Enhancing Stability and Flexibility for the Federal Long Term Care Insurance Program (FLTCIP)-Abbreviated Underwriting, Applications for FLTCIP Coverage, and Technical Corrections, 68595-68599 [2022-24849]
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68595
Rules and Regulations
Federal Register
Vol. 87, No. 220
Wednesday, November 16, 2022
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.
OFFICE OF PERSONNEL
MANAGEMENT
5 CFR Part 875
RIN 3206–AO21
Enhancing Stability and Flexibility for
the Federal Long Term Care Insurance
Program (FLTCIP)—Abbreviated
Underwriting, Applications for FLTCIP
Coverage, and Technical Corrections
Office of Personnel
Management.
ACTION: Final rule.
AGENCY:
The Office of Personnel
Management (OPM) is issuing a final
regulation to support enhancing
stability and flexibility in FLTCIP by
amending when abbreviated
underwriting will be offered to
prospective enrollees and finalizing
rules for the suspension of applications
for coverage and the requirements
around any such suspension periods.
OPM is also finalizing technical
corrections for the sake of clarity and to
remove redundancies. This final rule
adopts the proposed regulations with
one technical change correcting the
provision related to the Federal appeals
board that is delegated the authority to
resolve contract disputes between the
Carrier and OPM. Finally, OPM may
effectuate a suspension period after
publication of this final rule with a
separate document in the Federal
Register.
DATES: Effective on November 16, 2022.
OPM will publish a separate document
announcing the effective date of a
suspension period in the Federal
Register.
FOR FURTHER INFORMATION CONTACT:
Dyan Dyttmer, Senior Policy Analyst,
dyan.dyttmer@opm.gov, (202) 936–
0152.
SUPPLEMENTARY INFORMATION: On June 3,
2022, OPM published proposed
regulations (87 FR 33653), which
proposed amendments to 5 CFR part
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SUMMARY:
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875 to support FLTCIP stability and
flexibility by amending when
abbreviated underwriting will be offered
to prospective enrollees and proposing
rules for the suspension of applications
for coverage and the requirements
around any such suspension periods.
OPM also proposed technical
corrections for the sake of clarity and to
remove redundancies. Finally, with the
publication of the proposed rule, OPM
provided notice of an anticipated
suspension period.
The comment period for the proposed
rule closed on July 5, 2022. OPM
received three comments from
individuals on the proposed rule, and a
Federal appeals board contacted us
regarding OPM’s delegation of authority
to resolve contract disputes in 5 CFR
875.109. A summary of the comments
OPM received follows, along with our
responses to the comments and a
technical change OPM is making to the
final rule in response to the comments.
Responses to Comments on the
Proposed Rule
One commenter questioned OPM’s
authority to authorize a suspension
period and to change the 60-day
abbreviated underwriting period
allowed to newly eligible active
workforce members and spouses. The
commenter asserted that OPM lacked
authority to suspend applications based
on the statutory language in 5 U.S.C.
9002(a) which states that OPM shall
establish and administer the FLTCIP for
which eligible individuals may obtain
long term care insurance coverage. The
commenter stated that the statutory
construct should be interpreted to mean
that OPM must offer eligible individuals
an opportunity to enroll in the FLTCIP.
Another commenter questioned OPM’s
authority to suspend applications for a
period, as this would reduce premiums
received from enrollees prevented from
enrolling and therefore increase
premiums for those already enrolled.
OPM disagrees with these comments
and concludes that it has the authority
to institute these changes to FLTCIP.
OPM’s authority to establish and
administer the Program brings with it
the obligation to oversee the Program’s
functioning and to protect both current
and prospective enrollees, as well as the
health of the Program as a whole. OPM
has authority under 5 U.S.C. 9008 to
prescribe regulations to effectuate this
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authority, including to create through
regulation the ability to suspend
applications for coverage, with notice
and for a reasonable period of time,
when necessary for the proper
administration of the Program. It is also
within OPM’s authority to alter through
regulation the circumstances under
which abbreviated underwriting may be
offered. As OPM explained in the
preamble of the proposed rule, the
purpose of creating through regulation
the ability to suspend applications is to
protect eligible individuals from
applying to enroll when OPM has
determined that underwriting processes
may need revisions or when the current
premium rates offered to new applicants
may not reasonably and equitably reflect
the cost of the benefits as required
under 5 U.S.C. 9003(b)(2). Finally, OPM
acknowledges that if FLTCIP is
suspended for a period this would
prevent currently eligible and newly
eligible individuals from applying for
coverage during the suspension, and
individuals may have to wait to apply
after the suspension period or seek
alternative coverage. As explained in
the preamble of the proposed rule, the
number of potential new enrollees
would be small. OPM will only suspend
applications when it is in the best
interest of the Program, as required by
this final rule.
One commenter stated that the
proposed rule is arbitrary and
capricious under the Administrative
Procedure Act because OPM stated in
the preamble that it considered the
Notice of Proposed rulemaking to serve
as the notice required under the
proposed 5 CFR 875.110(b), which is
being finalized in this final rule. OPM
is clarifying that the proposed rule
served as notice to the public that OPM
intends to suspend FLTCIP applications
and establishes the process for
suspension, amends abbreviated
underwriting rules, and modifies the
regulations. OPM is clarifying that these
actions, including the process for
suspension as proposed in 5 CFR
875.110, will be effectuated after
publication of the final rule, not after
the proposed rule as the commenter
stated.
One commenter questioned whether
OPM consulted with the Secretaries of
the uniformed services before
promulgating the rule as required by 5
U.S.C. 9008(c). OPM fulfilled the
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requirement of consultation through the
inter-agency review process before it
published the proposed rule.
All three of the commenters expressed
general concerns about the manner in
which OPM administers FLTCIP. They
suggested that OPM should act in a
fashion similar to state insurance
regulators, such as by adopting
standards set by the National
Association of Insurance Commissioners
(NAIC) for long term care insurance rate
increases, conducting public rate
hearings, and taking expert and enrollee
testimony. They also suggested that
OPM should be more transparent in its
operation of the Program, such as by
making public its communications with
the FLTCIP Carrier. Finally, one
commenter suggested that OPM should
require the FLTCIP Carrier and
administrator to be more transparent
regarding their operations, such as by
publishing quarterly reports with
information about pay-outs, expenses,
reserves, and investment mix.
OPM acknowledges the importance of
transparency and consumer protections
for FLTCIP enrollees. OPM complies
with consumer protections in the
FLTCIP statute and the Health Insurance
Portability and Accountability Act of
1996, including by providing a
contingent benefit upon lapse, inflation
protection options, portability, and
guaranteed renewability (except when
enrollees fail to pay their premiums). As
part of contracting, OPM and the
FLTCIP Carrier agree to specific
requirements for the insurer to follow,
including certain NAIC model
standards. While OPM will consider
these comments in its future
administration of the Program, the
comments are outside the scope of this
rule and require no further response.
