Federal Employees Dental and Vision Insurance Program: Extension of Eligibility to Certain TRICARE-Eligible Individuals; Effective Date of Enrollment, 58175-58184 [2018-25114]

Agencies

• Office of Personnel Management

[Federal Register Volume 83, Number 223 (Monday, November 19, 2018)]
[Rules and Regulations]
[Pages 58175-58184]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-25114]



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Rules and Regulations
                                                Federal Register
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This section of the FEDERAL REGISTER contains regulatory documents 
having general applicability and legal effect, most of which are keyed 
to and codified in the Code of Federal Regulations, which is published 
under 50 titles pursuant to 44 U.S.C. 1510.

The Code of Federal Regulations is sold by the Superintendent of Documents. 

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Federal Register / Vol. 83, No. 223 / Monday, November 19, 2018 / 
Rules and Regulations

[[Page 58175]]



OFFICE OF PERSONNEL MANAGEMENT

5 CFR Part 894

RIN 3206-AN58


Federal Employees Dental and Vision Insurance Program: Extension 
of Eligibility to Certain TRICARE-Eligible Individuals; Effective Date 
of Enrollment

AGENCY: Office of Personnel Management.

ACTION: Interim final rule; request for comments.

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

SUMMARY: The Office of Personnel Management (OPM) is issuing an interim 
final rule to expand eligibility for enrollment in the Federal 
Employees Dental and Vision Insurance Program (FEDVIP) to additional 
groups. The National Defense Authorization Act for Fiscal Year 2017 
(FY17 NDAA), expanded FEDVIP eligibility to certain TRICARE-eligible 
individuals (TEIs).

DATES: This rule is effective on November 14, 2018. OPM must receive 
comments on or before January 18, 2019.

ADDRESSES: You may submit comments, identified by docket number and/or 
Regulatory Information Number (RIN) and title, by the following method:
     Federal Rulemaking Portal: https://www.regulations.gov. 
Follow the instructions for submitting comments.
    All submissions received must include the agency name and docket 
number or RIN for this document. The general policy for comments and 
other submissions from members of the public is to make these 
submissions available for public viewing at https://www.regulations.gov 
as they are received without change, including any personal identifiers 
or contact information.

FOR FURTHER INFORMATION CONTACT: Julia Elam, Program Analyst, at 
[email protected] or (202) 606-2128.

SUPPLEMENTARY INFORMATION:

Authority for This Rulemaking

    FEDVIP was created as a result of the passage of the Federal 
Employee Dental and Vision Benefits Enhancement Act of 2004, Public Law 
108-496. This Act required OPM to make stand-alone dental and vision 
insurance available to Federal employees, retirees, and their 
dependents. FEDVIP has 3.4 million enrollees with approximately 7.1 
covered individuals. FEDVIP is available to eligible Federal Civilian 
and U.S. Postal Service (USPS) employees, retirees (annuitants), 
survivor annuitants, compensationers, and their eligible family members 
(dependents) on an enrollee-pay-all basis; there is no government 
contribution towards premium.
    The program is administered by OPM in accordance with 5 U.S.C. 
chapters 89A and 89B and implementing regulations (5 CFR part 894). 
Section 715 of Public Law 114-328, authorizes the Secretary of Defense 
to enter into an agreement with the OPM Director to allow certain 
TRICARE-eligible individuals to enroll, or to be covered under an 
enrollment in FEDVIP, and amends 5 U.S.C. 8951 and 8958(c) (dental 
benefits) and 5 U.S.C. 8981 and 8988(c) (vision benefits), to establish 
eligibility of certain TRICARE-eligible individuals to enroll so that 
they and their eligible family members may obtain dental and vision 
benefits under FEDVIP.

Discussion of the Proposed Changes

    This rule will assist newly eligible individuals and their family 
members in enrolling in this program. Under 5 U.S.C. 8951, a TRICARE-
eligible individual (TEI) who is eligible for FEDVIP dental benefits 
means an individual who is eligible for coverage pursuant to 10 U.S.C. 
1076c(b) (the TRICARE Retiree Dental Program (TRDP)). Under this 
regulation, all individuals that are currently eligible for TRDP will 
be eligible for FEDVIP dental benefits beginning plan year 2019. Under 
5 U.S.C. 8981, as amended, a TRICARE-eligible individual who is 
eligible for FEDVIP vision benefits means an individual who is covered 
pursuant to 10 U.S.C. 1076d (i.e., TRICARE Reserve Select), 1076e 
(i.e., TRICARE Retired Reserve), 1079(a) (i.e., uniformed services 
active duty family members enrolled in TRICARE Select or TRICARE 
Prime), 1086(c) (i.e., uniformed services retirees and retiree family 
members enrolled in TRICARE Select or TRICARE Prime), or 1086(d) (i.e., 
TRICARE for Life). These individuals will be eligible for FEDVIP vision 
benefits beginning plan year 2019. It is estimated that there are 
approximately 7.6 million individuals who will be newly eligible for 
FEDVIP vision benefits and 3 million individuals who will be newly 
eligible for FEDVIP dental benefits. Coverage, eligibility, and 
enrollment for these individuals are discussed in subparts C and E and 
the new subpart H of this regulation.
    Under subpart H, TRICARE-eligible individuals will need to actively 
enroll in FEDVIP in order to be covered for plan year 2019, even if 
those individuals are currently enrolled in TRDP. Generally, the 
uniformed services retiree will be the sponsor and enrollee in whose 
name the enrollment is carried for eligible dependent family members. 
Uniformed services members on active duty are not eligible for FEDVIP 
benefits, and a family member that is eligible for vision benefits will 
serve as the enrollee and will enroll eligible family members in one 
FEDVIP vision benefit plan.
    There are technical corrections and clarifications such as the 
addition of definitions at 5 CFR 894.101, inclusion of terminology to 
include TRICARE-eligible individuals throughout subpart A, and a 
special provision for TRICARE-eligible individuals (TEIs) at 5 CFR 
894.106. There is inclusion of language regarding coverage, types of 
enrollment, and cost of coverage for TRICARE-eligible individuals at 5 
CFR 894.204, 5 CFR 894.401, 5 CFR 894.403, and 5 CFR 894.406. Technical 
corrections to include newly eligible TEIs are proposed in 5 CFR 
894.305 through 894.307. The TEIs that can enroll and cover TEI family 
members are discussed at 5 CFR 894.309. Technical corrections for 
enrollment and termination or cancellation of coverage for TEIs have 
been included throughout subparts E and F.
    The first enrollment opportunity for the newly eligible TRICARE-
eligible individuals will occur during the 2018 Federal Benefits Open 
Season period, which will run from November 12 through December 10, 
2018 with the

[[Page 58176]]

first effective date of coverage beginning on January 1, 2019.

