Federal Employees Health Benefits Program Self Plus One Enrollment Type, 55726-55739 [2015-23348]

Agencies

• Office of Personnel Management

[Federal Register Volume 80, Number 180 (Thursday, September 17, 2015)]
[Rules and Regulations]
[Pages 55726-55739]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-23348]


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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: Final rule.

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SUMMARY: The United States Office of Personnel Management (OPM) is 
issuing a final 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: This rule is effective September 17, 2015.

FOR FURTHER INFORMATION CONTACT: Chelsea Ruediger at 
Chelsea.Ruediger@opm.gov or (202) 606-0004.

SUPPLEMENTARY INFORMATION: The U.S. Office of Personnel Management 
(OPM) issued a Notice of Proposed Rulemaking on December 2, 2014 to 
amend title 5 of the Code of Federal Regulations parts 890 and 892 to 
include a self plus one enrollment type to comply with the 2013 
Bipartisan Budget Act. During the comment period on the proposed rule, 
OPM received 64 comments including 5 from Federal Employees Health 
Benefits (FEHB) Program carriers, 2 from employee organizations or 
unions, 1 from a carrier organization, and 56 from individuals, many of 
them enrollees in the FEHB Program. These comments are addressed below.

[[Page 55727]]

General Comments Regarding Self Plus One

    OPM received a variety of comments, mostly from FEHB enrollees, 
expressing excitement about the self plus one enrollment type. 
Commenters indicated that the enrollment type will benefit them 
personally and financially.
    One commenter requested justification for the implementation of the 
self plus one enrollment type and expressed concern over the level of 
complexity that this additional statutorily required enrollment type 
introduces to consumer choice in the FEHB Program. The commenter noted 
that under the current two-tier system, ``the typical enrollee . . . 
has a choice of about 20 plan options'' and projected that options 
available for families may double and premiums might vary greatly.
    OPM is updating 5 CFR parts 890 and 892 to comply with provisions 
of the 2013 Bipartisan Budget Act. This more closely aligns insurance 
offerings for Federal employees with those available in the commercial 
market and to more equitably spread costs among the enrollment types 
offered.
    OPM is aware that creation of a new enrollment tier may create 
additional complexity. However, this complexity is limited because the 
rule only introduces a new enrollment type. Benefits design will not 
differ from other enrollment types offered within the same plan option, 
which minimizes the complexity introduced by the rule. To alleviate 
potential concerns about complexity during the introductory year, Sec.  
892.207(d) has been amended in this final rule to include a one-time 
limited enrollment period to be held in early 2016. Final dates for the 
Limited Enrollment Period will be announced by OPM following the 
publication of this rule. During this period, enrollees will be allowed 
to decrease enrollment from self and family to self plus one. 
Enrollment changes made in conjunction with the limited enrollment 
period will be effective on the first day of the first pay period 
following the one in which the appropriate request is received by the 
employing office. Because enrollees who do not participate in premium 
conversion (pre-tax deduction of premiums), including annuitants, may 
decrease their enrollment at any time, this limited enrollment period 
is intended only for premium conversion participants. No new 
enrollments, changes in plan or plan option, or increases in enrollment 
will be allowed in conjunction with the limited enrollment period.
    In advance of Open Season each year, OPM, agencies and carriers 
inform employees and annuitants of their enrollment options and provide 
them with decision-making tools. Given the addition of the self plus 
one enrollment type, this communications strategy will be augmented for 
the 2015 Open Season. OPM communications will encourage enrollees to 
carefully review the options available to them for plan year 2016.
    An FEHB carrier requested clarification that ``enrollees will need 
to make a positive election through their agency or retirement office 
in order to switch from self only or self and family to self plus 
one.'' This statement is correct. Just as is the case under the current 
two-tier system, enrollees must inform their agency, either through an 
electronic or paper copy of the Standard Form 2809, when they increase 
or decrease coverage. Agencies are responsible for submitting this 
information to carriers. This requirement will be no different for self 
plus one.

Comments on Effective Dates

    Several commenters requested additional information about the 
timing of the implementation of the self plus one enrollment type. 
Others requested that OPM delay implementation by at least one year in 
order to conduct additional analysis. Another questioned the decision 
to implement the new self plus one enrollment option for plan year 
2016, as this date was not required by law.
    The effective date in this final rule has not been altered. The 
Bipartisan Budget Act was passed in 2013 and OPM has been working 
diligently to implement this statutory mandate within a reasonable 
timeframe. Enrollees who have been looking forward to this change will 
now be able to select a self plus one enrollment type during the 2015 
Open Season for effective dates in January of 2016.

Comments on Family Member Eligibility

    OPM received three comments about family member eligibility. Two 
commenters asked about the eligibility of domestic partners and 
cohabitating (unmarried) opposite sex couples. A third comment asked if 
a sibling could be covered.
    Family member eligibility is defined in title 5 U.S. Code section 
8901 and includes spouses and children up to age 26. As stated in the 
supplementary information of the proposed rule, family member 
eligibility guidelines remain the same as in place under the two tier 
system. Domestic partners, cohabitating (unmarried) couples, and 
siblings are not considered eligible family members under the law at 
this time.