The Armed Services Board of Contract
Appeals (ASBCA) also contacted OPM
seeking clarification regarding the
appropriate board of contract appeals to
resolve contract disputes between OPM
and the FLTCIP Carrier. The ASBCA
correctly noted that although OPM’s
regulations currently identified the
ASBCA as the board of contract appeals
with jurisdiction, the National Defense
Authorization Act for Fiscal Year 2006
created the Civilian Board of Contract
Appeals (CBCA) and specified the
jurisdiction of the ASBCA and CBCA.
As an executive agency, OPM contract
disputes are within the jurisdiction of
the CBCA pursuant to 41 U.S.C. 7105(b).
OPM is making a technical correction
that updates our regulations to reflect
that the CBCA, not the ASBCA, will
resolve contract disputes related to
FLTCIP.
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Notice of Suspension Period
OPM will issue a separate Federal
Register document announcing the
beginning date and anticipated length of
any suspension period at least 30 days
before the suspension period starts.
Changes From Proposed Rule
OPM has made a change to the final
rule to clarify 5 CFR 875.110. The
proposed rule included the process for
suspending applications for FLTCIP
coverage after publication of a
document in the Federal Register. The
proposed rule also included a process
for extending such a suspension. The
final rule clarifies that each extension to
the suspension period is limited to 24
months. Each extension will be based
on current information supporting
OPM’s conclusion that continuing the
suspension is in the best interest of the
Program, and each extension will
require publication in the Federal
Register.
OPM has made one technical
correction to this final rule. This final
rule clarifies in 5 CFR 875.109 that the
Civilian Board of Contract Appeals has
jurisdiction to resolve contract disputes
related to FLTCIP. Except for the change
above and this technical correction,
OPM is issuing this final rule with no
other changes.
Expected Impact of the Final Rule
The changes in this final rule,
including underwriting changes and any
future suspensions of applications for
FLTCIP coverage, will not affect current
FLTCIP enrollees. Individuals already
enrolled in FLTCIP will retain their
coverage as long as they continue to pay
premiums. The changes impact new
enrollment and are expected to impose
no more than de minimus
administrative costs to Federal agencies
since FLTCIP is an enrollee-pay-all
program, and there is no Government
contribution toward enrollee premiums.
OPM expects that the rule will not
result in a significant impact on the
eligible or newly eligible population.
Approximately 6,000 eligible
individuals enroll in FLTCIP annually,
which is less than 0.1% of 11 million
eligible federal and military actives and
annuitants (not including spouses and
other qualified relatives who are also
eligible). This low percentage mirrors
the low uptake for purchasing long term
care insurance (LTCI) in the broader
LTC market. According to a Treasury
Report of the Federal Interagency Task
Force on Long-Term Care Insurance,
sales of new LTCI policies have
declined since the early 2000s, as
numerous insurers decided to exit the
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market due to the poor financial
performance of the product line; and
low take-up rates for LTCI appear to
stem in part from low demand for these
products.1 The report identifies factors
influencing demand including:
substitutes for private LTCI such as
Medicaid; unpaid care or the ability to
receive informal care from family; a
desire to leave assets to heirs can
suppress demand because people may
be motivated to postpone consumption
and save money; lack of information
and awareness about LTC costs and the
ways to finance those costs; lack of trust
in insurers; and premiums, costs, and
loads.2
Since less than 0.1% of the eligible
population annually enroll in FLTCIP,
based on this trend and market trends,
it is unlikely that newly eligible
individuals would have a high demand
for LTCI during a suspension of
applications. Further, there are other
options for eligible individuals to plan
for LTC needs. Some other options to
plan for LTC needs during a suspension
period include the following: saving for
future needs by setting aside funds to
invest in a 401(k), an IRA, or a nonretirement investment account;
investing in a long-term care annuity;
purchasing a ‘‘combination’’ or
‘‘hybrid’’ product that combines a life
insurance policy with a LTC rider; or
purchasing a short-term care insurance
policy.
Indirect Effects on Other Parties
OPM does not believe this regulation
will have a large impact on the broader
LTCI market. Approximately 6,000
eligible individuals enroll in FLTCIP
annually, which is less than 0.1% of the
eligible population. At an average
premium of $125 per month or $1,500
per year, the forgone annual premium
for new enrollees would total less than
$10 million per year during any FLTCIP
enrollment suspension. As discussed
above, affected individuals would likely
pursue substitute savings and insurance
products during a suspension period.
OPM estimates that the magnitude of
the forgone $10 million on other parties,
such as LTC insurers in the LTCI
market, would be quite small compared
to the larger LTCI market.
1 U.S. Department of the Treasury, ‘‘Long-Term
Care Insurance: Recommendations for Improvement
of Regulation.’’ Report of the Federal Interagency
Task Force on Long-Term Care Insurance, August
2020, https://home.treasury.gov/system/files/136/
Report-Federal-Interagency-Task-Force-LongTermCare-Insurance.pdf.
2 See footnote 1.
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Benefits of the Final Rule
This final rule establishes provisions
for OPM to suspend applications to
FLTCIP when it is in the best interest of
the program; for example, in order to
allow for adjustment to underwriting
processes or to reprice premium rates
after a review of actuarial assumptions.
The rule aims to protect eligible
individuals from applying to enroll
when it has been determined that
underwriting processes may need
revisions or when the current premium
rates may not reflect the cost of the
benefits provided due to market
volatility and changes to projections
about future costs. This allows OPM and
the FLTCIP carrier to agree on
underwriting changes or new premium
rates that reasonably and equitably
reflect the cost of the benefits provided
as required by the FLTCIP statute.
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563
direct 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). Executive Order 13563
emphasizes the importance of
quantifying both costs and benefits and
of reducing costs, harmonizing rules,
and promoting flexibility. This rule has
been designated as a significant, but not
economically significant, regulatory
action under Executive Order 12866.
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Congressional Review Act
This rule is not a major rule under 5
U.S.C. 804(2). Subtitle E of the Small
Business Regulatory Enforcement
Fairness Act of 1996 (codified at 5
U.S.C. 801–808), also known as the
Congressional Review Act or CRA,
generally provides that before a rule
may take effect, the agency
promulgating the rule must submit a
rule report, which includes a copy of
the rule, to each House of the Congress
and to the Comptroller General of the
United States. A major rule under the
CRA cannot take effect until 60 days
after it is published in the Federal
Register.