Expected Impact of Proposed Changes

    This rule is expected to be an E.O. 13771 deregulatory action 
because it offers more dental coverage options and new vision coverage 
in FEDVIP for TRICARE-eligible individuals. TRDP beneficiaries 
currently have one option for dental coverage or can seek coverage in 
the private dental insurance market. Vision coverage is a new 
government-offered benefit for this population. Eligibility to enroll 
in FEDVIP provides more coverage options for these individuals than are 
currently available to them.
    OPM contracts with 10 dental carriers and 4 vision carriers to 
offer plans under FEDVIP. There are 15 dental plan options available 
across FEDVIP from these 10 dental carriers. Within the 4 vision 
carriers, there are 8 vision plan options that are nationwide and 
internationally available to all potential enrollees. While this rule 
expands the number of individuals who are potentially eligible for this 
FEDVIP, OPM does not believe this regulation will have a large impact 
on the broader dental or vision insurance markets as FEDVIP generally 
constitutes a smaller percentage of an overall carrier's book of 
business.
    In plan year 2018, FEDVIP overall program enrollment includes 3.3 
million individuals. The number enrolled has not changed significantly 
in recent years. For example, there were 3.2 million in plan year 2017 
and 2.98 million in plan year 2016. Based on OPM data, between 2013 and 
2017, an average of 87,849 people made plan changes during open season.
    Based on the changes required by FY17 NDAA, OPM estimates there are 
approximately 7.82 million individuals who will be newly eligible for 
FEDVIP vision benefits and 5.93 million individuals who will be newly 
eligible for FEDVIP dental benefits. However, OPM does not expect every 
newly eligible individual to enroll in FEDVIP as they may choose not to 
enroll or may opt instead to enroll in private dental and/or vision 
insurance. Since OPM does not have extensive data on and cannot 
estimate the potential uptake of TRICARE-eligible individuals to 
determine the impact of this regulation, we are seeking comments on the 
following:
    1. How will the changes made by this regulation impact the non-
group dental or vision insurance market?
    2. How will the changes made by this regulation impact the choices 
available to terminating FEDVIP enrollees?
    3. How will the changes made by this regulation impact the 
enrollment of annuitants compared to employees?
    4. How will the regulation impact changes to enrollment in FEDVIP?

Waiver of Proposed Rulemaking

    OPM is issuing this rulemaking as an interim final rule and has 
determined that, under the Administrative Procedure Act (APA), 5 U.S.C. 
553(b)(B), it would be impracticable, unnecessary, and contrary to the 
public interest to delay a final regulation until a public notice and 
comment process has been completed.
    The conclusion of a public notice and comment period before the 
rule is finalized would be impracticable because it would impede due 
and timely execution of OPM's functions: Uniformed services retirees 
and their family members and active duty family members would not have 
time to enroll or be enrolled in FEDVIP during the November 2018 open 
season. Since the enactment of Public Law 114-328, OPM and the 
Department of Defense (DoD) have worked in coordination on a number of 
actions necessary to implement the law. Before OPM could start any 
rulemaking implementation, a Memorandum of Agreement (MOA) was needed 
between the DoD's Defense Health Agency (DHA) and OPM to provide 
certain TRICARE-eligible individuals the opportunity to purchase FEDVIP 
dental and/or vision coverage beginning January 1, 2019. The MOA was 
signed on March 26, 2018, leaving OPM insufficient time to prepare and 
complete a full public notice and comment rulemaking proceeding and to 
timely incorporate a final rule into open season materials prior to the 
open season's commencement date.
    To the extent that an NPRM would furnish general public information 
about enrollment opportunities, it is unnecessary in light of the 
extensive outreach already undertaken by OPM and DoD, which provided 
more specific and more detailed notice to affected beneficiaries than 
an NPRM would provide. Outreach included identifying the eligible 
population of uniformed services retirees and family members for both 
FEDVIP dental and vision coverage and active duty family members for 
vision coverage; joint efforts to communicate with potential enrollees 
about eligibility, enrollment, and key dates for enrolling in FEDVIP; 
and working with the FEDVIP Administrator to update enrollment systems 
to allow enrollment of newly eligible individuals. Furthermore, both 
OPM and DHA have worked in coordination to inform current TRICARE 
Retiree Dental Program (TRDP) enrollees about the end of dental benefit 
delivery under the TRDP by December 31, 2018 to ensure TRDP enrollees 
are aware of the transition of the program to FEDVIP.
    In addition, it is unnecessary to the extent that OPM's rule simply 
extends the coverage of DoD regulations at 32 CFR 199.22 that were 
promulgated through notice and comment. The lost opportunity to enroll 
in the November 2018 open season would result in serious damage to 
important interests, since uniformed services retirees and their family 
members will no longer have access to the TRDP, the prior plan that 
FEDVIP is replacing, and the gap in coverage could have significant 
health and financial impact on them. This outcome would be contrary to 
the public interest.
    For these reasons, OPM has determined that the public notice and 
participation that the APA ordinarily requires would, in this case, be 
impracticable, unnecessary, and contrary to the public interest and 
that good cause exists for waiving proposed rulemaking and delaying its 
solicitation of comments from the public until after it issues an 
interim final rule. OPM will consider those comments received upon its 
interim final rulemaking in a subsequent final rule.

Regulatory Impact Analysis

    OPM has examined the impact of this rule as required by Executive 
Order 12866 and Executive Order 13563, which directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public, 
health, and safety effects, distributive impacts, and equity). A 
regulatory impact analysis must be prepared for major rules with 
economically significant effects of $100 million or more in any one 
year. This rule has been designated as a ``significant regulatory 
action,'' under Executive Order 12866.

Reducing Regulation and Controlling Regulatory Costs

    This rule is expected to be an E.O. 13771 deregulatory action. 
Details can be found in the ``Expected Impact of the Proposed Changes'' 
section of the rule.

Regulatory Flexibility Act

    I certify that this regulation will not have a significant economic 
impact on a substantial number of small entities.

[[Page 58177]]

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.

Civil Justice Reform

    This regulation meets the applicable standard set forth in 
Executive Order 12988.

Unfunded Mandates Reform Act of 1995

    This rule will not result in the expenditure by State, local or 
tribal governments of more than $100 million annually. Thus, no written 
assessment of unfunded mandates is required.

Congressional Review Act

    This action pertains to agency management, personnel and 
organization and does not substantially affect the rights or 
obligations of nonagency parties and, accordingly, is not a ``rule'' as 
that term is used by the Congressional Review Act (Subtitle E of the 
Small Business Regulatory Enforcement Fairness Act of 1996 (SBREFA)). 
Therefore, the reporting requirement of 5 U.S.C. 801 does not apply.

Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35)

    Notwithstanding any other provision of law, no person is required 
to respond to, nor shall any person be subject to a penalty for failure 
to comply with a collection of information subject to the requirements 
of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) (PRA), 
unless that collection of information displays a currently valid Office 
of Management and Budget (OMB) Control Number.
    This rule involves a collection of information subject to the PRA 
for the Federal Employees Dental and Vision Insurance Program (FEDVIP) 
Enrollment System, known as BENEFEDS OPM is in the process of seeking 
OMB approval. The public reporting burden for this collection is 
estimated to average 8 minutes for a respondent to submit an enrollment 
including time for reviewing education and support but may not include 
time for reviewing a plan and specific benefits. The total burden hour 
estimate for this form is 44,307 hours. The systems of record notice 
for this collection is: Central-1 found on https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-central-1-civil-service-retirement-and-insurance-records.pdf.
    The FEDVIP currently has a total of 15 dental plan options 
available across the program from 10 dental plan choices within 6 
nationwide and 4 regional plans. Each potential enrollee has access to 
all nationwide options. Regional options are available in at least 29 
states and Puerto Rico. There are 8 vision plan choices that are 
nationwide and international available to all potential enrollees. 
Historically, an average of 87,849 FEDVIP enrollees made plan changes 
during each open season between 2013-2017. This regulation is not 
anticipated to change the burden associated with this collection 
although the number of participants will increase due to the expansion 
of eligibility.
    Send comments regarding the burden estimate or any other aspect of 
this collection of information, including suggestions for reducing this 
burden to [email protected]. The final rule will respond to any OMB 
or public comments on the information collection requirements contained 
in this proposal.