Switching a Covered Family Member

    The proposed rule outlined the circumstances in which an enrollee 
with a self plus one enrollment would be allowed to switch their 
covered family member. Some commenters expressed concerns that these 
provisions might lead to adverse selection. OPM believes that adequate 
protection against adverse selection is provided in the manner in which 
Qualifying Life Events (QLEs) allowing such a change have been limited. 
Further, the general rule applies that the change must be consistent 
with the QLE experienced. The following chart, which was published with 
the proposed rule, clarifies which QLE codes will allow an enrollee to 
switch a covered family member outside of Open Season (definitions for 
each of the event codes can be found on the SF2809 at https://www.opm.gov/forms/pdf_fill/sf2809.pdf):

------------------------------------------------------------------------
                                           Permitted for the following
                 Change                            event codes
------------------------------------------------------------------------
            For Enrollees Participating in Premium Conversion
------------------------------------------------------------------------
Switch covered family member under a     1B, 1C, 1I, 1J, 1M, 1N, 1O, 1P,
 self plus one enrollment.                1Q, 1R
------------------------------------------------------------------------
  For Annuitants (decreases in enrollment type are allowed at any time)
------------------------------------------------------------------------
Switch covered family member under a     2A, 2B, 2F, 2G, 2H, 2I, 2J
 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 a     3B, 3C, 3F, 3G, 3H, 3I
 self plus one enrollment.
------------------------------------------------------------------------

[[Page 55728]]

 
    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 a     4B, 4C, 4D, 4F, 4G, 4H
 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 a     5B, 5C, 5F, 5G, 5H, 5I, 5J, 5N
 self plus one enrollment.
------------------------------------------------------------------------

    One carrier organization requested that OPM require a 30 day 
advance notice to carriers before allowing a switch in covered family 
member in order to prevent overpayments as well as verification of 
alternative health insurance for the family member being removed. OPM 
declines to make this change. It is expected that carriers will utilize 
current standard operating procedures to process the switching of a 
covered family member; generally changes are effective at the beginning 
of the next pay period after receipt by the agency.
    A commenter urged OPM to treat the switch as a cancellation for the 
family member who is being removed from the self plus one enrollment, 
thereby rendering the individual ineligible for the 31 day extension of 
coverage. Just as is the case under the two tier system, under Sec.  
890.401(a)(1) eligibility for the 31 day extension of coverage is 
provided for covered family members whose coverage is terminated other 
than by cancellation of the enrollment or discontinuance of the plan, 
in whole or in part. For family members, terminations are typically 
based on a loss of eligibility such as, in the case of a child, turning 
age 26; or, in the case of a spouse, a divorce. Cancellation is 
typically a voluntary election to no longer be covered under an FEHB 
plan, for example when a family member becomes eligible for other group 
coverage. Switching a covered family member may occur as the result of 
either a termination or a cancellation. Therefore, OPM declines to make 
this change.
    One commenter urged OPM to apply a blanket policy against 
discretionary retroactive switching of a covered family member. Section 
892.207(b) has been updated in the final rule to include switching a 
covered family member in order to accommodate this suggestion. 
Enrollment changes made under Sec.  892.207 are, in general, effective 
on the first day of the first pay period following the one in which the 
appropriate request is received by the employing office. In addition, 
paragraph (f)(2) has been added to Sec.  890.302 in the final rule to 
specify that the effective date for switching a covered family member 
will be prospective. A definition of the term ``switching a covered 
family member'' has also been added to Sec.  890.101.
    One commenter requested that OPM clarify that ``enrollees cannot 
switch the covered family member under the self plus one without a QLE 
to validate dependent eligibility.'' As described in the proposed rule, 
and supported in the final rule, enrollees must experience a QLE in 
order to switch their covered family member.
    One commenter requested additional information about how carriers 
will be notified of the designated covered family member under the self 
plus one enrollment. The Standard Form 2809 and electronic enrollment 
transmissions will be utilized just as they are currently to 
communicate enrollment information. Additionally, OPM is assessing 
other methods, including updating enrollment systems government-wide to 
allow for the transmittal of changes in the designated family member 
from agencies to carriers.
    One commenter asked that OPM require the capture of a Social 
Security Number for dependents. As this is outside the scope of this 
rule, we decline to comment at this time.

Qualifying Life Events (QLE)

    One commenter requested that OPM clarify whether or not enrollees 
must experience a QLE in order to decrease enrollment outside of Open 
Season. Under Sec.  892.208, enrollees who participate in premium 
conversion must experience a QLE in order to decrease enrollment 
outside of Open Season. Under Sec.  890.301(e), enrollees who do not 
participate in premium conversion may decrease enrollment at any time. 
This final rule has not altered these requirements.
    Another commenter requested that OPM clarify that ``retired federal 
employees/annuitants will have the option to change plans and/or 
enrollment types upon retirement, regardless of Medicare eligibility or 
age at the time of retirement.''
    Retirement is not a QLE and therefore no changes may be made based 
solely on retirement. Retirement is a change from one payroll office to 
another. After an individual is retired, under the provisions in Sec.  
890.301(e), they may decrease enrollment or cancel coverage at any 
time. QLEs are still required for increasing coverage or changing plans 
outside of Open Season.
    It was requested that OPM clarify the process for handling an 
annuitant who, upon experiencing the death of her spouse, forgets to 
decrease her enrollment to self only. As this question is beyond the 
scope of this regulation, OPM declines to comment at this time.
    Additional guidance was requested regarding carrier 
responsibilities to notify enrollees and agencies when a family member 
has aged out of eligibility or passed away. OPM encourages carriers to 
contact their enrollees when a child ages out or if they learn of the 
death of a covered family member in order to inform the enrollee of 
their QLE opportunity at that time.