Paperwork Reduction Act
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
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information displays a currently valid
Office of Management and Budget
(OMB) Control Number.
Regulatory Flexibility Act
I certify that this regulation will not
have a significant economic impact on
a substantial number of small entities.
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.
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satisfied with it and receive a refund of
any premium you paid for that coverage.
It will be as if the coverage was never
issued.
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Special application period is a period
in which active workforce members and
their spouses may apply based on
abbreviated underwriting. Such
application periods will be provided for
pursuant to OPM’s authority in section
9008 of title 5, United States Code.
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■ 3. Revise § 875.102 to read as follows:
§ 875.102
Where do I send benefit claims?
Office of Personnel Management.
Stephen Hickman,
Federal Register Liaison.
You must submit your benefit claims
to the FLTCIP Carrier.
■ 4. Amend § 875.107 by removing
‘‘and’’ at the end of paragraph (b),
removing the semicolon and adding a
period at the end of paragraph (c) and
adding a semicolon in its place, and
adding paragraphs (d) and (e).
The additions read as follows:
Accordingly, OPM amends 5 CFR part
875 as follows:
§ 875.107 What are OPM’s responsibilities
as regulator under this Program?
List of Subjects in 5 CFR Part 875
Administration and general
provisions, Eligibility, Cost, and
Coverage.
PART 875—FEDERAL LONG TERM
CARE INSURANCE PROGRAM
1. The authority citation for part 875
continues to read as follows:
■
Authority: 5 U.S.C. 9008; Pub. L. 116–92,
133 Stat. 1198 (5 U.S.C. 8956 note).
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(d) Suspending applications for
FLTCIP coverage, including coverage
increases as specified in § 875.110; and
(e) Holding special application
periods as specified in § 875.402.
■ 5. Revise § 875.109 to read as follows:
Subpart A—Administration and
General Provisions
§ 875.109 Which board of contract appeals
has jurisdiction for resolving contract
disputes between OPM and the Carrier?
2. Amend § 875.101 by revising the
definitions of ‘‘Carrier’’, ‘‘Eligible
individual’’, and ‘‘Free look’’ and
adding in alphabetical order a definition
for ‘‘Special application period’’ to read
as follows:
For purposes of applying chapter 71
of title 41 to disputes arising between
OPM and the Carrier, the Civilian Board
of Contract Appeals has jurisdiction to
decide an appeal relative to such a
dispute.
■ 6. Add § 875.110 to read as follows:
■
§ 875.101
Definitions.
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Carrier means a ‘‘qualified carrier’’ as
defined in section 9001 of title 5, United
States Code, with which OPM has
contracted to provide long term care
insurance coverage under this section. A
Carrier may designate one or more
administrators to perform some of its
obligations.
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Eligible individual means an
employee, annuitant, member of the
uniformed services, retired member of
the uniformed services or qualified
relative, as defined in section 9001 of
title 5, United States Code.
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Free look means that within 30 days
after you are approved for coverage and
receive the Benefit Booklet, you may
cancel that coverage if you are not
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§ 875.110 May OPM suspend applications
for FLTCIP coverage?
(a) OPM may suspend applications for
FLTCIP coverage, including coverage
increases, when OPM determines that a
suspension is in the best interest of the
Program.
(b) OPM will issue a document in the
Federal Register with the effective date
of the suspension period, during which
no applications for FLTCIP coverage
will be accepted. The effective date will
be determined at the discretion of the
Director and will be at least 30 days
after the publication date of the
document.
(c) The duration of the suspension
period, as determined at the discretion
of the Director and not to exceed 24
months unless subsequently extended,
will be announced in a document
published in the Federal Register.
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(d) At least 30 days before the end of
the suspension period, OPM may issue
a document in the Federal Register
announcing an extension of the
suspension period when OPM
determines that such extension is in the
best interest of the Program. The
duration of any extension to the
suspension period will not exceed 24
months, unless subsequently extended
by additional periods of suspension,
each not to exceed 24 months.
Subpart B—Eligibility
■
7. Revise § 875.203 to read as follows:
§ 875.203 Am I eligible if I separated under
the FERS MRA+10 provision?
If you have separated from service
under the FERS Minimum Retirement
Age and 10 years of service (MRA+10)
provision of 5 U.S.C. 8412(g), and have
postponed receiving an annuity under
that provision, you are eligible to apply
for coverage as an annuitant under this
part.
■ 8. Amend § 875.204 by revising
paragraph (c) to read as follows:
§ 875.204 Am I eligible as a member of the
uniformed services?
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(c) You are not eligible to apply for
coverage solely because you belong to
the Individual Ready Reserve. The
Individual Ready Reserves includes
Reservists who are assigned to a
Voluntary Training Unit in the Naval
Reserve and Category E in the Air Force
Reserve.
§ 875.206
[Removed and Reserved]
9. Remove and reserve § 875.206.
10. Revise § 875.207 to read as
follows:
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§ 875.207 What happens if I am in nonpay
status during a special application period?
(a) If you return to pay status from
nonpay status during a special
application period, you have 60 days
from the date of your return, or until the
end of the special application period,
whichever gives you more time, to
apply for coverage pursuant to the rules
of that special application period.
(b) If you return to pay status from
nonpay status within 180 days after the
end of the special application period,
you have 60 days from the date of your
return to apply for coverage pursuant to
the rules of that special application
period.
(c) Paragraphs (a) and (b) of this
section apply only when you have been
in nonpay status for more than one-half
of a special application period, unless
you went into nonpay status for a reason
beyond your control.
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11. Amend § 875.209 by revising
paragraph (a) to read as follows:
■
§ 875.209 How do I demonstrate that I am
eligible to apply for coverage?
(a) When you submit your application
for coverage, you must make known
your status as a member of an eligible
group. If you are a qualified relative,
you need to provide identifying
information about the workforce
member who makes you an eligible
individual.
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■ 12. Amend § 875.210 by revising
paragraph (b)(1) to read as follows:
§ 875.210 What happens if I become
ineligible after I submit an application?
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(b) * * *
(1) When you are involuntarily
separated from Federal civilian service
(except for misconduct) or from the
uniformed services (except for a
dishonorable discharge); or, when you
are the qualified relative of a workforce
member who has been involuntarily
separated from Federal civilian service
(except for misconduct) or from the
uniformed services (except for a
dishonorable discharge).
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■ 13. Revise § 875.211 to read as
follows:
§ 875.211 What happens if my eligibility
status changes after I submit my
application?
(a) If you applied as an active
workforce member, and you retire or
separate from service after you submit
an application for coverage, but before
your coverage becomes effective, you
must notify the Carrier of this change.