List of Subjects in 5 CFR Part 894

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

Office of Personnel Management.
Alexys Stanley,
Regulatory Affairs Analyst.

    Accordingly, OPM amends 5 CFR part 894 as follows:

PART 894--FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM

    1. The authority citation for part 894 is revised to read as 
follows:

    Authority:  5 U.S.C. 8962; 5 U.S.C. 8992; Subpart C also issued 
under section 1 of Pub. L. 110-279, 122 Stat. 2604; Pub. L. 114-328.

Subpart A--Administration and General Provisions

0
2. Amend Sec.  894.101 by:
0
a. In the definition of ``Child,'' revising the introductory text, 
adding introductry text to paragraph (1), and adding paragraph (4).
0
b. Adding the definition of ``Enrollee'' in alphabetical order.
0
c. Revising the definition of ``Family member.''
0
d. Adding the definition of ``Sponsor'' in alphabetical order.
0
e. Revising the definition of ``Stephchild.''
0
f. Adding the definitions of ``TEI,'' ``TEI certifying family member,'' 
``TEI child,'' ``TEI former spouse,'' ``TRICARE-eligible individual 
(TEI),'' ``TRICARE-eligible individual for FEDVIP dental benefits (TEI-
D),'' and ``TRICARE-eligible individual for FEDVIP vision benefits 
(TEI-V)'' in alphabetical order.
    The revisions and additions read as follows:


Sec.  894.101  Definitions.

* * * * *
    Child means:
    (1) Except as discussed in paragraph (4) of this definition, a 
child is one of the following:
* * * * *
    (4) With respect to a TEl, child means a TEI child.
* * * * *
    Enrollee means the individual in whose name the FEDVIP enrollment 
is carried. There is one FEDVIP enrollment for each enrollee in a 
dental plan, and/or in a vision plan and that enrollment may include 
family members who may be covered by the enrollment. The term enrollee 
includes individuals eligible to enroll based upon a status described 
at subpart C of this part, who enroll and are covered. With respect to 
the Federal workforce, enrollee generally means an employee or 
annuitant. With respect to a TEI, enrollee generally means the sponsor 
who is a TEI with respect to a FEDVIP plan; but if the sponsor is not a 
TEI, or for FEDVIP dental benefits if the sponsor defined at 894.804 is 
not enrolled and meets a condition at Sec.  894.309(a)(3)(iii), then 
enrollee means the TEI certifying family member. A TEI former spouse 
may be an enrollee only for a self-only FEDVIP vision plan. An enrollee 
may enroll and elect a FEDVIP dental and/or vision plan, option, and 
type of enrollment, except as provided at Sec.  894.309.
* * * * *
    Family member means a spouse (including a spouse under a valid 
common law marriage) and/or unmarried dependent child(ren) under age 22 
or beyond age 22, if incapable of self-support because of mental or 
physical disability which existed before reaching age 22, as defined at 
5 U.S.C. 8901(5). With respect to a TEI, the term family member means a 
TEI family member.
* * * * *
    Sponsor generally means the individual who is eligible for medical 
or dental benefits under 10 U.S.C. chapter 55 based on his or her 
direct affiliation with the uniformed services (including military 
members of the National Guard

[[Page 58178]]

and Reserves), in accordance with Sec.  894.804.
    Stepchild means:
    (1) Except as provided in paragraph (2) of this definition, the 
child of an enrollee's spouse or domestic partner and shall continue to 
refer to such child after the enrollee's divorce from the spouse, 
termination of the domestic partnership, or death of the spouse or 
domestic partner, so long as the child continues to live with the 
enrollee in a regular parent-child relationship.
    (2) Your spouse's child born within or outside marriage or his or 
her adopted child. The child of your spouse shall continue to be 
considered your stepchild after your divorce from your spouse or the 
death of your spouse so long as the child continues to live with you in 
a regular parent-child relationship.
    TEI means TRICARE-eligible individual for FEDVIP dental benefits 
(TEI-D) or a TRICARE-eligible individual for FEDVIP vision benefits 
(TEI-V).
    TEI certifying family member means, where the sponsor is not an 
enrollee under Sec.  894.309, the TEI family member who may accept 
responsibility to self-certify as an enrollee in accordance with Sec.  
894.809.
    TEI child means an individual who is a TEI and who meets the 
definition of dependent in 10 U.S.C. 1072(2)(D) or (I) with respect to 
a sponsor.
    TEI family member means a TEI who is a dependent with respect to a 
sponsor, as defined in 10 U.S.C. 1072(2)(A) (spouse), 10 U.S.C. 
1072(2)(B) (unremarried widow), 10 U.S.C. 1072(2)(C) (unremarried 
widower), 10 U.S.C. 1072(2)(D) (child), or 10 U.S.C 1072(2)(I) 
(unmarried person).
    TEI former spouse means a TEI who is an unremarried former spouse 
as defined in 10 U.S.C. 1072(2)(F), (G), or (H) and is entitled to 
medical care under 10 U.S.C. 1086(c) or (d).
    TRICARE-eligible individual (TEI) means a TRICARE-eligible 
individual for FEDVIP dental benefits (TEI-D) or a TRICARE-eligible 
individual for FEDVIP vision benefits (TEI-V), as the case may be.
    TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) 
means an individual who is eligible for FEDVIP dental coverage based on 
the individual's eligibility to enroll or be covered under the TRICARE 
Retiree Dental Program, 10 U.S.C. 1076c(b) in accordance with Sec.  
894.802.
    TRICARE-eligible individual for FEDVIP vision benefits (TEI-V) 
means an individual who is eligible for FEDVIP vision coverage based on 
the individual's enrollment in a specified TRICARE health plan in 
accordance with Sec.  894.803.
* * * * *

0
3. Add Sec.  894.106 to read as follows:


Sec.  894.106  Special provisions for TRICARE-eligible individuals 
(TEI).

    Generally, applicable provisions of this part are effective for 
TEIs. Provisions that are specific to Federal employees, annuitants and 
their family members do not apply to TEIs. See Sec.  894.101 for 
application of defined terms to TEIs and subpart H of this part for 
special provisions for TEIs, which governs in the event of ambiguity.

Subpart B--Coverage and Types of Enrollment

0
4. Revise Sec.  894.204 to read as follows:


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

    You may be enrolled or be covered in a FEDVIP dental plan and a 
separate FEDVIP vision plan at the same time. But no one may enroll or 
be covered as a family member in a FEDVIP dental or vision plan if he 
or she is covered under another person's FEDVIP dental or vision self 
plus one or self and family enrollment, except as provided under Sec.  
890.302(a)(2) through (4) of this chapter, with respect to dual 
enrollments. If two parents of a TEI child are entitled to be a 
sponsor, they must choose one parent to be the child's sponsor. Dual 
enrollments of TEIs are permitted as provided under Sec.  890.302(a)(2) 
through (4) of this chapter as applied with respect to TEI family 
members.