Alternative Enrollment Types

    Four commenters suggested alternative enrollment types. One 
commenter suggested that OPM provide rates based on the number of 
family members enrolled. Another suggested an enrollment type available 
to only those enrolled in both FEHB and Medicare. A third commenter 
suggested that, instead of self plus one, OPM alter eligibility 
guidelines to allow spouses and dependents to enroll in their own right 
in self only enrollments. Finally, an FEHB carrier commented that OPM 
should implement a four-tier system: Self only, employee and spouse, 
employee and one non-spousal family member, and self and family. 
Commenters urged OPM to consider methods for encouraging or requiring 
Medicare enrollment. One suggested that OPM should consider reducing 
premiums for annuitants enrolled in Medicare as FEHB is the secondary 
payer. Another expressed concerns that the addition of the self plus 
one enrollment type would exacerbate an existing problem in which 
younger

[[Page 55729]]

enrollees subsidize higher cost annuitants.
    OPM is unable to implement these suggested changes. The FEHB 
statute only allows the following enrollment types: Self only, self 
plus one, and self and family. Any other enrollment types, including 
separate enrollment tiers for individuals enrolled in Medicare, would 
require legislative change.

Definition of Self Plus One

    OPM received four comments indicating that the definition of self 
plus one in the proposed rule, which does not preclude an individual 
with only one eligible family member from enrolling in self and family, 
has potentially negative consequences. These commenters indicated the 
definition, coupled with concerns that self plus one premiums and/or 
enrollee shares may rise above self and family premiums and/or enrollee 
shares, could result in revenue shortfall for carriers. They predicted 
that some consumers with only one eligible family member will likely 
select a self and family enrollment if the enrollee share is lower, 
leading to a financial loss for plans with higher claims costs for self 
plus one enrollments.
    Individual choice is, and always has been, one of the hallmarks of 
the FEHB Program. Before the addition of the self plus one enrollment 
type, individuals have been free to select a self only or self and 
family enrollment, regardless of whether or not they have eligible 
family members. In that tradition, the final rule adopts the proposed 
rule's provision, providing individuals the freedom to select among all 
three enrollment types available, regardless of the number of their 
eligible family members.
    One commenter requested that OPM use this opportunity to expressly 
state that all eligible family members are covered under a self and 
family enrollment. Current regulatory language, which has not been 
altered in this rule, already adequately expresses this. Section 
890.302(a)(1) states that an enrollment for self and family includes 
all family member who are eligible to be covered by the enrollment. 
Further, the definition of self and family, as added by this final rule 
states that self and family enrollment means an enrollment that covers 
the enrollee and all eligible family members.

Government Contribution Calculations

    The government contribution to premium is calculated based on 
weighted average of the subscription charges described in 5 U.S. Code 
section 8906. One commenter points out that most carriers are unable to 
predict the government contribution for their plans because they do not 
cover an adequate portion of the total market to estimate actual FEHB 
enrollment to determine the weighted average. Thus, many plans propose 
total premiums to OPM without a complete understanding of what the 
government and enrollee contributions will be, putting them at a 
disadvantage in a competitive market. Given the additional uncertainty 
for plan year 2016, with the addition of the self plus one enrollment 
type, the commenter requested that OPM provide carriers more 
flexibility to adjust final premium rates during the negotiation 
process after the government contribution has been calculated. OPM will 
adhere to standard operating procedures for plan year 2016 final rate 
negotiations.
    An FEHB carrier requested that OPM provide additional information 
to carriers concerning rate setting for plan year 2016. In addition, 
they cautioned OPM against applying the same government contribution 
for both self plus one and self and family enrollments for plan year 
2016 as this method might lead to increased ``unpredictability of which 
subscribers will choose which tier.'' Many commenters requested 
additional information about the weighted averages that would be used 
to determine the government contribution for plan year 2016.
    The 2013 Bipartisan Budget Act provides OPM with flexibility in the 
first year that self plus one is offered to ``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.'' \1\ The weighted average is used to 
calculate the Government contribution, according to a formula set in 
statute (5 U.S.C. 8906). OPM takes a count of enrollments with 
Government contributions in March of each year (referred to in the 
following paragraphs as the ``March enrollment count''). This March 
enrollment count is used to determine the maximum Government 
contribution for the following plan year. For each enrollment type, OPM 
sums the product of the new premium and the March enrollment count for 
each option and divides the sum by the total number of individuals 
enrolled in that enrollment type.
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    \1\ Full text available at https://www.gpo.gov/fdsys/pkg/BILLS-113hjres59enr/pdf/BILLS-113hjres59enr.pdf.
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    Because we do not have self plus one data from our March 2015 
enrollment count, OPM has determined that it will use the 2015 self and 
family March enrollment count to calculate the weighted average for 
both the 2016 self plus one and self and family enrollment types. The 
weighted average for self plus one will be based on the 2016 self plus 
one premiums and the 2015 self and family March enrollment count. OPM 
provides rate-setting guidance to carriers on an annual basis. For the 
2016 plan year, OPM requested that carriers propose self plus one 
premiums that are no greater than self and family premiums.\2\ Although 
OPM does not expect this policy to change in the out years, the right 
to reevaluate is reserved.
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    \2\ United States Office of Personnel Management, Federal 
Employees Health Benefits Program Call Letter, Fiscal Year 2016, 
Issued March 13, 2015. https://www.opm.gov/healthcare-insurance/healthcare/carriers/2015/2015-02.pdf
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Rate-Setting and the Cost of Self Plus One