(b) If you applied with abbreviated
underwriting during a special
application period as an active
workforce member or the spouse of an
active workforce member, and the active
workforce member retires or separates
from service before your coverage
becomes effective, you must reapply
based on your new eligibility status.
■ 14. Revise § 875.213 to read as
follows:
§ 875.213 May I apply as a qualified
relative if I am the domestic partner of an
employee or annuitant?
You may apply for coverage as a
qualified relative if you are a domestic
partner, as described in § 875.101. As
prescribed by OPM, you will be
required to provide documentation to
demonstrate that you meet these
requirements, and you must submit to
full underwriting requirements.
However, as explained in § 875.210, if
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you lose your status as a domestic
partner, and therefore status as a
qualified relative, before your coverage
goes into effect, you are no longer
eligible for FLTCIP coverage.
Subpart D—Coverage
15. Revise § 875.401 to read as
follows:
■
§ 875.401
How do I apply for coverage?
To apply for coverage, you must
complete the application in a form
appropriate for your eligibility status as
prescribed by the Carrier and approved
by OPM.
■ 16. Revise § 875.402 to read as
follows:
§ 875.402
held?
When will open seasons be
(a) There are no regularly scheduled
open seasons for long term care
insurance. OPM may have special
application periods in which active
workforce members and their spouses
may apply based on abbreviated
underwriting.
(b) In situations where OPM
determines that it is appropriate to have
a special application period, OPM will
announce any such period via
publication of a document in the
Federal Register. The document will
include the requirements for eligible
applicants during the special
application period.
■ 17. Revise § 875.403 to read as
follows:
§ 875.403
When may I apply for coverage?
If you are an eligible individual, you
may apply at any time outside of a
suspension period described in
§ 875.110. You will be subject to full
underwriting requirements. The only
exceptions to the full underwriting
requirements are described in § 875.402.
You may apply as a qualified relative of
a workforce member even if the
workforce member does not apply for
coverage.
■ 18. Revise § 875.404 to read as
follows:
§ 875.404 What is the effective date of
coverage?
(a)(1) The effective dates of coverage
under special application period
enrollments will be announced in a
document published in the Federal
Register that announces special
application period dates.
(2) If you are an active workforce
member or the spouse of an active
workforce member and you are applying
for coverage during a special application
period, the workforce member must be
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actively at work at least 1 day during the
calendar week immediately before the
week which contains your coverage
effective date for your coverage to
become effective. You must inform the
Carrier if you do not meet this
requirement. In the event you do not
meet this requirement, the Carrier will
issue you a revised effective date, which
will be the 1st day of the next month.
The workforce member also must meet
the actively at work requirement for any
revised effective date for coverage to
become effective, or you will be issued
another revised effective date in the
same manner.
(b) If you enroll at any time outside
of a special application period, your
coverage effective date is the 1st day of
the month after the date your
application is approved.
■ 19. Revise § 875.405 to read as
follows:
§ 875.405 May a spouse, domestic partner,
or other qualified relative of a workforce
member apply for coverage?
A spouse, domestic partner, or other
qualified relative of a workforce member
may apply for coverage with full
underwriting at any time following the
marriage or commencing date of the
domestic partnership, outside of a
suspension period as described in
§ 875.110.
■ 20. Amend § 875.406 by revising
paragraph (a)(1) to read as follows:
§ 875.406
May I change my coverage?
Office of the Secretary
6 CFR Part 5
[Docket No. DHS–2021–0020]
RIN 1601–AB04
The Department of Homeland
Security (DHS or Department) is
amending its regulations under the
Privacy Act of 1974. DHS is updating
and streamlining the language of several
provisions. In addition, DHS is making
minor, technical edits to its Freedom of
Information Act regulations.
DATES: This final rule is effective
December 16, 2022.
FOR FURTHER INFORMATION CONTACT:
Lynn Parker Dupree, Chief Privacy
Officer, Privacy Office, Department of
Homeland Security, Washington, DC
20528, (202) 343–1717, Privacy@
hq.dhs.gov.
SUMMARY:
§ 875.413 Is it possible to have coverage
reinstated?
khammond on DSKJM1Z7X2PROD with RULES
DEPARTMENT OF HOMELAND
SECURITY
Office of the Secretary,
Department of Homeland Security.
ACTION: Final rule.
If you are an active workforce
member, your coverage will
automatically continue when you leave
active service, as long as the Carrier
continues to receive the required
premium when due.
■ 22. Revise § 875.413 to read as
follows:
(a) Under certain circumstances, your
coverage can be reinstated. The Carrier
will reinstate your coverage if it receives
proof satisfactory to it, within 6 months
from the date of the written notice of
termination, that you suffered from a
cognitive impairment or loss of
functional capacity, before the grace
Jkt 259001
BILLING CODE 6325–63–P
AGENCY:
§ 875.410 May I continue my coverage
when I leave Federal or military service?
15:43 Nov 15, 2022
[FR Doc. 2022–24849 Filed 11–14–22; 8:45 am]
Privacy Act of 1974
(a) * * *
(1) At any time outside of a
suspension period described in
§ 875.110, you may apply to increase
your coverage with full underwriting.
*
*
*
*
*
■ 21. Revise § 875.410 to read as
follows:
VerDate Sep<11>2014
period ended, that caused you to miss
making premium payments. In that
event, you will not be required to
submit to underwriting. Your coverage
will be reinstated retroactively to the
termination date but you must pay back
premiums for that period. The premium
will be the same as it was prior to
termination.
(b) If your coverage has terminated
because you did not pay premiums or
because you requested cancellation, the
Carrier may reinstate your coverage
within 12 months from the date of the
written notice of termination at your
request. You will be required to reapply
based on full underwriting, and the
Carrier will determine whether you are
still insurable. If you are insurable, your
coverage will be reinstated retroactively
to the termination date and you must
pay back premiums for that period. The
premium will be the same as it was
prior to termination.
SUPPLEMENTARY INFORMATION:
I. Background
The Secretary of Homeland Security
has authority under 5 U.S.C. 301, 552,
and 552a, and 6 U.S.C. 112(e) to issue
Privacy Act regulations. That authority
has been delegated to the Chief Privacy
PO 00000
Frm 00005
Fmt 4700
Sfmt 4700
68599
Officer of the Department pursuant to 6
U.S.C. 142 and DHS Del. No. 13001,
Rev. 01 (June 2, 2020).
On January 27, 2003, DHS published
an interim rule in the Federal Register
(68 FR 4056) that established DHS
procedures implementing the Privacy
Act, 5 U.S.C. 552a. DHS has since
issued minor procedural amendments to
the interim rule, see 85 FR 11829 (Feb.
