Federal Employees Dental and Vision Insurance Program, 58243-58248 [E7-20193]
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58243
Rules and Regulations
Federal Register
Vol. 72, No. 198
Monday, October 15, 2007
This section of the FEDERAL REGISTER
contains regulatory documents having general
applicability and legal effect, most of which
are keyed to and codified in the Code of
Federal Regulations, which is published under
50 titles pursuant to 44 U.S.C. 1510.
The Code of Federal Regulations is sold by
the Superintendent of Documents. Prices of
new books are listed in the first FEDERAL
REGISTER issue of each week.
OFFICE OF PERSONNEL
MANAGEMENT
5 CFR Part 894
RIN 3206–AL03
Federal Employees Dental and Vision
Insurance Program
Office of Personnel
Management.
ACTION: Interim rule with request for
comments.
AGENCY:
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SUMMARY: The Office of Personnel
Management (OPM) is issuing interim
regulations to administer the Federal
Employee Dental and Vision Benefits
Enhancement Act of 2004, which was
enacted December 23, 2004. This law
establishes dental and vision benefits
programs for Federal employees,
annuitants, and their eligible family
members.
DATES: Interim rules are effective
November 14, 2007. OPM must receive
comments on or before December 14,
2007.
ADDRESSES: Send written comments to
Nataya Battle, Senior Policy Analyst,
Center for Employee and Family
Support Policy, Strategic Human
Resources Policy Division, Office of
Personnel Management, 1900 E Street,
NW., Washington, DC 20415; or deliver
to OPM, Room 3415, 1900 E Street,
NW., Washington, DC; or FAX to (202)
606–0633.
FOR FURTHER INFORMATION CONTACT:
Nataya Battle, (202) 606–1874, or e-mail
at nataya.battle@opm.gov.
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
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effective date of coverage was December
31, 2006.
Waiver of Notice of Proposed
Rulemaking
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.
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For the reasons stated in the Preamble,
OPM is adding part 894 to title 5, Code
of Federal Regulations, as follows:
I
In accordance with section
553(b)(3)(B) of title 5 of the U.S. Code,
I find that good cause exists for waiving
the general notice of proposed
rulemaking for this rule because general
notice of proposed rulemaking is
unnecessary and would be contrary to
the public interest. By law the Federal
Employees Dental and Vision Insurance
Program became effective in 2006.
Congress and the Administration
intended for the Program to be available
to enrollees as of the end of 2006, and
the rules governing the program are
effectively established in the existing
contracts that OPM has entered into
with the dental and vision carriers
pursuant to the FEDVIP law. These
interim regulations explain the program
rules to affected enrollees and the
general public, and will assist the
administration of the Program. OPM
will accept comment on these interim
rules, and will consider changes to the
Program for future years.
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U.S. Office of Personnel Management.
Linda M. Springer,
Director.
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?
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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
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§ 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 § 894.306;
(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
§ 890.302(b) of this chapter; and
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(6) An otherwise eligible child’s lose
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). General, 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
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 § 894.306).
(3) The child must be unmarried and
under age 22. A child age 22 or over is
eligible if the child is incapable of selfsupport 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
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employee additionally means an
employee of the United States Postal
Service and an employee of the District
of Columbia courts.
Enrollment reconsideration means the
carriers’ administrative 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 § 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.
§ 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. Carriers may not deny an
individual the right to enroll solely
because of a preexisting dental or vision
condition.
§ 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.
§ 894.104 Who makes enrollment
decisions and reconsiderations?
The carriers’ make enrollment
decisions and the carriers review
requests for reconsideration of an
enrollment decision. The carrier’s initial
enrollment decision denying enrollment
or an opportunity to change coverage
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must be in writing and must inform you
about your right to reconsideration.
chapter, with respect to dual
enrollments.
§ 894.105 Who may correct an error in my
enrollment?
Subpart C—Eligibility
(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).
§ 894.301
FEDVIP?
Subpart B—Coverage and Types of
Enrollment
§ 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.
§ 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.
§ 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.
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§ 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
§ 890.302 (a)(2) through (4) of this
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Am I eligible to enroll in the
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.
§ 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
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 § 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
§ 316.401 and § 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
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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 nonfull-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 parttime 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
§ 772.102 of this chapter.
§ 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 § 894.302(a) through (d), your
enrollment stops.
(b) If you have FEDVIP coverage and
you transfer to a position excluded
under § 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.
§ 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).
§ 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.
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§ 894.306 Are foster children eligible as
family members?
Yes, foster children may be eligible
for coverage as family members under
FEDVIP.
§ 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
§ 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 § 894.405.
§ 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.
Subpart E—Enrollment and Changing
Enrollment
§ 894.501
When may I enroll?
The premiums you pay shall
reasonably and equitably reflect the cost
of the benefits provided.