Subpart C--Eligibility

0
5. Revise Sec.  894.305 to read as follows:


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

    No. Former spouses receiving an apportionment of annuity are not 
eligible to enroll in FEDVIP. However, a TEI former spouse is eligible 
to enroll in a FEDVIP vision plan as long as he or she remains 
unremarried.

0
6. Revise Sec.  894.306 to read as follows:


Sec.  894.306  Are foster children eligible as family members?

    Generally, foster children are eligible for coverage as family 
members under FEDVIP. However, a foster child is excluded from the 
definition of a TEI family member. A pre-adoptive child and an eligible 
ward of the state are eligible as TEI family members.

0
7. Revise Sec.  894.307 to read as follows:


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

    (a) Except as provided at paragraph (b) of this section, a child 
age 22 or over is an eligible family member if the child is incapable 
of self-support because of a physical or mental disability that existed 
before the child reached age 22.
    (b) A TEI child is a TEI family member as long as the TEI child is 
under the age of 21 or 23 as provided at 10 U.S.C. 1072(2)(D) or (I), 
and, if disabled during the age of eligibility, the TEI child remains a 
TEI family member regardless of age as long as the TEI child meets the 
standard for incapacity and support at 10 U.S.C. 1072(2)(D)(iii) or 
incapacity and dependency at 10 U.S.C. 1072(2)(I)(ii)(III), (iii), (iv) 
and (v).

0
8. Add Sec.  894.309 to read as follows:


Sec.  894.309  I am a TEI-D or TEI-V. Am I eligible to enroll in 
FEDVIP, and cover my TEI family members?

    (a) FEDVIP dental plan. (1) A sponsor who is a TEI-D is eligible to 
enroll and cover TEI-D family members under the enrollment.
    (2) A sponsor who is a TEI-D but who does not enroll even though 
eligible, is not an enrollee and cannot enroll or cover TEI family 
members.
    (3) A TEI certifying family member who is a TEI-D is eligible to 
enroll and to cover TEI-D family members under the enrollment when:
    (i) The sponsor is not a TEI-D;
    (ii) The sponsor is deceased; or
    (iii) The sponsor is a TEI-D described at Sec.  894.804(b)(1) or 
(2) who does not enroll (therefore is not an enrollee and cannot cover 
TEI family members) and the sponsor:
    (A) Receives dental services from the Department of Veterans 
Affairs (VA);
    (B) Has employer-sponsored dental coverage without a family 
coverage option; or
    (C) Has a medical or dental condition that prevents him or her from 
obtaining dental benefits.
    (b) FEDVIP vision plan. (1) A sponsor who is a TEI-V is eligible to 
enroll and cover TEI-V family members.
    (2) A TEI certifying family member who is a TEI-V is eligible to 
enroll and cover TEI-V family members under the enrollment when:
    (i) The sponsor is not a TEI-V; or
    (ii) The sponsor is deceased.
    (3) A TEI former spouse is eligible to enroll for self only, but 
may not elect a self plus one or self and family type of enrollment and 
may not cover family members, even if they are TEI family members.

[[Page 58179]]

Subpart D--Cost of Coverage

0
9. In Sec.  894.401, add paragraph (e) to read as follows:


Sec.  894.401  How do I pay premiums?

* * * * *
    (e) A sponsor, TEI certifying family member, TEI former spouse, or 
TEI who is an unremarried survivor pays premiums the following ways:
    (1) A sponsor or TEI certifying family member who receives 
uniformed services pay or uniformed services retirement pay shall pay 
premiums through deduction from payroll (including uniformed services 
retirement pay deduction).
    (2) A sponsor or TEI certifying family member who is not described 
in paragraph (e)(1) of this section, and a TEI former spouse or TEI who 
is an unremarried survivor shall pay premiums through:
    (i) Automatic bank withdrawal; or
    (ii) Direct premium payments.

0
10. In Sec.  894.403, add paragraph (b)(5) to read as follows:


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

* * * * *
    (b) * * *
    (5) You are a TEI.

0
11. Add Sec.  894.406 to read as follows:


Sec.  894.406  What happens if my uniformed services pay or uniformed 
services retirement pay is insufficient to cover my FEDVIP premiums, or 
I go into a nonpay status?

    (a) You must contact the Administrator to arrange to pay your 
premiums by direct premium payment or automatic bank withdrawal to the 
Administrator.
    (b) If you do not make the premium payments, your FEDVIP coverage 
will stop. You will not be able to reenroll until the next open season 
after:
    (1) You are in pay status; or
    (2) Your uniformed services pay or uniformed services retirement 
pay (retired, retainer, or equivalent) is sufficient to make the 
premium payment.

Subpart E--Enrollment and Changing Enrollment

0
12. In Sec.  894.501:
0
a. Remove the word ``or'' at the end of paragraph (b)(2).
0
b. Remove the period and add a semicolon in its place at the end of 
paragraph (b)(3).
0
c. Add paragraphs (b)(4) through (6).
0
d. Remove the word ``or'' at the end of paragraph (e).
0
e. Remove the period and add a semicolon in its place at the end of 
paragraph (f).
0
f. Add paragraph (g).
    The additions read as follows:


Sec.  894.501  When may I enroll?

* * * * *
    (b) * * *
    (4) A sponsor who is a TEI;
    (5) A TEI certifying family member, but only if, on your first date 
of eligibility to enroll, your sponsor is not a TEI or is deceased, or 
for FEDVIP dental coverage, if your sponsor is defined at Sec.  
890.309(a)(3)(iii); or
    (6) A TEI former spouse.
* * * * *
    (g) For a TEI, within 60 days of your uniformed services pay or 
uniformed services retirement pay being restored after having being 
reduced, forfeited, or terminated.

0
13. In Sec.  894.502:
0
a. Revise the section heading.
0
b. Add introductory text.
0
c. Revise paragraph (a).
0
d. Remove the word ``or'' at the end of paragraph (d).
0
e. Remove the period and add a semicolon in its place at the end of 
paragraph (e).
0
e. Add paragraphs (f) and (g).
    The revisions and additions read as follows:


Sec.  894.502  What are the Qualifying Life Events (QLEs) that allow me 
to enroll or become covered in FEDVIP outside of open season?

    You may enroll or become covered outside of open season if you are 
otherwise eligible to enroll and:
    (a) You or a family member or TEI family member lose other dental/
vision coverage;
* * * * *
    (f) You are a TEI and your uniformed services pay or uniformed 
services retirement pay is restored after having been reduced, 
forfeited, or terminated; or
    (g) You are not a TEI and you marry a TEI and can be covered as a 
TEI family member; or, you are not a TEI and you marry a non-TEI 
sponsor that is on active duty and can be covered as a TEI certifying 
family member. However, upon remarriage, a TEI former spouse or TEI 
surviving spouse or widow loses status as a TEI with respect to a 
former or deceased sponsor.