28, 2020), but DHS has not issued a
more comprehensive update since 2003.
On November 22, 2016, DHS issued a
final rule amending the Department’s
regulations under the Freedom of
Information Act (FOIA), 6 CFR part 5,
subpart A, in order to update and
streamline the language of several
procedural provisions, to incorporate
changes brought by the amendments to
the FOIA under the Open Government
Act of 2007 and FOIA Improvement Act
of 2016, and to reflect developments in
the case law. See 81 FR 83625.
On October 6, 2021, DHS published a
proposed rule to amend existing
regulations under the Privacy Act at 6
CFR part 5, subpart B, and make minor,
technical edits to 6 CFR part 5, subpart
A, for the limited purpose of replacing
references to appendix I to subpart A
with references to appendix A to part 5.
See 86 FR 55528.1 DHS accepted
comments on the proposed rule through
December 6, 2021. DHS is now
finalizing the rule with minor clarifying
changes, the more prominent of which
are discussed below.
II. Discussion of Final Rule
A. Response to Comments
In total, DHS received 6 public
submissions to its proposed rule, of
which only one provided a specific
recommendation. The commenter stated
that DHS should add language to the
proposed regulation to address the
ability of the public to seek corrections
to records maintained about them or
organizations they are associated with.
The comment stated that when federal
agencies maintain records that are
inaccurate it can expose individuals to
risk, and such individuals should have
redress to correct such errors. DHS
interprets the comment to refer to
content that is already included in
proposed 6 CFR 5.26, Requests for
Amendment or Correction of Records.
After review and consideration, DHS
has decided to not make additional
changes to this section. This section
clearly explains how an individual can
1 Except as explicitly stated below, DHS
incorporates by reference the section-by-section
analysis contained in the preamble to the proposed
rule.
E:\FR\FM\16NOR1.SGM
16NOR1
Agencies
[Federal Register Volume 87, Number 220 (Wednesday, November 16, 2022)]
[Rules and Regulations]
[Pages 68595-68599]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-24849]
========================================================================
Rules and Regulations
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains regulatory documents
having general applicability and legal effect, most of which are keyed
to and codified in the Code of Federal Regulations, which is published
under 50 titles pursuant to 44 U.S.C. 1510.
The Code of Federal Regulations is sold by the Superintendent of Documents.
========================================================================
Federal Register / Vol. 87, No. 220 / Wednesday, November 16, 2022 /
Rules and Regulations
[[Page 68595]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 875
RIN 3206-AO21
Enhancing Stability and Flexibility for the Federal Long Term
Care Insurance Program (FLTCIP)--Abbreviated Underwriting, Applications
for FLTCIP Coverage, and Technical Corrections
AGENCY: Office of Personnel Management.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: The Office of Personnel Management (OPM) is issuing a final
regulation to support enhancing stability and flexibility in FLTCIP by
amending when abbreviated underwriting will be offered to prospective
enrollees and finalizing rules for the suspension of applications for
coverage and the requirements around any such suspension periods. OPM
is also finalizing technical corrections for the sake of clarity and to
remove redundancies. This final rule adopts the proposed regulations
with one technical change correcting the provision related to the
Federal appeals board that is delegated the authority to resolve
contract disputes between the Carrier and OPM. Finally, OPM may
effectuate a suspension period after publication of this final rule
with a separate document in the Federal Register.
DATES: Effective on November 16, 2022. OPM will publish a separate
document announcing the effective date of a suspension period in the
Federal Register.
FOR FURTHER INFORMATION CONTACT: Dyan Dyttmer, Senior Policy Analyst,
[email protected], (202) 936-0152.
SUPPLEMENTARY INFORMATION: On June 3, 2022, OPM published proposed
regulations (87 FR 33653), which proposed amendments to 5 CFR part 875
to support FLTCIP stability and flexibility by amending when
abbreviated underwriting will be offered to prospective enrollees and
proposing rules for the suspension of applications for coverage and the
requirements around any such suspension periods. OPM also proposed
technical corrections for the sake of clarity and to remove
redundancies. Finally, with the publication of the proposed rule, OPM
provided notice of an anticipated suspension period.
The comment period for the proposed rule closed on July 5, 2022.
OPM received three comments from individuals on the proposed rule, and
a Federal appeals board contacted us regarding OPM's delegation of
authority to resolve contract disputes in 5 CFR 875.109. A summary of
the comments OPM received follows, along with our responses to the
comments and a technical change OPM is making to the final rule in
response to the comments.
Responses to Comments on the Proposed Rule
One commenter questioned OPM's authority to authorize a suspension
period and to change the 60-day abbreviated underwriting period allowed
to newly eligible active workforce members and spouses. The commenter
asserted that OPM lacked authority to suspend applications based on the
statutory language in 5 U.S.C. 9002(a) which states that OPM shall
establish and administer the FLTCIP for which eligible individuals may
obtain long term care insurance coverage. The commenter stated that the
statutory construct should be interpreted to mean that OPM must offer
eligible individuals an opportunity to enroll in the FLTCIP. Another
commenter questioned OPM's authority to suspend applications for a
period, as this would reduce premiums received from enrollees prevented
from enrolling and therefore increase premiums for those already
enrolled.
OPM disagrees with these comments and concludes that it has the
authority to institute these changes to FLTCIP. OPM's authority to
establish and administer the Program brings with it the obligation to
oversee the Program's functioning and to protect both current and
prospective enrollees, as well as the health of the Program as a whole.
OPM has authority under 5 U.S.C. 9008 to prescribe regulations to
effectuate this authority, including to create through regulation the
ability to suspend applications for coverage, with notice and for a
reasonable period of time, when necessary for the proper administration
of the Program. It is also within OPM's authority to alter through
regulation the circumstances under which abbreviated underwriting may
be offered. As OPM explained in the preamble of the proposed rule, the
purpose of creating through regulation the ability to suspend
applications is to protect eligible individuals from applying to enroll
when OPM has determined that underwriting processes may need revisions
or when the current premium rates offered to new applicants may not
reasonably and equitably reflect the cost of the benefits as required
under 5 U.S.C. 9003(b)(2). Finally, OPM acknowledges that if FLTCIP is
suspended for a period this would prevent currently eligible and newly
eligible individuals from applying for coverage during the suspension,
and individuals may have to wait to apply after the suspension period
or seek alternative coverage. As explained in the preamble of the
proposed rule, the number of potential new enrollees would be small.
OPM will only suspend applications when it is in the best interest of
the Program, as required by this final rule.