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.
§ 894.403 Are FEDVIP premiums paid on a
pre-tax basis?
§ 894.502 What are the Qualifying Life
Events (QLEs) that allow me to enroll?
(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.
(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.
§ 894.404 May I opt out of premium
conversion?
§ 894.504 When is my enrollment
effective?
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.
(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
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§ 894.402 Do the premiums I pay reflect
the cost of providing benefits?
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§ 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
carrier that you were not able to enroll
or change your enrollment on time for
reasons beyond your control.
(b) If the carrier allows you to make
a belated enrollment or enrollment
change, you must enroll or change
within 30 days after the carrier notifies
you of its determination.
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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.
§ 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.
§ 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 FEHB Program open season.
§ 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 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.
§ 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.
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(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 § 894.508(b).
§ 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.
§ 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 § 894.508(b).
§ 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 duty.
yshivers on PROD1PC62 with RULES
§ 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 § 894.701,
your FEDVIP coverage continues.
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(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
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
§ 894.601
stop?
When does my FEDVIP coverage
(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.
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Fmt 4700
Sfmt 4700
58247
(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.
§ 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 deployment to active
military duty. These cancellations will
become effective at the end of the pay
period that you submit your request.
§ 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
§ 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.
§ 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
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Federal Register / Vol. 72, No. 198 / Monday, October 15, 2007 / Rules and Regulations
make enrollment changes under the
same circumstances as active
employees.
ACTION:
C. Regulatory Procedures
Final rule.
The NCUA is amending its
management interlocks rule to conform
it to a change the Financial Services
Regulatory Relief Act of 2006 (FSRAA)
made in the dollar threshold that
triggers the prohibition on management
officials serving at unaffiliated
depository organizations. This final rule
changes the threshold from $20 million
to $50 million.
SUMMARY:
§ 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.
§ 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.
This rule is effective as of
October 15, 2007.
DATES:
FOR FURTHER INFORMATION CONTACT:
Annette Tapia, Staff Attorney, Office of
General Counsel, National Credit Union
Administration, 1775 Duke Street,
Alexandria, Virginia 22314–3428 or
telephone: (703) 518–6540.
SUPPLEMENTARY INFORMATION:
A. Background
(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.
The Depository Institution
Management Interlocks Act (Interlocks
Act) prohibits individuals from
simultaneously serving as a
management official at two unaffiliated
depository institutions or their holding
companies (collectively, depository
organizations) under certain
circumstances. 12 U.S.C. 3201 et seq.
Section 203(1) of the Interlocks Act
prohibits interlocks between
unaffiliated depository organizations if
each depository organization or its
affiliate has an office in the same
relevant metropolitan statistical area
(RMSA prohibition), unless each of the
depository organizations or affiliates
involved has total assets below a
specified threshold. Before enactment of
FSRRA, this asset threshold was $20
million; however, section 610 of FSRRA
amended the Interlocks Act by raising
this asset threshold to $50 million,
effective October 13, 2006.
This final rule tracks changes the
other federal financial institution
regulators have made in their
management interlocks rules. 72 FR
38753 (July 16, 2007).
[FR Doc. E7–20193 Filed 10–12–07; 8:45 am]
B. Regulatory Changes
Subpart H—Benefits in Underserved
Areas
§ 894.801 Will benefits be available in
underserved areas?
BILLING CODE 6325–39–P
NATIONAL CREDIT UNION
ADMINISTRATION
yshivers on PROD1PC62 with RULES
12 CFR Part 711
Management Official Interlocks
Threshold Change
National Credit Union
Administration (NCUA).
AGENCY:
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NCUA is amending § 711.3(b) to
implement section 610 of FSRRA.
Specifically, the final rule modifies the
RMSA prohibition to allow a
management official of one depository
organization to serve as a management
official of an unaffiliated depository
organization that has an office in the
same RMSA as the first organization if
each of the depository organizations or
affiliates involved has total assets of less
than $50 million.
PO 00000
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Fmt 4700
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Final Rule Under the Administrative
Procedure Act
Generally, the Administrative
Procedure Act (APA) requires a federal
agency to provide the public with notice
and the opportunity to comment on
agency rulemakings. The amendment in
this rule is not substantive but technical
in that it merely incorporates into
NCUA’s regulations a statutory increase
in the threshold. The APA permits an
agency to forego the notice and
comment period under certain
circumstances, such as when a
rulemaking is technical and not
substantive. For these reasons, NCUA
finds good cause that notice and public
comment are unnecessary under Section
553(b)(3)(B) of the APA, 5 U.S.C.
553(b)(3)(B), and also finds good cause
to dispense with the 30-day delayed
effective date requirement under
Section 553(d)(3) of the APA. 5 U.S.C.
553(d)(3). The rule will, therefore, be
effective upon publication.