    Comments were received that indicated the addition of the self plus 
one enrollment type would translate into cost savings for enrollees 
with only one eligible family member. Commenters in this category 
praised OPM for implementing the new enrollment type. Other commenters 
expressed concerns about rate setting for the new self plus one 
enrollment type. In particular, a concern that self and family premiums 
would rise drastically in plan year 2016 in order to accommodate the 
new self plus one enrollment type. It was suggested that OPM impose a 
10% cap on such growth in the final rule, especially for the first year 
of implementation. Others expressed concerns about the differential 
between the three enrollment tiers. OPM was asked to clarify whether or 
not the enrollee share of a self plus one enrollment would be less than 
or exactly equal to two self only enrollments. One carrier projected 
that, although self plus one premiums might not rise above self and 
family premiums, the differential between the two would be negligible, 
calling into question the cost-benefit of such a change given the high 
administrative burden of implementation.
    Other commenters expressed concerns about actual claims costs. One 
highlighted the unique nature of the FEHB risk pool because the 
annuitant population is combined with the active employee population, 
indicating that many annuitants, who traditionally have higher claims 
costs, have only one eligible family member and therefore might make up 
the bulk of self plus one enrollees. Two commenters pointed out that 
HMO plans might be especially impacted. They expressed concerns that, 
if OPM were to require that self

[[Page 55730]]

plus one total premiums remain below self and family total premiums, 
the end result would be an even more dramatic increase for self and 
family enrollees. The commenter projected that this change would render 
some regional HMOs non-competitive, forcing them out of the FEHB 
market.
    The final rule does not set differentials between tiers, nor does 
it impose caps on premium growth. Under the three tier system, carriers 
will set rate differentials between tiers that are appropriate for the 
expected population, just as they do under the two tier system. An 
artificial cap is unwarranted because plans must set rates that reflect 
the costs of the population they will be covering. Further, enrollees 
have free choice to stay in their current plan or shop for a less 
expensive plan or option that meets their needs. Because the FEHB 
Program is market-based, artificial caps on premium are likely to cause 
adverse consequences such as inadequate rates for some products.
    One commenter requested that rate information be provided earlier 
than normally scheduled to provide individuals adequate time to analyze 
their options. Given the rate negotiation process outlined in Sec.  
890.501, OPM cannot set the government contribution before September 
1st for the following plan year.

Comments on the Regulatory Impact Analysis

    Commenters who discussed OPM's Regulatory Impact Analysis (RIA) in 
the proposed rule asked that OPM provide a more robust analysis for 
public comment. Four commenters suggested that the RIA provided in the 
proposed rule was insufficient under requirements outlined in the 
Administrative Procedures Act, Executive Order 12866, Executive Order 
13563, and the Congressional Review Act. They suggested a delay in 
implementation in order to conduct additional analysis, provide details 
to the public, and allow for an additional comment period. One 
commenter stated OPM had failed to properly justify the change and to 
explain the potential impacts on the FEHB Program. Multiple commenters 
disagreed with OPM's assertion that self plus one premiums would likely 
be lower than self and family. One commenter noted that the RIA failed 
to discuss the possibility of rate differentials between the enrollment 
types. The commenter suggested that all carriers should be required to 
maintain the same differentials between their plan tiers. The commenter 
requested an actuarial analysis of the method that will be utilized to 
determine the weighted average of all FEHB plans for plan year 2015.
    OPM believes the analysis provided in the proposed rule fulfills 
legal requirements. As noted in the proposed and reiterated in the 
final rule, this change is being implemented to comply with the 2013 
Bipartisan Budget Act. In addition, this change aligns insurance 
offerings with those available in the commercial market and more 
equitably spreads costs among the enrollment types offered.

Information Provided to Carriers

    Four commenters requested that we clarify information for carriers. 
One commenter asked OPM to release details, including the final rule, 
by March 31, 2015 to allow carriers ample time to prepare. Another 
commenter asked for additional details on enrollment and eligibility 
under the new self plus one enrollment type; however, provided no 
specific questions.
    One commenter asked that OPM clarify benefits structures including 
deductibles and out of pocket maximums. OPM addressed these issues 
through normal carrier communications including the annual call letter, 
carrier letters, and teleconferences. OPM utilizes several methods for 
communicating with carriers including, but not limited to carrier 
letters, brochure tools, and teleconferences. Some of the information 
requested during the public comment period either has already been 
released or is forthcoming via these alternative communication methods.