One commenter stated that the proposed rule is arbitrary and
capricious under the Administrative Procedure Act because OPM stated in
the preamble that it considered the Notice of Proposed rulemaking to
serve as the notice required under the proposed 5 CFR 875.110(b), which
is being finalized in this final rule. OPM is clarifying that the
proposed rule served as notice to the public that OPM intends to
suspend FLTCIP applications and establishes the process for suspension,
amends abbreviated underwriting rules, and modifies the regulations.
OPM is clarifying that these actions, including the process for
suspension as proposed in 5 CFR 875.110, will be effectuated after
publication of the final rule, not after the proposed rule as the
commenter stated.
One commenter questioned whether OPM consulted with the Secretaries
of the uniformed services before promulgating the rule as required by 5
U.S.C. 9008(c). OPM fulfilled the
[[Page 68596]]
requirement of consultation through the inter-agency review process
before it published the proposed rule.
All three of the commenters expressed general concerns about the
manner in which OPM administers FLTCIP. They suggested that OPM should
act in a fashion similar to state insurance regulators, such as by
adopting standards set by the National Association of Insurance
Commissioners (NAIC) for long term care insurance rate increases,
conducting public rate hearings, and taking expert and enrollee
testimony. They also suggested that OPM should be more transparent in
its operation of the Program, such as by making public its
communications with the FLTCIP Carrier. Finally, one commenter
suggested that OPM should require the FLTCIP Carrier and administrator
to be more transparent regarding their operations, such as by
publishing quarterly reports with information about pay-outs, expenses,
reserves, and investment mix.
OPM acknowledges the importance of transparency and consumer
protections for FLTCIP enrollees. OPM complies with consumer
protections in the FLTCIP statute and the Health Insurance Portability
and Accountability Act of 1996, including by providing a contingent
benefit upon lapse, inflation protection options, portability, and
guaranteed renewability (except when enrollees fail to pay their
premiums). As part of contracting, OPM and the FLTCIP Carrier agree to
specific requirements for the insurer to follow, including certain NAIC
model standards. While OPM will consider these comments in its future
administration of the Program, the comments are outside the scope of
this rule and require no further response.
The Armed Services Board of Contract Appeals (ASBCA) also contacted
OPM seeking clarification regarding the appropriate board of contract
appeals to resolve contract disputes between OPM and the FLTCIP
Carrier. The ASBCA correctly noted that although OPM's regulations
currently identified the ASBCA as the board of contract appeals with
jurisdiction, the National Defense Authorization Act for Fiscal Year
2006 created the Civilian Board of Contract Appeals (CBCA) and
specified the jurisdiction of the ASBCA and CBCA. As an executive
agency, OPM contract disputes are within the jurisdiction of the CBCA
pursuant to 41 U.S.C. 7105(b). OPM is making a technical correction
that updates our regulations to reflect that the CBCA, not the ASBCA,
will resolve contract disputes related to FLTCIP.
Notice of Suspension Period
OPM will issue a separate Federal Register document announcing the
beginning date and anticipated length of any suspension period at least
30 days before the suspension period starts.
Changes From Proposed Rule
OPM has made a change to the final rule to clarify 5 CFR 875.110.
The proposed rule included the process for suspending applications for
FLTCIP coverage after publication of a document in the Federal
Register. The proposed rule also included a process for extending such
a suspension. The final rule clarifies that each extension to the
suspension period is limited to 24 months. Each extension will be based
on current information supporting OPM's conclusion that continuing the
suspension is in the best interest of the Program, and each extension
will require publication in the Federal Register.
OPM has made one technical correction to this final rule. This
final rule clarifies in 5 CFR 875.109 that the Civilian Board of
Contract Appeals has jurisdiction to resolve contract disputes related
to FLTCIP. Except for the change above and this technical correction,
OPM is issuing this final rule with no other changes.
Expected Impact of the Final Rule
The changes in this final rule, including underwriting changes and
any future suspensions of applications for FLTCIP coverage, will not
affect current FLTCIP enrollees. Individuals already enrolled in FLTCIP
will retain their coverage as long as they continue to pay premiums.
The changes impact new enrollment and are expected to impose no more
than de minimus administrative costs to Federal agencies since FLTCIP
is an enrollee-pay-all program, and there is no Government contribution
toward enrollee premiums.
OPM expects that the rule will not result in a significant impact
on the eligible or newly eligible population. Approximately 6,000
eligible individuals enroll in FLTCIP annually, which is less than 0.1%
of 11 million eligible federal and military actives and annuitants (not
including spouses and other qualified relatives who are also eligible).
This low percentage mirrors the low uptake for purchasing long term
care insurance (LTCI) in the broader LTC market. According to a
Treasury Report of the Federal Interagency Task Force on Long-Term Care
Insurance, sales of new LTCI policies have declined since the early
2000s, as numerous insurers decided to exit the market due to the poor
financial performance of the product line; and low take-up rates for
LTCI appear to stem in part from low demand for these products.\1\ The
report identifies factors influencing demand including: substitutes for
private LTCI such as Medicaid; unpaid care or the ability to receive
informal care from family; a desire to leave assets to heirs can
suppress demand because people may be motivated to postpone consumption
and save money; lack of information and awareness about LTC costs and
the ways to finance those costs; lack of trust in insurers; and
premiums, costs, and loads.\2\
---------------------------------------------------------------------------
\1\ U.S. Department of the Treasury, ``Long-Term Care Insurance:
Recommendations for Improvement of Regulation.'' Report of the
Federal Interagency Task Force on Long-Term Care Insurance, August
2020, https://home.treasury.gov/system/files/136/Report-Federal-Interagency-Task-Force-Long-TermCare-Insurance.pdf.
\2\ See footnote 1.
---------------------------------------------------------------------------
Since less than 0.1% of the eligible population annually enroll in
FLTCIP, based on this trend and market trends, it is unlikely that
newly eligible individuals would have a high demand for LTCI during a
suspension of applications. Further, there are other options for
eligible individuals to plan for LTC needs. Some other options to plan
for LTC needs during a suspension period include the following: saving
for future needs by setting aside funds to invest in a 401(k), an IRA,
or a non-retirement investment account; investing in a long-term care
annuity; purchasing a ``combination'' or ``hybrid'' product that
combines a life insurance policy with a LTC rider; or purchasing a
short-term care insurance policy.
Indirect Effects on Other Parties
OPM does not believe this regulation will have a large impact on
the broader LTCI market. Approximately 6,000 eligible individuals
enroll in FLTCIP annually, which is less than 0.1% of the eligible
population. At an average premium of $125 per month or $1,500 per year,
the forgone annual premium for new enrollees would total less than $10
million per year during any FLTCIP enrollment suspension. As discussed
above, affected individuals would likely pursue substitute savings and
insurance products during a suspension period. OPM estimates that the
magnitude of the forgone $10 million on other parties, such as LTC
insurers in the LTCI market, would be quite small compared to the
larger LTCI market.