Regulatory Flexibility Act
The Regulatory Flexibility Act
requires NCUA to prepare an analysis to
describe any significant economic
impact a rule may have on a substantial
number of small entities (those credit
unions under ten million dollars in
assets). This rule changes NCUA’s
regulation to conform to a statutory
change. This rule will not have a
significant economic impact on a
substantial number of small credit
unions, and, therefore, a regulatory
flexibility analysis is not required.
Paperwork Reduction Act
NCUA has determined that this rule
will not increase paperwork
requirements under the Paperwork
Reduction Act of 1995 and regulations
of the Office of Management and
Budget.
Executive Order 13132
Executive Order 13132 encourages
independent regulatory agencies to
consider the impact of their actions on
state and local interests. In adherence to
fundamental federalism principles,
NCUA, an independent regulatory
agency as defined in 44 U.S.C. 3502(5),
voluntarily complies with the executive
order. This rule will not have
substantial direct effects on the states,
on the relationship between the national
government and the states, or on the
distribution of power and
responsibilities among the various
levels of government. NCUA has
determined that this rule does not
constitute a policy that has federalism
E:\FR\FM\15OCR1.SGM
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]]>Agencies
[Federal Register Volume 72, Number 198 (Monday, October 15, 2007)]
[Rules and Regulations]
[Pages 58243-58248]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-20193]
========================================================================
Rules and Regulations
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains regulatory documents
having general applicability and legal effect, most of which are keyed
to and codified in the Code of Federal Regulations, which is published
under 50 titles pursuant to 44 U.S.C. 1510.
The Code of Federal Regulations is sold by the Superintendent of Documents.
Prices of new books are listed in the first FEDERAL REGISTER issue of each
week.
========================================================================
Federal Register / Vol. 72, No. 198 / Monday, October 15, 2007 /
Rules and Regulations
[[Page 58243]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 894
RIN 3206-AL03
Federal Employees Dental and Vision Insurance Program
AGENCY: Office of Personnel Management.
ACTION: Interim rule with request for comments.
-----------------------------------------------------------------------
SUMMARY: The Office of Personnel Management (OPM) is issuing interim
regulations to administer the Federal Employee Dental and Vision
Benefits Enhancement Act of 2004, which was enacted December 23, 2004.
This law establishes dental and vision benefits programs for Federal
employees, annuitants, and their eligible family members.
DATES: Interim rules are effective November 14, 2007. OPM must receive
comments on or before December 14, 2007.
ADDRESSES: Send written comments to Nataya Battle, Senior Policy
Analyst, Center for Employee and Family Support Policy, Strategic Human
Resources Policy Division, Office of Personnel Management, 1900 E
Street, NW., Washington, DC 20415; or deliver to OPM, Room 3415, 1900 E
Street, NW., Washington, DC; or FAX to (202) 606-0633.
FOR FURTHER INFORMATION CONTACT: Nataya Battle, (202) 606-1874, or e-
mail at nataya.battle@opm.gov.
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.
Waiver of Notice of Proposed Rulemaking
In accordance with section 553(b)(3)(B) of title 5 of the U.S.
Code, I find that good cause exists for waiving the general notice of
proposed rulemaking for this rule because general notice of proposed
rulemaking is unnecessary and would be contrary to the public interest.
By law the Federal Employees Dental and Vision Insurance Program became
effective in 2006. Congress and the Administration intended for the
Program to be available to enrollees as of the end of 2006, and the
rules governing the program are effectively established in the existing
contracts that OPM has entered into with the dental and vision carriers
pursuant to the FEDVIP law. These interim regulations explain the
program rules to affected enrollees and the general public, and will
assist the administration of the Program. OPM will accept comment on
these interim rules, and will consider changes to the Program for
future years.
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.
U.S. Office of Personnel Management.
Linda M. Springer,
Director.
0
For the reasons stated in the Preamble, OPM is adding part 894 to title
5, Code of Federal Regulations, 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?
[[Page 58244]]
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. 894.306;
(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 lose 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). General,
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 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. 894.306).
(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 carriers' administrative
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. Carriers 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 carriers' make enrollment decisions and the carriers review
requests for reconsideration of an enrollment decision. The carrier's
initial enrollment decision denying enrollment or an opportunity to
change coverage
[[Page 58245]]
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 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.
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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.
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 carrier that you were not able to enroll or change
your enrollment on time for reasons beyond your control.
(b) If the carrier allows you to make a belated enrollment or
enrollment change, you must enroll or change within 30 days after the
carrier 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 FEHB Program 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 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.
[[Page 58247]]
(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. 894.508(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. 894.508(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 duty.
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 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 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
[[Page 58248]]
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.
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. E7-20193 Filed 10-12-07; 8:45 am]
BILLING CODE 6325-39-P