0
14. In Sec.  894.504, revise paragraph (c) and add paragraphs (d) and 
(e) to read as follows:


Sec.  894.504  When is my enrollment effective?

* * * * *
    (c) If you are a TEI and enroll or are enrolled during the open 
season, your enrollment is effective no earlier than January 1, 2019.
    (d) A QLE enrollment or change is effective the 1st day of the pay 
period following the date of your QLE.
    (e)(l) A belated open season enrollment or change is effective 
retroactive to the date it would have been effective if you had made a 
timely enrollment or request for a change.
    (2) Any belated enrollment or change outside of open season that 
goes beyond the allowable 60 day enrollment timeframe is effective 
retroactive to the 1st day of the pay period following the one in which 
you became newly eligible or the date of your QLE.
    (3) You are responsible for any retroactive premiums due to a 
belated enrollment or request for a change.

0
15. Revise Sec.  894.507 to read as follows:


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

    (a) You may change from one dental plan to another, and/or from one 
vision plan to another, or you may change from one plan option to 
another option in that same plan:
    (1) During the annual open season;
    (2) When you get married (except for TEIs who are unremarried 
survivors, TEI former spouses, and TEI children); or
    (3) For employees, when you return to Federal employment after 
being on leave without pay if you did not have Federal dental or vision 
coverage prior to going on leave without pay, or your coverage was 
terminated or canceled during your period of leave without pay.
    (b)(1) If you are enrolled in a dental or vision plan with a 
geographically restricted service area, and you or a covered eligible 
family member or TEI family member move out of the service area, you 
may change to a different dental or vision plan that serves that area.
    (2) You may make this change at any time before or after the move, 
once you or a covered eligible family member or TEI family member has a 
new address.
    (3) The enrollment change is effective the first day of the pay 
period following the pay period in which you make the change.
    (4) You may not change your type of enrollment unless you also have 
a QLE that allows you to change your type of enrollment.

0
16. Revise Sec.  894.509 to read as follows:

[[Page 58180]]

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

    (a) Marriage; except for a TEI who is an unremarried survivor, 
widow or widower; TEI former spouse; and TEI child(ren);
    (b) Acquiring an eligible child or TEI child; or
    (c) Loss of other dental or vision coverage by an eligible family 
member or TEI family member.

0
17. In Sec.  894.510, revise paragraphs (c) and (d)(1) to read as 
follows:


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

* * * * *
    (c)(1) Except as provided in paragraph (c)(2) of this section, you 
may decrease your type of enrollment only during the period beginning 
31 days before your QLE and ending 60 days after your QLE.
    (2) You may make any of the following enrollment changes at any 
time beginning 31 days before a QLE listed in Sec.  894.511(a):
    (i) A decrease in your self plus one enrollment;
    (ii) A decrease in your self and family enrollment to a self plus 
one enrollment, when you have only one remaining eligible family member 
or TEI family member; or
    (iii) A decrease in your self and family enrollment to a self only 
enrollment, when you have no remaining eligible family members or TEI 
family members.
    (d)(1) Except as provided in paragraph (d)(2) of this section, your 
change in enrollment is effective the first day of the first pay period 
following the one in which you make the change.
* * * * *

0
18. Revise Sec.  894.511 to read as follows:


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

    (a) Loss of an eligible family member or TEI family member due to:
    (1) Divorce;
    (2) Death; or
    (3) Loss of eligibility of a previously enrolled child or TEI 
child.
    (b) You are an employee, annuitant or compensationer and your 
spouse deploys to active military service.

0
19. Add Sec.  894.513 to read as follows:


Sec.  894.513  Do I have to elect FEDVIP coverage each year in order to 
remain covered?

    No. If you do not change or cancel your enrollment, and if your 
enrollment does not terminate pursuant to this part, then your current 
enrollment will continue into the next year. Before open season, you 
should review the plan brochure for any changes in benefits and 
premiums for the next year.

Subpart F--Termination or Cancellation of Coverage

0
20. Amend Sec.  894.601 by revising paragraphs (a) through (c) and 
adding paragraphs (g) and (h) to read as follows:


Sec.  894.601  When does my FEDVIP coverage stop?

    (a) If you no longer meet the definition of an eligible employee or 
annuitant, or TEI, your FEDVIP coverage stops at the end of the pay 
period in which you were last eligible.
    (b) If you go into a period of nonpay or insufficient pay (or 
insufficient uniformed services pay or uniformed services retirement 
pay) and you do not make direct premium payments, your FEDVIP coverage 
stops at the end of the pay period for which your agency, retirement 
system, OWCP, uniformed services or uniformed services retirement 
system last deducted your premium payment.
    (c) If you are making direct premium payments or payments by 
automatic bank withdrawal, and you stop making the payments, your 
FEDVIP coverage stops at the end of the pay period for which you last 
made a payment.
* * * * *
    (g) If your status as a uniformed services retiree discontinues and 
you become a uniformed services member on active duty, your FEDVIP 
dental and/or vision plan enrollment terminates and your coverage stops 
at the end of the last pay period for which the premium payment was 
made from your uniformed services retirement pay. You will still be the 
sponsor but no longer the enrollee, and your TEI certifying family 
member would have to reenroll in vision and cover all TEI family 
members. As sponsor, you must notify your family members of changes in 
your eligibility and enrollment status changes. See Sec.  894.815.
    (h) If your status as a uniformed services member on active duty 
discontinues and you become a uniformed services retiree, the FEDVIP 
vision plan enrollment of your TEI family members terminates and 
coverage for your TEI family members will stop at the end of the pay 
period for which the last premium payment was made. As the sponsor who 
is an enrollee, you would have to enroll yourself and reenroll all TEI 
family members. As sponsor, you must notify your family members of 
changes in your eligibility and enrollment status changes. See Sec.  
894.815.

0
21. Revise Sec.  894.603 to read as follows:


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

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

Subpart H--[Redesignated as Subpart I and Amended]

0
22. Redesignate subpart H (consisting of Sec.  894.801) as subpart I 
(consisting of Sec.  894.901) and revise newly redesignated subpart I 
to read as follows:

Subpart I--Benefits in Underserved Areas


Sec.  894.901  Will benefits be available in underserved areas?

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

0
23. Add new subpart H to read as follows:
Subpart H--Special Provisions for TRICARE-Eligible Individuals (TEI)
Sec.
894.801 Am I eligible for FEDVIP based on my eligibility to enroll 
in a TRICARE dental or health plan?
894.802 Am I a TEI for a FEDVIP dental plan (TEI-D) if I am eligible 
to enroll or be covered under the TRICARE Retiree Dental Program?
894.803 Am I a TEI for a FEDVIP vision plan (TEI-V) based on my 
enrollment in a TRICARE health plan?
894.804 Am I a sponsor for a FEDVIP dental or vision plan?
894.805 I am not a TEI-D or TEI-V, but I am a sponsor. Am I eligible 
to cover my TEI family members?
894.806 Can a retiree or Retired Reserve member enroll and cover TEI 
family members in a FEDVIP dental plan?
894.807 Can an active duty member enroll or be covered under a 
FEDVIP vision plan?
894.808 I am a TEI family member. Can I enroll myself in FEDVIP?