Systems Updates

    OPM received three comments relative to the systems updates 
required to implement the new self plus one enrollment type. One 
commenter also asked that the brochure template language be available 
early. Two commenters suggested that OPM improve processes by which 
dependent information is communicated to carriers. An employee 
organization noted that the number of enrollment changes in Open Season 
2015 is likely to far exceed the average Open Season and expressed 
concerns that the overall system would not be able to handle this 
increased number of enrollment changes.
    OPM has carefully and deliberately been reviewing, modifying, and 
testing internal systems to ensure that enrollee information is 
accurately collected and disseminated to carriers. In addition, 
numerous communications have been distributed on the required systems 
changes with agencies, carriers, and enrollment systems. We are 
confident that, through all of these efforts, all necessary systems 
updates will be completed in time for a smooth implementation of the 
self plus one enrollment type in plan year 2016.

Paperwork Reduction Act (PRA)

    OPM has reviewed this final rule for PRA implications and has 
determined that it does not apply to this section.

Regulatory Impact Analysis

    Executive Order 12866 and Executive Order 13563 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, including 
approximately one million two-person self and family enrollments, and 
participation involves hundreds of dollars per member per month, we 
cannot rule out the possibility that this final rule's changes to the 
FEHB Program will have effects that meet the threshold for economic 
significance. We do expect the overall federal budget impact of this 
final rule to be net neutral, though this is subject to uncertainty.
    The new enrollment tier will align FEHB Program offerings with the 
commercial market and serve to more equitably spread costs across 
different enrollment types; in other words, it will shift costs among 
program participants. For plan year 2016, OPM has required that that 
the self plus one enrollment type have total premiums no greater than 
self and family total premiums.

Current FEHB Enrollment Trends

    In plan year 2015 there were over 4 million FEHB contracts. This 
includes 1.89 million self only contracts (47%) and 2.13 million self 
and family contracts (53%).
    During a typical year, approximately 6% of FEHB enrollees change 
their enrollment by selecting a new plan option or a new enrollment 
type (approximately 8% of active employees and 4% of annuitants). 
However, as this is the first time the FEHB Program has experienced a 
large-scale programmatic change as the addition of a new enrollment 
type, it is expected that

[[Page 55731]]

movement will be greater in the coming years as enrollees learn more 
about their options.

Predicting Enrollment Trends Under the Three Tier System

    In order to estimate the impact of the addition of the self plus 
one enrollment type, OPM has conducted an analysis to predict the 
potential shift in enrollment that may occur.
    OPM determined that the following movement patterns were possible:
     FEHB eligible individuals who are currently not enrolled 
may choose to enroll in FEHB after self plus one becomes available.
     Current self only enrollees may choose to increase 
enrollment to include coverage for an eligible family member who is not 
currently covered under an FEHB enrollment.
     Current self only enrollees may choose to cancel coverage 
in order to be covered under a spouse or parent's self plus one FEHB 
enrollment.
     Current self and family enrollees with only one eligible 
family member may choose to decrease to a self plus one enrollment.
     Current self and family enrollees with two or more 
eligible family members may choose to decrease to a self plus one 
enrollment to cover only one of their eligible family members.
     Some FEHB enrollees in either self only or self and family 
may choose to cancel their enrollments.
     Enrollees in either self only or self and family may 
choose to remain in their current enrollment type.
    Based on available data and experience, OPM estimates that much of 
the movement that will occur will result in a shift from one enrollment 
type to another. There are a limited number of circumstances where the 
addition of the self plus one enrollment type may result in new FEHB 
enrollees or in enrollees leaving the program. It is difficult to 
estimate how many individuals may newly enroll in the program. Most 
employees who do not participate in the FEHB Program do so because they 
have access to other insurance options. This rule will not alter access 
to other insurance for FEHB eligible employees. Also, because OPM does 
not have government-wide eligible and covered family member data, it is 
not known exactly how many individuals are covered under self and 
family enrollments, nor is it known how many eligible family members 
exist but are not currently covered because the enrollee has chosen a 
self only enrollment.
    In order to learn more about potential movement between enrollment 
types, OPM requested data on covered enrollees and family members from 
carriers with the 2014 rate proposals. Carriers reported that over one 
million self and family contracts had only one dependent listed. Of 
those enrollments, approximately 60% were annuitants and 40% were 
active employees. While this number does not capture the universe of 
enrollees who may choose a self plus one enrollment, it does provide a 
starting place for estimating the potential movement between tiers.
    OPM also examined enrollment data for the Federal Employees Dental 
and Vision Insurance Program (FEDVIP). FEDVIP has offered self plus one 
as an enrollment option since its inception in 2007. There are 
currently approximately 2.7 million FEDVIP contracts. Of those, 41% are 
self only, 32% are self plus one, and 27% are self and family.
    Comparing FEHB and FEDVIP enrollment patterns may be illustrative 
because the pool of eligible individuals is roughly the same. Most 
FEDVIP enrollees are also eligible for FEHB. However, there are some 
key differences between the programs. First, family member eligibility 
guidelines are slightly different. Eligible children are covered under 
FEDVIP enrollments until the age of 22 whereas eligible children are 
covered under FEHB until the age of 26. Second, FEDVIP has lower 
participation as it is an employee-pay-all program with no government 
contribution towards the premium. In addition, benefits offered in 
standalone dental and vision programs are limited, and therefore, 
enrollee behavior and motivation based on those benefits would be 
different.
    Examining the types of movement that are possible and comparing 
FEHB enrollment trends with other programs provides only a limited view 
of the complex factors that affect enrollment decisions for enrollees. 
Enrollee choice and movement is an individualized decision based on the 
needs of the enrollee and their dependents. Self plus one uptake is 
dependent on a combination of factors including premiums, benefits 
structures, and the level of communication from agencies, carriers, and 
OPM about new enrollment options.
    For most enrollees, the enrollee share for self plus one will be 
lower than for self and family; however, it is possible that, because 
of the statutory formula used to calculate the government contribution, 
some plans may have a higher enrollee share for self plus one than for 
self and family. This will make it even more important for enrollees to 
review their enrollment options before selecting a plan and an 
enrollment type that meets their needs. OPM is implementing a robust 
communications strategy to ensure that as many enrollees as possible 
are aware of the new self plus one enrollment type.
    Plan design remains the same between enrollment types offered in 
the same plan option. Therefore, OPM expects that cognitive costs for 
enrollees would be relatively low. For those enrollees that do not 
typically reevaluate their enrollment every Open Season, the cognitive 
costs of a review of the plans, plan options, and enrollment types 
available may well be worth incurring, as they may discover better 
alternatives (though these improvements may represent transfers from 
other members of society, rather than benefits to society as whole). 
Ultimately, actual enrollment decisions cannot be predicted with 
precision. Further, it will likely take years for enrollment numbers to 
reach an equilibrium following this Program change.\3\
---------------------------------------------------------------------------

