
* * * * *
    (j) Loss of coverage under this part or under another group 
insurance plan. An enrolled former spouse may decrease or increase 
enrollment type, change from one plan or option to another or make any 
combination of these changes when the former spouse or a child who 
meets the eligibility requirements under Sec.  890.804 loses coverage 
under another enrollment under this part or under another group health 
benefits plan. Except as otherwise provided, the former spouse must 
change the enrollment within the period beginning 31 days before the 
date of loss of coverage and ending 60 days after the date of loss of 
coverage, provided he or she continues to meet the eligibility 
requirements under Sec.  890.803. Losses of coverage include but are 
not limited to--
    (1) Loss of coverage under another FEHB enrollment due to the 
termination, cancellation, or a change to self plus one or self only, 
of the covering enrollment;
* * * * *
0
12. Amend Sec.  890.1103 by revising paragraphs (a)(2) and (3) to read 
as follows:


Sec.  890.1103  Eligibility.

    (a) * * *
    (2) Individuals whose coverage as children under the self plus one 
or self and family enrollment of an employee, former employee, or 
annuitant ends because they cease meeting the requirements for being 
considered covered family members. For the purpose of this section, 
children who are enrolled under this part as survivors of deceased 
employees or annuitants are considered to be children under a self plus 
one or self and family enrollment of an employee or annuitant at the 
time of the qualifying event.
    (3) Former spouses of employees, of former employees having 
continued self plus one or self and family coverage under this subpart, 
or of annuitants, if the former spouse would be eligible for continued 
coverage under subpart H of this part except for failure to meet the 
requirement of Sec.  890.803(a)(1) or Sec.  890.803(a)(3) of this part 
or the documentation requirements of Sec.  890.806(a) of this part, 
including former spouses who lose eligibility under subpart H within 36 
months after termination of the marriage because they ceased meeting 
the requirement of Sec.  890.803(a)(1) or Sec.  890.803(a)(3) of this 
part.
* * * * *
0
13. Amend Sec.  890.1106 by revising paragraph (a) introductory text to 
read as follows:


Sec.  890.1106  Coverage.

    (a) Type of enrollment. An individual who enrolls under this 
subpart may elect coverage for self only, self plus one, or self and 
family.
* * * * *
0
14. Amend Sec.  890.1108 by revising paragraphs (d), (e)(1), (f)(1) and 
(2), (h) introductory text, and (h)(1) to read as follows:


Sec.  890.1108  Opportunities to change enrollment; effective dates.

* * * * *
    (d) Decreasing enrollment type. (1) An enrollee may decrease 
enrollment type at any time.
    (2) A decrease in enrollment type takes effect on the first day of 
the first pay period that begins after the date the employing office 
receives an appropriate request to change the enrollment, except that 
at the request of the enrollee and upon a showing satisfactory to the 
employing office that there was no family member eligible for coverage 
under the self plus one or self and family enrollment, or only one 
family member eligible for coverage under the self and family 
enrollment, as appropriate, the employing office may make the change 
effective on the first day of the pay period following the one in which 
there was, in the case of a self plus one enrollment, no family member 
or, in the case of a self and family enrollment, only one or no family 
member.
    (e) Open season. (1) During an open season as provided by Sec.  
890.301(f), an enrollee (except for a former spouse who is eligible for 
continued coverage under Sec.  890.1103(a)(3)) may decrease or increase 
enrollment type, change from one plan or option to another, or make any 
combination of these changes. A former spouse who is eligible for 
continued coverage under Sec.  890.1103(a)(3) may change from one plan 
or option to another, but may not change from self only to self plus 
one or self and family unless the individual to be covered under the 
self plus one or self and family enrollment qualifies as a family 
member under Sec.  890.1106(a)(2).
* * * * *
    (f) Change in family status. (1) Except for a former spouse, an 
enrollee may decrease or increase enrollment type, change from one plan 
or option to