[[Page 58181]]

894.809 Who is a TEI certifying family member, and may I be the 
enrollee if I accept this responsibility?
894.810 If I enroll for self plus one, may I decide which TEI family 
member to cover?
894.811 I am a TEI family member of a sponsor who is a retiree or 
Retired Reserve member who is not on active duty. My sponsor is a 
TEI-D but is not enrolled in a FEDVIP dental plan. Can I enroll in a 
FEDVIP dental plan even though my sponsor is eligible to enroll but 
is not enrolled?
894.812 I am a widow or widower TEI family member. Can I enroll my 
TEI child who is a TEI family member without enrolling myself in 
FEDVIP?
894.813 I am a TEI former spouse. Am I eligible to enroll in a 
FEDVIP vision plan?
894.814 Is a foster child included in the definition of TEI family 
member?
894.815 I am a sponsor. Am I responsible to notify the Administrator 
and my TEI family members when my FEDVIP dental or vision 
eligibility and/or enrollment status changes?
894.816 If I return from active duty and retire, what happens to my 
TEI family members' enrollment in their FEDVIP vision plan?
894.817 If I am a retiree who is a TEI-V and I return to active 
duty, what happens to my TEI family members' enrollment in their 
FEDVIP vision plan?

Subpart H--Special Provisions for TRICARE-Eligible Individuals 
(TEI)


Sec.  894.801  Am I eligible for FEDVIP based on my eligibility to 
enroll in a TRICARE dental or health plan?

    (a) The U.S. Department of Defense (DOD) is responsible for 
regulating eligibility for obtaining medical and dental care under the 
TRICARE Program, pursuant to 10 U.S.C. chapter 55. The FEDVIP laws at 5 
U.S.C. chapter 89A was amended by the National Defense Authorization 
Act for Fiscal Year 2017, Public Law 114-328, to allow individuals who 
were eligible for coverage under the TRICARE Retiree Dental Program 
(TRDP) in accordance with DOD rules to obtain dental coverage in a 
FEDVIP dental plan. Public Law 114-328 also added a provision allowing 
certain individuals who are concurrently enrolled for medical care in 
specified TRICARE health plans to obtain FEDVIP vision coverage.
    (b) Categories of individuals who were eligible for TRDP and who 
are eligible to be covered under a FEDVIP dental plan are set forth in 
Sec.  894.802. Categories of individuals who may be covered under 
specified TRICARE health plans and, if so covered, are eligible to be 
covered under a FEDVIP vision plan, are set forth in Sec.  894.803. 
Individuals eligible for FEDVIP coverage are referred to as TRICARE 
eligible individuals (TEI).
    (c)(1) FEDVIP rules provide an enrollee with the right to select:
    (i) A dental and/or a vision plan; and
    (ii) Type of enrollment that may cover the eligible individual in a 
self only enrollment or the eligible individual with one or more family 
members in a self plus one or self and family enrollment.
    (2) For TRICARE eligible individuals (TEI), this means that:
    (i) If the sponsor is both a TEI and enrolled, the sponsor may be 
an enrollee and may cover the sponsor and TEI family members under the 
plan.
    (ii) If a sponsor is not eligible to enroll (or pursuant to Sec.  
894.309(a)(3)(iii) is not enrolled), a TEI who is a TEI family member 
may self-certify to serve as enrollee instead, and may cover other TEI 
family members.
    (d) If a FEDVIP dental or vision plan has a specific geographic 
enrollment area, TEI family members must live or work in that area in 
order to be enrolled for coverage. An enrollee whose TEI family members 
are located in different geographic locations may select a plan that is 
nationwide/international in scope in order to obtain accessible 
coverage.


Sec.  894.802  Am I a TEI for a FEDVIP dental plan (TEI-D) if I am 
eligible to enroll or be covered under the TRICARE Retiree Dental 
Program?

    A TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) 
means an individual who is eligible to be enrolled and/or who may be 
covered under the TRICARE Retiree Dental Program (TRDP) pursuant to 10 
U.S.C. 1076c(b) as set forth in 32 CFR 199.3 and 199.22. Individuals 
covered under any of the following programs are excluded and are not 
TEI-D: TRICARE Young Adult provisions of 10 U.S.C. 1110b; Transitional 
Assistance Management Program (TAMP), 10 U.S.C. 1145(a)); Continued 
Health Care Benefit Program (CHCBP); 10 U.S.C. 1078a; or Foreign 
Military (including NATO) sponsor/family coverage.


Sec.  894.803  Am I a TEI for a FEDVIP vision plan (TEI-V) based on my 
concurrent enrollment in a TRICARE health plan?

    (a) Except as provided in paragraphs (b) and (c) of this section, a 
TEI-V is an individual who is concurrently enrolled in and/or covered 
pursuant to:
    (1) 10 U.S.C. 1076d (TRICARE Reserve Select (TRS));
    (2) 10 U.S.C. 1076e (TRICARE Retired Reserve (TRR));
    (3) 10 U.S.C. 1079(a) (uniformed services active duty family 
members concurrently enrolled in TRICARE Select or TRICARE Prime);
    (4) 10 U.S.C. 1086(c) (uniformed services retirees and retiree 
family members or former spouses concurrently enrolled in TRICARE 
Select or TRICARE Prime); or
    (5) 10 U.S.C. 1086(d) (TRICARE for Life (TFL)), as set forth in 32 
CFR 199.3. The provisions of TFL require Medicare eligible retirees and 
individual Medicare eligible retiree family members or former spouses 
to enroll in Medicare Part B (requires payment of applicable premiums), 
otherwise they are not a TEI-V.
    (b) An individual covered under any of the following programs is 
not a TEI-V:
    (1) TRICARE Young Adult provisions of 10 U.S.C. 1110b;
    (2) Transitional Assistance Management Program (TAMP), 10 U.S.C. 
1145(a);
    (3) Continued Health Care Benefit Program (CHCBP), 10 U.S.C. 1078a; 
or
    (4) Foreign Military (including NATO) sponsor/family coverage.
    (c) An active duty member of the uniformed services under 10 U.S.C. 
1074(a) is not a TEI-V.


Sec.  894.804  Am I a sponsor for a FEDVIP dental or vision plan?

    (a) Generally, the sponsor is the individual who is eligible for 
medical or dental benefits under 10 U.S.C. chapter 55 based on his or 
her direct affiliation with the uniformed services, including military 
members of the National Guard and Reserves. Relationship to a sponsor 
conveys TEI status to a TEI family member. If two parents of a TEI 
child are entitled to be a sponsor, see restriction on dual enrollment 
at Sec.  894.203.
    (b) Sponsor for a FEDVIP dental plan means:
    (1) Retiree. A member or former member of a uniformed service who 
is entitled to uniformed services retirement pay. To determine a 
sponsor's enrollee status for a FEDVIP dental plan, see Sec.  894.309 
and the definition of TEI-D;
    (2) Retired Reserve member under the age of 60 (``Gray Area 
Retiree''). To determine sponsor's enrollee status for a FEDVIP dental 
plan, see Sec.  894.309 and the definition of TEI-D;
    (3) Medal of Honor recipient who is not otherwise entitled to 
dental benefits; or
    (4) Deceased Member described in paragraph (b)(1) or (2) of this 
section who died after retiring from active duty and a deceased member 
who was a Medal of Honor recipient described in paragraph (b)(3) of 
this section.