    \3\ As discussed in more detail elsewhere in this analysis, plan 
switching--in which federal employees and annuitants with one 
eligible family member gravitate toward plans with relatively low 
self plus one premiums and federal employees and annuitants with 
multiple eligible family members gravitate toward plans with 
relatively low self and family premiums--would lead to further 
changes in premiums, and several iterations of switching activity 
and premium adjustments may occur before the new equilibrium is 
reached. Moreover, because health insurance decisions tend to be 
characterized by inertia, the behavioral changes discussed here and 
throughout this analysis may be relatively rare when this rule is 
first implemented and then become more widespread over time, as 
turnover occurs in the federal workforce and there is an 
accumulation of qualifying life events that cause FEHB participants 
to reconsider their health insurance choices.
---------------------------------------------------------------------------

Cost Analysis

    OPM's Fiscal Year 2014 Congressional Budget Justification \4\ 
included a projection that the addition of the self plus one enrollment 
would have a net neutral impact on the Federal budget. This projection, 
based on FEHB carriers' relative costs and population

[[Page 55732]]

distributions, included the following assumptions:
---------------------------------------------------------------------------

    \4\ 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 https://www.cbo.gov/sites/default/files/cbofiles/attachments/Bipartisan%20Budget%20Act% 20of%202013.pdf. In estimating potential 
premium changes, OPM used data on FEHB enrollees' medical 
expenditures, while CBO used data on medical expenditures for the 
general population. Because of the large number of annuitants in the 
FEHB enrolled population, two-person FEHB enrollments tend to have 
higher costs than two-person enrollments in the nation as a whole, 
thus explaining some of the difference between OPM's and CBO's 
estimates.
---------------------------------------------------------------------------

     The average premium for self plus one coverage will be 
approximately 94% of the cost of existing self and family coverage.
     The average premium for self and family coverage will be 
approximately 107% of the cost of existing self and family coverage.
     33% of active employees with existing self and family will 
shift to self plus one coverage.
     Only 20% of annuitants with existing self and family 
coverage will retain that coverage (80% will shift to self plus one).
    As discussed above, there are several ways in which enrollees may 
choose to change their enrollment based on the addition of the self 
plus one enrollment type. The magnitudes of these changes (and the 
effects experienced by the government that depend on FEHB participants' 
behavior) would be correlated with the amount that participant premium 
contributions change. If, as shown above, self plus one premiums are 
only slightly lower than baseline self and family premiums, then two-
person families will have little incentive to transfer family members 
from other coverage to FEHB. Similarly, if self and family premiums 
increase only slightly as a result of this rule, then families larger 
than two people will have little incentive to switch some or all of 
their members from FEHB to other health insurance coverage. As a 
result, in this example, a change in the cost of the Program would be 
contingent, in part, upon the amount of switching into or out of FEHB 
from/to other health insurance.
    Current enrollees with self and family coverage who only have one 
dependent and choose to decrease enrollment to self plus one, will 
likely benefit from lower premiums. Those with more than one dependent 
covered under a self and family enrollment will likely incur higher 
premiums. A large percentage of annuitants who currently have self and 
family coverage would likely benefit from the lower total premiums of a 
self plus one enrollment type, resulting in score-able savings to the 
government because the government share of annuitant premiums will 
decrease.
    OPM estimated that, in total, savings for annuitants and the 
government would rise above $450 million in the first year of self plus 
one. Conversely, costs for non-Postal employees and the government 
would rise about $450 million for the same time frame. This converse 
relationship between costs associated with annuitants and employees 
continues into future year projections and results in the overall net-
neutral projection.
    Actual cost shifting cannot be measured until rate negotiations are 
finalized and enrollment changes take place. As enrollees shift from 
self only and self and family enrollments, OPM will closely monitor the 
effect on premiums. If premiums for active employees with two or more 
covered family members rise, there will be increasing costs to 
government agencies (assuming appropriation of necessary funds).\5\
---------------------------------------------------------------------------