[[Page 68597]]
Benefits of the Final Rule
This final rule establishes provisions for OPM to suspend
applications to FLTCIP when it is in the best interest of the program;
for example, in order to allow for adjustment to underwriting processes
or to reprice premium rates after a review of actuarial assumptions.
The rule aims to protect eligible individuals from applying to enroll
when it has been determined that underwriting processes may need
revisions or when the current premium rates may not reflect the cost of
the benefits provided due to market volatility and changes to
projections about future costs. This allows OPM and the FLTCIP carrier
to agree on underwriting changes or new premium rates that reasonably
and equitably reflect the cost of the benefits provided as required by
the FLTCIP statute.
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563 direct 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).
Executive Order 13563 emphasizes the importance of quantifying both
costs and benefits and of reducing costs, harmonizing rules, and
promoting flexibility. This rule has been designated as a significant,
but not economically significant, regulatory action under Executive
Order 12866.
Congressional Review Act
This rule is not a major rule under 5 U.S.C. 804(2). Subtitle E of
the Small Business Regulatory Enforcement Fairness Act of 1996
(codified at 5 U.S.C. 801-808), also known as the Congressional Review
Act or CRA, generally provides that before a rule may take effect, the
agency promulgating the rule must submit a rule report, which includes
a copy of the rule, to each House of the Congress and to the
Comptroller General of the United States. A major rule under the CRA
cannot take effect until 60 days after it is published in the Federal
Register.
Paperwork Reduction Act
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.
Regulatory Flexibility Act
I certify that this regulation will not have a significant economic
impact on a substantial number of small entities.
Federalism
We have examined this rule in accordance with Executive Order
13132, Federalism, and have determined that this rule will not have any
negative impact on the rights, roles, and responsibilities of State,
local, or tribal governments.
List of Subjects in 5 CFR Part 875
Administration and general provisions, Eligibility, Cost, and
Coverage.
Office of Personnel Management.
Stephen Hickman,
Federal Register Liaison.
Accordingly, OPM amends 5 CFR part 875 as follows:
PART 875--FEDERAL LONG TERM CARE INSURANCE PROGRAM
0
1. The authority citation for part 875 continues to read as follows:
Authority: 5 U.S.C. 9008; Pub. L. 116-92, 133 Stat. 1198 (5
U.S.C. 8956 note).
Subpart A--Administration and General Provisions
0
2. Amend Sec. 875.101 by revising the definitions of ``Carrier'',
``Eligible individual'', and ``Free look'' and adding in alphabetical
order a definition for ``Special application period'' to read as
follows:
Sec. 875.101 Definitions.
* * * * *
Carrier means a ``qualified carrier'' as defined in section 9001 of
title 5, United States Code, with which OPM has contracted to provide
long term care insurance coverage under this section. A Carrier may
designate one or more administrators to perform some of its
obligations.
* * * * *
Eligible individual means an employee, annuitant, member of the
uniformed services, retired member of the uniformed services or
qualified relative, as defined in section 9001 of title 5, United
States Code.
* * * * *
Free look means that within 30 days after you are approved for
coverage and receive the Benefit Booklet, you may cancel that coverage
if you are not satisfied with it and receive a refund of any premium
you paid for that coverage. It will be as if the coverage was never
issued.
* * * * *
Special application period is a period in which active workforce
members and their spouses may apply based on abbreviated underwriting.
Such application periods will be provided for pursuant to OPM's
authority in section 9008 of title 5, United States Code.
* * * * *
0
3. Revise Sec. 875.102 to read as follows:
Sec. 875.102 Where do I send benefit claims?
You must submit your benefit claims to the FLTCIP Carrier.
0
4. Amend Sec. 875.107 by removing ``and'' at the end of paragraph (b),
removing the semicolon and adding a period at the end of paragraph (c)
and adding a semicolon in its place, and adding paragraphs (d) and (e).
The additions read as follows:
Sec. 875.107 What are OPM's responsibilities as regulator under this
Program?
* * * * *
(d) Suspending applications for FLTCIP coverage, including coverage
increases as specified in Sec. 875.110; and
(e) Holding special application periods as specified in Sec.
875.402.
0
5. Revise Sec. 875.109 to read as follows:
Sec. 875.109 Which board of contract appeals has jurisdiction for
resolving contract disputes between OPM and the Carrier?
For purposes of applying chapter 71 of title 41 to disputes arising
between OPM and the Carrier, the Civilian Board of Contract Appeals has
jurisdiction to decide an appeal relative to such a dispute.
0
6. Add Sec. 875.110 to read as follows:
Sec. 875.110 May OPM suspend applications for FLTCIP coverage?
(a) OPM may suspend applications for FLTCIP coverage, including
coverage increases, when OPM determines that a suspension is in the
best interest of the Program.
(b) OPM will issue a document in the Federal Register with the
effective date of the suspension period, during which no applications
for FLTCIP coverage will be accepted. The effective date will be
determined at the discretion of the Director and will be at least 30
days after the publication date of the document.
(c) The duration of the suspension period, as determined at the
discretion of the Director and not to exceed 24 months unless
subsequently extended, will be announced in a document published in the
Federal Register.
[[Page 68598]]
(d) At least 30 days before the end of the suspension period, OPM
may issue a document in the Federal Register announcing an extension of
the suspension period when OPM determines that such extension is in the
best interest of the Program. The duration of any extension to the
suspension period will not exceed 24 months, unless subsequently
extended by additional periods of suspension, each not to exceed 24
months.
Subpart B--Eligibility
0
7. Revise Sec. 875.203 to read as follows:
Sec. 875.203 Am I eligible if I separated under the FERS MRA+10
provision?
If you have separated from service under the FERS Minimum
Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C.
8412(g), and have postponed receiving an annuity under that provision,
you are eligible to apply for coverage as an annuitant under this part.
0
8. Amend Sec. 875.204 by revising paragraph (c) to read as follows:
Sec. 875.204 Am I eligible as a member of the uniformed services?
* * * * *
(c) You are not eligible to apply for coverage solely because you
belong to the Individual Ready Reserve. The Individual Ready Reserves
includes Reservists who are assigned to a Voluntary Training Unit in
the Naval Reserve and Category E in the Air Force Reserve.
Sec. 875.206 [Removed and Reserved]
0
9. Remove and reserve Sec. 875.206.
0
10. Revise Sec. 875.207 to read as follows:
Sec. 875.207 What happens if I am in nonpay status during a special
application period?