[[Page 58182]]

    (c) Sponsor for a FEDVIP vision plan includes:
    (1) Retiree. A member or former member of a uniformed service who 
is entitled to uniformed services retirement pay.
    (2) Retired Reserve member under the age of 60 (``Gray Area 
Retiree'');
    (3) Medal of Honor recipient who is enrolled in TRICARE Select or 
TRICARE
    Prime and who is not on active duty;
    (4) Member of the uniformed services (active or Reserve Component) 
on active duty for more than 30 days. An active duty member of the 
uniformed services under 10 U.S.C. 1074(a) is not a TEI-V and is not an 
enrollee for a FEDVIP vision plan, see Sec.  894.309 and definition of 
TEI-V;
    (5) Ready Reserve member;
    (6) Deceased member described at paragraphs (c)(1) through (5) of 
this section; or
    (7) Deceased Reserve Component member (deceased in the line of 
duty).


Sec.  894.805  I am not a TEI-D or TEI-V, but I am a sponsor. Am I 
eligible to cover my TEI family members?

    (a) FEDVIP dental plan. (1) No, a sponsor must be both a TEI-D and 
an enrollee, in order to cover TEI family members in a FEDVIP dental 
plan.
    (2) However, a TEI certifying family member may enroll and cover 
TEI family members in a FEDVIP dental plan if the sponsor described at 
Sec.  894.804 is a retiree or Retired Reserve Member who is a TEI-D, 
but who is not enrolled and the retiree or Retired Reserve Member:
    (i) Receives VA dental services;
    (ii) Has employer-sponsored dental coverage without a family 
coverage option; or
    (iii) Has a medical or dental condition that prevents him or her 
from obtaining dental benefits. See Sec.  894.309.
    (b) FEDVIP vision plan. (1) No, a sponsor must be both a TEI-V and 
an enrollee in order to enroll and cover TEI family members in his or 
her FEDVIP vision plan.
    (2) However, a TEI certifying family member may enroll TEI family 
members. A uniformed services member (active or Reserve Component) on 
active duty for more than 30 days described in Sec.  894.804(c)(4) is 
not a TEI-V and is not eligible to enroll and cover TEI family members. 
See Sec.  894.309.


Sec.  894.806  Can a retiree or Retired Reserve member enroll and cover 
TEI family members in a FEDVIP dental plan?

    Generally, yes, since a retiree or Retired Reserve member who is a 
sponsor is also a TEI-D. However, if a retiree or Retired Reserve 
member who is eligible to enroll does not in fact enroll, then the 
member is not an enrollee and cannot cover TEI family members. A TEI 
certifying family member may serve as enrollee only if the member does 
not enroll and meets at least one of the following conditions:
    (a) Receives VA dental services;
    (b) Has employer-sponsored dental coverage without a family 
coverage option; or
    (c) Has a medical or dental condition that prevents him or her from 
obtaining dental benefits. See description of eligibility in Sec.  
894.309(a)(3)(iii).


Sec.  894.807  Can an active duty member enroll or be covered under a 
FEDVIP vision plan?

    No, a uniformed services member on active duty is not a TEI-V and 
may not enroll or be covered under a FEDVIP vision plan. However, an 
active duty member is a sponsor, therefore their TEI family members may 
be eligible to enroll in a vision plan. See definition of TEI for 
FEDVIP vision benefits (TEI-V) in Sec.  894.101.


Sec.  894.808  I am a TEI family member. Can I enroll myself in FEDVIP?

    Generally, you are not eligible to enroll yourself as a TEI family 
member. Only an enrollee designated at subpart C of this part may 
enroll in FEDVIP and select a plan, option, and type of enrollment 
(self only, self plus one, or self and family) that may cover TEI 
family members. There is only one FEDVIP dental enrollment and one 
FEDVIP vision enrollment associated with a sponsor and either the 
sponsor or a TEI certifying family member may be the enrollee, who may 
enroll, and cover TEI family members under the enrollment, in 
accordance with Sec.  894.309.


Sec.  894.809  Who is a TEI certifying family member, and may I be the 
enrollee if I accept this responsibility?

    (a) TEI certifying family member means, where the sponsor is not an 
enrollee under Sec.  894.309, the TEI family member in order of 
precedence, as set forth in paragraph (b) of this section, who may 
accept responsibility to self-certify as the enrollee by enrolling and, 
if appropriate, covering the sponsor's TEI family members by electing a 
self plus one or self and family type of enrollment. Accepting 
responsibility to self-certify as the enrollee includes consulting all 
TEI family members regarding their preference for coverage under the 
enrollment, electing an appropriate plan, option, and type of 
enrollment.
    (b) The following order of precedence governs which TEI family 
member may self-certify as the enrollee:
    (1) An unremarried surviving spouse of a retiree or Medal of Honor 
recipient, if any, is the TEI certifying family member who may enroll 
and cover surviving TEI child(ren) of the retiree.
    (2) If there is no unremarried surviving spouse of a retiree or 
Medal of Honor recipient, the surviving TEI child of a retiree who 
accepts responsibility to self-certify as the enrollee is the TEI 
certifying family member who may enroll and cover other surviving 
child(ren) who are TEI family member(s) of the deceased retiree.
    (3) The TEI family member who is a spouse is the TEI certifying 
family member who may enroll and cover other TEI family member(s).
    (4) If there is no spouse, the TEI family member who accepts 
responsibility to self-certify as the enrollee is the TEI certifying 
family member who may enroll and cover other TEI family member(s).
    (c) In the event that the TEI family member or TEI certifying 
family member is a minor child or a disabled adult dependent, a legal 
guardian may exercise the TEI's rights on his or her behalf.
    (d) Accepting responsibility to self-certify as the enrollee means 
that you accept the Administrator's authority to make reconsideration 
decisions under Sec.  894.104 and OPM's authority to correct 
enrollments under Sec.  894.105.


Sec.  894.810  If I enroll for self plus one, may I decide which TEI 
family member to cover?

    Generally, yes, as specified in Sec.  894.202. However, if you are 
an enrollee and you do not elect a type of enrollment that covers a TEI 
family member, that TEI family member will not have FEDVIP coverage or 
benefits. A TEI family member who is not a TEI certifying family member 
may not self-certify and enroll himself or herself as a TEI family 
member in a FEDVIP plan. Note however, that a TEI family member may 
seek reconsideration of an erroneous enrollment under Sec.  894.104, 
and the Administrator and OPM retain authority to correct enrollments 
under Sec.  894.105.


Sec.  894.811  I am a TEI family member of a sponsor who is a retiree 
or Retired Reserve member who is not on active duty. My sponsor is a 
TEI-D but is not enrolled in a FEDVIP dental plan. Can I enroll in a 
FEDVIP dental plan even though my sponsor is eligible to enroll but is 
not enrolled?