    \5\ 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 https://www.cbo.gov/sites/default/files/cbofiles/attachments/Bipartisan%20Budget%20Act% 20of%202013.pdf.
---------------------------------------------------------------------------

    The impact of this final rule hinges upon the relative premiums for 
self plus one and self and family enrollment types. Because the self 
and family option includes coverage for a larger number of people, a 
natural assumption would be that premiums would be lower for a self 
plus one enrollment type than for a self and family enrollment type. 
For plan year 2016, OPM instructed carriers to propose total premiums 
for self plus one that were less than or equal to total premiums for 
self and family. 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 a self plus one enrollment, 
resulting in lower total premium payments between employees, 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 
who would be eligible for coverage under self and family enrollment may 
choose self plus one enrollment. This 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 non-federal employer, but the relevant 
FEHB self plus one premium is less than the combined premiums.\6\ 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 non-federal employer 
of the federal employee's spouse in the preceding example--would also 
pay less.
---------------------------------------------------------------------------

    \6\ Similarly, federal employees and annuitants who, in the 
absence of the rule, would choose not to participate in the FEHB 
Program may choose a self plus one enrollment. For example, this 
outcome might occur if the self plus one option available in the 
FEHB Program is less expensive than either a family or plus-one 
enrollment available via a federal employee's spouse or the combined 
premiums for the federal employee's self only enrollment and the 
spouse's self only enrollment.
---------------------------------------------------------------------------

    To the extent that new patterns of enrollment do not change how 
society uses its resources (i.e., amount or quality of medical services 
provided), then the effects described above would be transfers between 
members of society, rather than social costs or benefits.
    It is possible that two-person families are, on average, less 
healthy than larger families; indeed, multiple comments to the docket 
provided evidence that some plans' expenditures for two-person 
enrollments are higher than for enrollments with three or more total 
family members. For the 2016 plan year, because OPM has requested that 
carriers propose self plus one premiums no greater than self and family 
premiums, plans with this medical expenditure pattern will presumably 
set equal premiums for self plus one and self and family enrollment 
types. In the event that OPM does not repeat this request for future 
years, plans with higher average expenditures for two-person than for 
larger families will presumably set premiums higher for self plus one 
enrollment than for self and family

[[Page 55733]]

enrollment. If this pattern--in which self plus one premiums are 
greater than or equal to self and family premiums--held universally, 
the lack of premium decrease to give federal employees and annuitants 
an incentive to switch from self and family to self plus one enrollment 
would lead to the rule's enrollment impact being negligible.\7\ 
However, as indicated by docket submissions, relative expenditures on 
(and thus premiums for) two-person and larger enrollments differ across 
plans, and hence the effect of adding the self plus one option may be 
to increase switching between plans, as federal employees and 
annuitants with one eligible family member gravitate toward plans with 
relatively low self plus one premiums and federal employees and 
annuitants with multiple eligible family members gravitate toward plans 
with relatively low self and family premiums. Plan switching of this 
type would lead to further changes in premiums and several iterations 
of switching activity and premium adjustments may occur.
---------------------------------------------------------------------------

    \7\ This negligible-impact outcome may not occur if the 
government contribution, as determined by statutory formula, was 
such that enrollee contributions were lower for self plus one 
enrollments than for self and family enrollments even in cases where 
total premiums for self plus one enrollments were greater than or 
equal to total premiums for self and family enrollments.
---------------------------------------------------------------------------

    Additionally, the rule imposes implementation costs, such as the 
costs of systems updates, on FEHB-participating health insurance plans, 
federal agencies, and on OPM itself. These expenses are encompassed in 
existing workloads. OPM has no specific estimate for these costs, but 
expects them to be marginal.
    Though regulatory alternatives to this rule are limited due to the 
statutory mandate, OPM did consider delaying implementation of the rule 
until the 2017 plan year. OPM rejected this option for two reasons. 
First, delaying implementation will not provide additional information. 
Because OPM contracts with a number of carriers, proposed rates are 
proprietary and cannot be released publically without compromising 
confidential negotiation processes. Until first year negotiations are 
completed and enrollment changes occur, OPM would not have a precise 
understanding of the impact of the self plus one enrollment type on 
premiums.
    Second, implementation has already been delayed. After the passage 
of the 2013 Bipartisan Budget Act, the first year that implementation 
would have been possible was plan year 2015. OPM determined that this 
was not adequate time to implement the new enrollment type and chose to 
delay implementation until 2016. OPM, carriers, and Federal agencies 
are well into the implementation process. Rate negotiations between OPM 
and FEHB carriers have begun under the assumption that the 2016 plan 
year would include the self plus one enrollment type. Agencies and 
carriers are currently implementing the systems changes required to 
accommodate three tier enrollments. Delaying implementation would 
adversely impact the Federal benefits Open Season which is scheduled to 
begin in early November of this year.