[[Page 71702]]

another, or make any combination of these changes when the enrollee's 
family status changes, including a change in marital status or any 
other change in family status. The enrollee must change the enrollment 
within the period beginning 31 days before the date of the change in 
family status, and ending 60 days after the date of the change in 
family status.
    (2) A former spouse who is covered under this section may increase 
enrollment type, change from one plan or option to another, or make any 
combination of these changes within the period beginning 31 days before 
and ending 60 days after the birth or acquisition of a child who 
qualifies as a covered family member under Sec.  890.1106(a)(2).
* * * * *
    (h) Loss of coverage under this part or under another group 
insurance plan. An enrollee may decrease or increase enrollment type, 
change from one plan or option to another, or make any combination of 
these changes when the enrollee loses coverage under this part or a 
qualified family member of the enrollee loses coverage under this part 
or under another group health benefits plan. Except as otherwise 
provided, an enrollee must change the enrollment within the period 
beginning 31 days before the date of loss of coverage and ending 60 
days after the date of loss of coverage. Losses of coverage include, 
but are not limited to--
    (1) Loss of coverage under another FEHB enrollment due to the 
termination, cancellation, or change to self plus one or to self only, 
of the covering enrollment.
* * * * *
0
15. Amend Sec.  890.1202 by revising the definition of ``Covered family 
members'' to read as follows:


Sec.  890.1202  Definitions.

* * * * *
    Covered family members as it applies to individuals covered under 
this subpart has the same meaning as set forth in Sec.  890.101(a). For 
eligible survivors of individuals enrolled under this subpart, a self 
plus one enrollment covers only the survivor or former spouse and one 
eligible child of both the survivor or former spouse and hostage. A 
self and family enrollment covers only the survivor or former spouse 
and any eligible children of both the survivor or former spouse and 
hostage.
* * * * *
0
16. Amend Sec.  890.1203 by revising paragraph (b) to read as follows:


Sec.  890.1203  Coverage.

* * * * *
    (b) An individual who is covered under this subpart is covered 
under the Standard Option of the Service Benefit Plan. The individual 
has a self and family enrollment unless the U.S. Department of State 
determines that the individual is married and has no eligible children, 
or is unmarried and has one eligible child, in which case the 
individual is covered under a self plus one enrollment, or unless the 
U.S. Department of State determines that the individual is unmarried 
and has no eligible children, in which case the individual has a self 
only enrollment.
* * * * *
0
17. Amend Sec.  890.1205 by revising paragraphs (a) and (b) to read as 
follows:


Sec.  890.1205  Change in type of enrollment.

    (a) Individuals covered under this subpart or eligible survivors 
enrolled under this subpart may increase enrollment type if they 
acquire an eligible family member. The change may be made at the 
written request of the enrollee at any time after the family member is 
acquired. An increase in enrollment type under this paragraph becomes 
effective on the 1st day of the pay period after the pay period during 
which the request is received by the U.S. Department of State, except 
that a change based on the birth or addition of a child as a new family 
member is effective on the 1st day of the pay period during which the 
child is born or otherwise becomes a new family member.
    (b) Individuals covered under this subpart or eligible survivors 
enrolled under this subpart may decrease enrollment type from a self 
and family enrollment when the last eligible family member (other than 
the enrollee) ceases to be a family member or only one family member 
remains; and may decrease enrollment type from a self plus one 
enrollment when no family member remains. The change may be made at the 
written request of the enrollee at any time after the last family 
member is lost and it becomes effective on the 1st day of the pay 
period after the pay period during which the request is received by the 
U.S. Department of State.
* * * * *
0
18. Amend Sec.  890.1209 by revising paragraph (c) to read as follows:


Sec.  890.1209  Responsibilities of the U.S. Department of State.