    Generally, if your sponsor is a TEI-D, he or she must enroll in a 
FEDVIP dental plan in order to cover TEI family

[[Page 58183]]

members. As an exception, however, a TEI family member can accept the 
responsibility to self-certify and enroll in a FEDVIP dental plan as a 
TEI certifying family member, and cover other TEI family members, if 
the sponsor who is a TEI-D (eligible for FEDVIP dental benefits) is not 
enrolled and the sponsor meets at least one of the following conditions 
identified in Sec.  894.309(a)(3)(iii):
    (a) The retiree sponsor receives VA dental services;
    (b) The retiree sponsor has employer-sponsored dental coverage 
without a family coverage option; or
    (c) The retiree sponsor has a medical or dental condition that 
prevents him or her from obtaining dental benefits.


Sec.  894.812  I am a widow or widower TEI family member. Can I enroll 
my TEI child who is a TEI family member without enrolling myself in 
FEDVIP?

    No. A widow or widower who is a TEI family member is the TEI 
certifying family member. Because there is no available sponsor, you 
are the enrollee, and must either:
    (a) Enroll yourself and the TEI child in a self plus one 
enrollment; or
    (b) Enroll all TEI family members in a self and family enrollment, 
in order for the TEI child to receive FEDVIP coverage.


Sec.  894.813  I am a TEI former spouse. Am I eligible to enroll in a 
FEDVIP vision plan?

    Yes, you are eligible to enroll in a FEDVIP vision plan only. A TEI 
former spouse is not eligible to enroll in a FEDVIP dental plan. You 
are a TEI-V, and you are an enrollee, however your type of enrollment 
is limited to self only. You may not enroll a child, even if the child 
is a TEI child. The TEI child will have his or her opportunity for 
FEDVIP dental and/or vision coverage through your ex-spouse sponsor, or 
TEI certifying family member as the case may be. It is possible for a 
minor TEI child to be the TEI certifying family member eligible to 
enroll as an enrollee. If this is the case, you (or the TEI child's 
legal guardian if not you) may effectuate that enrollment by accepting 
responsibility on behalf of the TEI child to self-certify as enrollee 
by enrolling and, if appropriate, covering other TEI family members of 
the sponsor. Accepting responsibility to self-certify as enrollee on 
behalf of the TEI child includes consulting all of the TEI family 
members of the TEI certifying family member regarding their preference 
for coverage under the enrollment, electing an appropriate plan, option 
and type of enrollment, and paying the premium on behalf of the TEI 
child and other TEI family members for the enrollment.


Sec.  894.814  Is a foster child included in the definition of TEI 
family member?

    A foster child is excluded from coverage as they are not defined to 
be a TEI family member. However, a pre-adoptive child, adopted child, 
and an eligible ward of the state are considered TEI family members.


Sec.  894.815  I am a sponsor. Am I responsible to notify the 
Administrator and my TEI family members when my FEDVIP dental or vision 
eligibility and/or enrollment status changes?

    Yes, as sponsor, you must notify the Administrator and your TEI 
family members of changes in your eligibility and enrollment status. 
Status as an enrollee, with a right to the enrollment, depends upon 
your sponsor status and eligibility as a TEI, and the enrollment action 
you have taken. Failure to notify the Administrator and your TEI family 
members of a change in status within the uniformed services that 
affects your eligibility to enroll may result in invalid continued 
enrollment, or an unexpected termination of enrollment, for your TEI 
family members, for which you will be responsible.
    (a) Example 1. (1) Status change from non-enrollee to enrollee.
    (2) You are on active duty (not TEI and not an enrollee in a dental 
or vision plan). Your TEI certifying family member may enroll and cover 
TEI family members in a FEDVIP plan. Upon a change in your status to a 
retiree or Retired Reserve member (who is not on active duty), you 
become a TEI and may enroll yourself and TEI family members in a FEDVIP 
plan. Your TEI certifying family member is no longer the enrollee, and 
you must notify the Administrator of your change in status. The 
Administrator will send the TEI certifying family member notice that 
his or her enrollment is terminated, and notify them that their sponsor 
(i.e. you), may enroll, and may cover TEI family members on the new 
enrollment.
    (b) Example 2. (1) Status change from non-enrollee to enrollee.
    (2) You are a retiree or a retired Reserve member and as a TEI-D 
you are eligible for, but not enrolled in, a FEDVIP dental plan and you 
satisfy at least one of the conditions at Sec.  894.309(a)(3)(iii). You 
are not an enrollee because you are not enrolled, and therefore cannot 
cover TEI family members. Your TEI certifying family member may enroll 
and cover TEI family members in a FEDVIP dental plan. Upon a change in 
your status causing you to no longer satisfy one of the conditions, 
your TEI certifying family member is no longer the enrollee, and you 
must notify the Administrator. The Administrator will send your TEI 
certifying family member notice that their enrollment is terminated, 
and notify them that their sponsor (i.e. you), may enroll, and may 
cover TEI family members on the new enrollment.
    (c) Example 3. (1) Status change from enrollee to non-enrollee.
    (2) You are a retiree or Retired Reserve member (who is not on 
active duty), and you go on active duty. You lose TEI status and you 
are no longer eligible to be an enrollee. You must notify the 
Administrator of your change in status. The Administrator will 
terminate your enrollment and notify you that a TEI certifying family 
member may accept responsibility to self-certify as enrollee by 
enrolling and, if appropriate, covering other TEI family members by 
electing self plus one or self and family type of enrollment for only a 
FEDVIP vision plan. You are responsible to notify your covered TEI 
family members that your enrollment will terminate, and of their 
opportunity to accept responsibility to self-certify as enrollee.


Sec.  894.816  If I return from active duty and retire, what happens to 
my TEI family members' enrollment in their FEDVIP vision plan?

    As a uniformed services member on active duty, you are the sponsor 
but you are not eligible to enroll in a FEDVIP vision plan and you 
cannot be the enrollee. A TEI certifying family member may be the 
enrollee while you are on active duty. Upon your retirement, however, 
you become eligible to enroll as a TEI-V and TEI-D, and the current 
enrollee status of your TEI certifying family member ends. As sponsor, 
you are responsible for notifying the Administrator and your TEI family 
members of your change in status. The TEI family members' enrollment 
will be terminated and as a TEI-V and TEI-D who is both sponsor and 
enrollee, you may enroll yourself and cover TEI family members. See 
Sec.  894.601.


Sec.  894.817  If I am a retiree who is a TEI-V and I return to active 
duty, what happens to my TEI family members' enrollment in their FEDVIP 
vision plan?

    If you and your TEI family members are enrolled in a FEDVIP vision 
plan while you are retired, and you return to active duty, you will no 
longer be eligible to enroll in a FEDVIP vision plan and cannot 
continue to be the enrollee even though you are the sponsor. The 
current enrollment for you and your TEI family members will terminate 
and your coverage stops at the end of the pay period for which the 
premium payment was made from your

[[Page 58184]]

uniformed services retirement pay. A TEI certifying family member may 
accept responsibility to self-certify as the enrollee by enrolling and, 
if appropriate, covering other TEI family members. You are responsible 
for notifying your covered TEI family members that your enrollment will 
terminate and of their opportunity to accept responsibility to self-
certify as the enrollee. Once the TEI certifying family member enrolls, 
and covers your TEI family members, they can remain enrolled in a 
FEDVIP vision plan for the duration of your active duty service. See 
Sec.  894.601.

[FR Doc. 2018-25114 Filed 11-14-18; 4:15 pm]
 BILLING CODE 6325-64-P