Congressional Review Act

    OPM has determined that this regulatory action is not subject to 
the Congressional Review Act, 5 U.S.C. 801-08, because it relates to 
agency management and personnel. The program is not statutorily for 
general application but rather governs employment fringe benefits for 
Federal employees, annuitants and their families. Moreover, OPM has 
been statutorily granted discretion in terms of deciding how its 
actions may affect non-agency parties, such as carriers, by its 
authority to regulate enrollment. See, 5 U.S.C. 8905(a), 8905(g)(2), 
and 8913(b).

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 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

5 CFR Part 890

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

5 CFR Part 892

    Administrative practice and procedure, Government employees, Health 
insurance, Taxes, Wages.

U.S. Office of Personnel Management.
Beth F. Cobert,
Acting Director.

    Accordingly, OPM is amending title 5, Code of Federal Regulations 
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.


0
2. Amend Sec.  890.101 as follows:
0
a. By revising the definitions of ``Change the enrollment'' and 
``Covered family member.''
0
b. By adding the definitions of ``Decrease enrollment type,'' 
``Increase enrollment type,'' ``Self and family enrollment,'' ``Self 
only enrollment,'' ``Self plus one enrollment,'' and ``Switch a covered 
family member'' 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. Sec.  890.302, 890.804, or 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 self plus one or to self and family or a

[[Page 55734]]

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.
* * * * *
    Switch a covered family member means, under a self plus one 
enrollment, to terminate or cancel the enrollment of the designated 
covered family member and designate another eligible family member for 
coverage.
* * * * *

0
3. Amend Sec.  890.201 by revising paragraph (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) heading and introductory text, (i) introductory text, (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 paragraph (g)(3) of this section 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 and family 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 paragraph (g)(3) of 
this section 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

[[Page 55735]]

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 
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. (1) 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.
    (2) Switching a covered family member under a self plus one 
enrollment will be effective on the first day of the first pay period 
that begins after the date the employing office receives an appropriate 
request to switch the covered family member.

0
6. Amend Sec.  890.303 by revising paragraphs (c), (d)(2)(ii), and the 
heading of paragraph (d)(3) to read as follows:


Sec.  890.303  Continuation of enrollment.

* * * * *
    (c) On death. 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:
    (1) The survivor annuitant from whose annuity all or the greatest 
portion of the withholding for health benefits is made; or
    (2) The surviving spouse entitled to a basic employee death 
benefit. 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) to read 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

[[Page 55736]]

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 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 decrease the enrollment 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 paragraphs (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

[[Page 55737]]

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:


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) * * *
    (1) * * *
    (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 (3) or the documentation 
requirements of Sec.  890.806(a), 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 (3).
* * * * *

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

[[Page 55738]]

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 increase enrollment type 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 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 (a) 
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. In Sec.  892.101, the definition of ``Qualifying life event'' is 
amended by revising the introductory text and paragraphs (9) and (13) 
to read as follows:


Sec.  892.101  Definitions.

* * * * *
    Qualifying life event means an event that may permit changes to 
your FEHB enrollment as well as changes to your premium conversion 
election as described in Treasury regulations at 26 CFR 1.125-4. For 
purposes of determining whether a qualifying life event has occurred 
under this part, a stepchild who is the child of an employee's domestic 
partner as defined in part 890 of this chapter shall be treated as 
though the child were a dependent within the meaning of 26 CFR 1.125-4 
even if the child does not so qualify under such Treasury regulations. 
Such events include the following:
* * * * *
    (9) An employee becomes entitled to Medicare. (For change to self 
only, self plus one, cancellation, or change in premium conversion 
status see paragraph (11) of this definition.)
* * * * *
    (13) An employee or eligible family member becomes eligible for 
premium

[[Page 55739]]

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) and adding paragraph 
(d) 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, switch a covered family member, 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.
* * * * *
    (d) During the first plan year in which the self plus one 
enrollment type is available, OPM will administer a limited enrollment 
period for enrollees who participate in premium conversion. During this 
limited enrollment period, enrollees who participate in premium 
conversion will be allowed to decrease enrollment from self and family 
to self plus one during a time period determined by OPM. No other 
changes, including changes in plan or plan option or increases in 
enrollment, will be allowed. Enrollments will be effective on the first 
day of the first pay period following the one in which the appropriate 
request is received by the employing office.

0
22. Revise Sec.  892.208 to read as follows:


Sec.  892.208  Can I decrease my enrollment type at any time?

    If you are participating in premium conversion you may decrease 
your FEHB enrollment type under either of the following circumstances:
    (a) 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.
    (b) 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.
    (c) If you are subject to a court or administrative order as 
discussed in Sec.  890.301(g)(3), 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), 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. 2015-23348 Filed 9-16-15; 8:45 am]
BILLING CODE 6325-63-P