* * * * *
    (c) The U.S. Department of State must determine the number of 
eligible family members, if any, for the purpose of coverage under a 
self only, self plus one, or self and family enrollment as set forth in 
Sec.  890.1203(b). If the number of eligible family members of the 
individual cannot be determined, the U.S. Department of State must 
enroll the individual for self and family coverage.

PART 892--FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH 
BENEFITS PREMIUMS

0
19. The authority citation for part 892 is revised to read as follows:

    Authority: 5 U.S.C. 8913; 5 U.S.C. 1103(a)(7); 26 U.S.C. 125.

0
20. Amend Sec.  892.101 by revising paragraphs (9) and (13) in the 
definition of ``Qualifying life event'' to read as follows:


Sec.  892.101  Definitions.

* * * * *
    Qualifying life event.* * *
    (9) An employee becomes entitled to Medicare. (For change to self 
only, self plus one, cancellation, or change in premium conversion 
status see Sec.  892.101 (11)).
* * * * *
    (13) An employee or eligible family member becomes eligible for 
premium assistance under Medicaid or a State Children's Health 
Insurance Program (CHIP). An eligible employee may enroll and an 
enrolled employee may decrease or increase enrollment type, change from 
one plan or option to another, or make any combination of these changes 
when the employee or an eligible family member of the employee becomes 
eligible for premium assistance under a Medicaid plan or a State 
Children's Health Insurance Program. An employee must enroll or change 
his or her enrollment within 60 days after the date the employee or 
family member is determined to be eligible for assistance.
0
21. Amend Sec.  892.207 by revising paragraph (b) to read as follows:


Sec.  892.207  Can I make changes to my FEHB enrollment while I am 
participating in premium conversion?

* * * * *
    (b) However, if you are participating in premium conversion there 
are two exceptions: you must have a qualifying life event to decrease 
enrollment type or to cancel FEHB coverage entirely. (See Sec. Sec.  
892.209 and 892.210.) Your change in enrollment must be consistent with 
and correspond to your qualifying life event as described in Sec.  
892.101. These limitations apply only to changes you may wish to make 
outside open season.
* * * * *
0
22. Revise Sec.  892.208 to read as follows:

[[Page 71703]]

Sec.  892.208  Can I change my enrollment from self and family to self 
plus one or self only at any time?

    (a) If you are participating in premium conversion you may decrease 
your FEHB enrollment type under either of the following circumstances:
    (1) During the annual open season. A decrease in enrollment type 
made during the annual open season takes effect on the 1st day of the 
first pay period that begins in the next year.
    (2) Within 60 days after you have a qualifying life event. A 
decrease in enrollment type made because of a qualifying life event 
takes effect on the first day of the first pay period that begins after 
the date your employing office receives your appropriate request. Your 
change in enrollment must be consistent with and correspond to your 
qualifying life event. For example, if you get divorced and have no 
dependent children, changing to self only would be consistent with that 
qualifying life event. As another example, if both you and your spouse 
are Federal employees, and your youngest dependent turns age 26, 
changing from a self and family to a self plus one or two self only 
enrollments would be consistent and appropriate for that event.
    (b) If you are subject to a court or administrative order as 
discussed in Sec.  890.301(g)(3) of this chapter, you may not decrease 
enrollment type in a way that eliminates coverage of a child identified 
in the order as long as the court or administrative order is still in 
effect and you have at least one child identified in the order who is 
still eligible under the FEHB Program, unless you provide documentation 
to your agency that you have other coverage for your child or children. 
See also Sec. Sec.  892.207 and 892.209. If you are subject to a court 
or administrative order as discussed in Sec.  890.301(g)(3) of this 
chapter, you may not change your enrollment to self plus one as long as 
the court or administrative order is still in effect and you have more 
than one child identified in the order who is still eligible under the 
FEHB Program, unless you provide documentation to your agency that you 
have other coverage for your children. See also Sec. Sec.  892.207 and 
892.209.

[FR Doc. 2014-28429 Filed 12-2-14; 8:45 am]
BILLING CODE 6325-63-P