(a) If you return to pay status from nonpay status during a special
application period, you have 60 days from the date of your return, or
until the end of the special application period, whichever gives you
more time, to apply for coverage pursuant to the rules of that special
application period.
(b) If you return to pay status from nonpay status within 180 days
after the end of the special application period, you have 60 days from
the date of your return to apply for coverage pursuant to the rules of
that special application period.
(c) Paragraphs (a) and (b) of this section apply only when you have
been in nonpay status for more than one-half of a special application
period, unless you went into nonpay status for a reason beyond your
control.
0
11. Amend Sec. 875.209 by revising paragraph (a) to read as follows:
Sec. 875.209 How do I demonstrate that I am eligible to apply for
coverage?
(a) When you submit your application for coverage, you must make
known your status as a member of an eligible group. If you are a
qualified relative, you need to provide identifying information about
the workforce member who makes you an eligible individual.
* * * * *
0
12. Amend Sec. 875.210 by revising paragraph (b)(1) to read as
follows:
Sec. 875.210 What happens if I become ineligible after I submit an
application?
* * * * *
(b) * * *
(1) When you are involuntarily separated from Federal civilian
service (except for misconduct) or from the uniformed services (except
for a dishonorable discharge); or, when you are the qualified relative
of a workforce member who has been involuntarily separated from Federal
civilian service (except for misconduct) or from the uniformed services
(except for a dishonorable discharge).
* * * * *
0
13. Revise Sec. 875.211 to read as follows:
Sec. 875.211 What happens if my eligibility status changes after I
submit my application?
(a) If you applied as an active workforce member, and you retire or
separate from service after you submit an application for coverage, but
before your coverage becomes effective, you must notify the Carrier of
this change.
(b) If you applied with abbreviated underwriting during a special
application period as an active workforce member or the spouse of an
active workforce member, and the active workforce member retires or
separates from service before your coverage becomes effective, you must
reapply based on your new eligibility status.
0
14. Revise Sec. 875.213 to read as follows:
Sec. 875.213 May I apply as a qualified relative if I am the
domestic partner of an employee or annuitant?
You may apply for coverage as a qualified relative if you are a
domestic partner, as described in Sec. 875.101. As prescribed by OPM,
you will be required to provide documentation to demonstrate that you
meet these requirements, and you must submit to full underwriting
requirements. However, as explained in Sec. 875.210, if you lose your
status as a domestic partner, and therefore status as a qualified
relative, before your coverage goes into effect, you are no longer
eligible for FLTCIP coverage.
Subpart D--Coverage
0
15. Revise Sec. 875.401 to read as follows:
Sec. 875.401 How do I apply for coverage?
To apply for coverage, you must complete the application in a form
appropriate for your eligibility status as prescribed by the Carrier
and approved by OPM.
0
16. Revise Sec. 875.402 to read as follows:
Sec. 875.402 When will open seasons be held?
(a) There are no regularly scheduled open seasons for long term
care insurance. OPM may have special application periods in which
active workforce members and their spouses may apply based on
abbreviated underwriting.
(b) In situations where OPM determines that it is appropriate to
have a special application period, OPM will announce any such period
via publication of a document in the Federal Register. The document
will include the requirements for eligible applicants during the
special application period.
0
17. Revise Sec. 875.403 to read as follows:
Sec. 875.403 When may I apply for coverage?
If you are an eligible individual, you may apply at any time
outside of a suspension period described in Sec. 875.110. You will be
subject to full underwriting requirements. The only exceptions to the
full underwriting requirements are described in Sec. 875.402. You may
apply as a qualified relative of a workforce member even if the
workforce member does not apply for coverage.
0
18. Revise Sec. 875.404 to read as follows:
Sec. 875.404 What is the effective date of coverage?
(a)(1) The effective dates of coverage under special application
period enrollments will be announced in a document published in the
Federal Register that announces special application period dates.
(2) If you are an active workforce member or the spouse of an
active workforce member and you are applying for coverage during a
special application period, the workforce member must be
[[Page 68599]]
actively at work at least 1 day during the calendar week immediately
before the week which contains your coverage effective date for your
coverage to become effective. You must inform the Carrier if you do not
meet this requirement. In the event you do not meet this requirement,
the Carrier will issue you a revised effective date, which will be the
1st day of the next month. The workforce member also must meet the
actively at work requirement for any revised effective date for
coverage to become effective, or you will be issued another revised
effective date in the same manner.
(b) If you enroll at any time outside of a special application
period, your coverage effective date is the 1st day of the month after
the date your application is approved.
0
19. Revise Sec. 875.405 to read as follows:
Sec. 875.405 May a spouse, domestic partner, or other qualified
relative of a workforce member apply for coverage?
A spouse, domestic partner, or other qualified relative of a
workforce member may apply for coverage with full underwriting at any
time following the marriage or commencing date of the domestic
partnership, outside of a suspension period as described in Sec.
875.110.
0
20. Amend Sec. 875.406 by revising paragraph (a)(1) to read as
follows:
Sec. 875.406 May I change my coverage?
(a) * * *
(1) At any time outside of a suspension period described in Sec.
875.110, you may apply to increase your coverage with full
underwriting.
* * * * *
0
21. Revise Sec. 875.410 to read as follows:
Sec. 875.410 May I continue my coverage when I leave Federal or
military service?
If you are an active workforce member, your coverage will
automatically continue when you leave active service, as long as the
Carrier continues to receive the required premium when due.
0
22. Revise Sec. 875.413 to read as follows:
Sec. 875.413 Is it possible to have coverage reinstated?
(a) Under certain circumstances, your coverage can be reinstated.
The Carrier will reinstate your coverage if it receives proof
satisfactory to it, within 6 months from the date of the written notice
of termination, that you suffered from a cognitive impairment or loss
of functional capacity, before the grace period ended, that caused you
to miss making premium payments. In that event, you will not be
required to submit to underwriting. Your coverage will be reinstated
retroactively to the termination date but you must pay back premiums
for that period. The premium will be the same as it was prior to
termination.
(b) If your coverage has terminated because you did not pay
premiums or because you requested cancellation, the Carrier may
reinstate your coverage within 12 months from the date of the written
notice of termination at your request. You will be required to reapply
based on full underwriting, and the Carrier will determine whether you
are still insurable. If you are insurable, your coverage will be
reinstated retroactively to the termination date and you must pay back
premiums for that period. The premium will be the same as it was prior
to termination.
[FR Doc. 2022-24849 Filed 11-14-22; 8:45 am]
BILLING CODE 6325-63-P