[Federal Register: September 26, 2001 (Volume 66, Number 187)]
[Rules and Regulations]
[Page 49086-49088]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr26se01-2]
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OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
RIN: 3206-AJ36
Suspension of TRICARE-Eligible's Enrollment in the Federal
Employees Health Benefits (FEHB) Program
AGENCY: Office of Personnel Management.
ACTION: Interim Rule.
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SUMMARY: The Office of Personnel Management is issuing an interim rule
to allow TRICARE-eligible FEHB Program annuitants and former spouses to
suspend their FEHB enrollments, and then return to the FEHB Program
during the Open Season, or return to FEHB coverage immediately, if they
involuntarily lose TRICARE coverage. The intent of this rule is to
allow TRICARE-eligible beneficiaries to avoid the expense of continuing
to pay FEHB Program premiums while they are using TRICARE coverage,
without endangering their ability to return to the FEHB Program in the
future.
DATES: Effective September 26, 2001. Comments received on or before
November 26, 2001.
FOR FURTHER INFORMATION CONTACT: Michael W. Kaszynski, Policy Analyst,
Insurance Policy and Information Division, OPM, Room 3425, 1900 E
Street, NW., Washington, DC 20415-0001. He can also be reached at (202)
606-0004 or by electronic mail (e-mail) at: mwkaszyn@opm.gov.
SUPPLEMENTARY INFORMATION: Effective October 1, 2001, the National
Defense Authorization Act for 2001 will reinstate TRICARE coverage for
Medicare-eligible uniformed services retirees, their survivors and
eligible dependents. TRICARE coverage will be advantageous to many
Medicare-eligible military system beneficiaries who now are covered
under the FEHB Program as Federal civilian retirees, family members, or
former spouses.
Under current FEHB regulations, however, an annuitant or former
spouse who cancels his or her FEHB coverage to use TRICARE coverage
would not be allowed to return to FEHB coverage. Therefore, OPM is
issuing these interim regulations, with a request for comments, to
allow these FEHB participants to suspend, rather than cancel, their
FEHB coverage when they begin TRICARE coverage. Under this rule, they
would be allowed to return to FEHB coverage immediately if they
involuntarily lose TRICARE coverage or, if not, during the next annual
FEHB Open Season.
We are also amending our regulations to clarify a similar situation
involving FEHB-covered annuitants and former spouses. The regulations
allow an individual who drops FEHB coverage when he or she enrolls in a
Medicare-sponsored plan, or in Medicaid or a similar State-sponsored
program of medical assistance for the needy, to return to FEHB coverage
during the annual Open Season or immediately upon being involuntarily
disenrolled from the non-FEHB coverage.
Waiver of Notice of Proposed Rule Making
Pursuant to section 553(b)(3)(B) of title 5 of the United States
Code, I find that good cause exists for waiving the general notice of
proposed rule making. The notice is being waived so that FEHB enrollees
who are eligible for the new TRICARE benefits can suspend their FEHB
coverage and use their new benefits at their first opportunity.
Regulatory Flexibility Act
I certify that this regulation will not have a significant economic
impact on a substantial number of small entities because the regulation
will only affect health insurance carriers under the Federal Employees
Health Benefits Program.
Executive Order 12866, Regulatory Review
This regulation has been reviewed by the Office of Management and
Budget in accordance with Executive Order 12866.
List of Subjects in 5 CFR Part 890
Administrative practice and procedure, Government employees, Health
facilities, Health insurance, Health professionals, Hostages, Iraq,
Kuwait, Lebanon, Reporting and record keeping requirements, Retirement.
U.S. Office of Personnel Management.
Kay Coles James,
Director.
For the reasons set forth in the preamble, OPM is amending 5 CFR
Part 890 as follows:
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
1. The authority citation for Part 890 continues to read as
follows:
Authority: 5 U.S.C. 8913; Sec. 890.803 also issued under 50
U.S.C. 403p, 22 U.S.C. 4069c and 4069c-1; subpart L also issued
under sec. 599C of Pub. L. 101-513, 104 Stat. 2064, as amended;
Sec. 890.102 also issued under sections 11202(f), 11232(e), 11246(b)
and (c) of Pub. L. 105-33, 111 Stat. 251; and section 721 of Pub. L.
105-261, 112 Stat. 2061.
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
2. In Sec. 890.304, paragraph (d)(2) is revised to read as follows:
Sec. 890.304 Termination of enrollment.
* * * * *
(d) * * *
(2) An annuitant may suspend enrollment in FEHB for the purpose of
enrolling in a Medicare-sponsored plan under sections 1833, 1876, or
1851 of the Social Security Act, or to enroll in the Medicaid program
or a similar State-sponsored program of medical assistance for the
needy, or for the purpose of using TRICARE coverage (including coverage
provided by the Uniformed Services Family Health Plan) under title 10
U.S.C. instead of FEHB coverage. To suspend FEHB coverage,
documentation must be submitted to the employing office or retirement
system within the period beginning 31 days before and ending 31 days
after the effective date of the enrollment in the Medicare-sponsored
plan, or the Medicaid or similar program, or the first day of using
TRICARE (including the Uniformed Services Family Health Plan) instead
of FEHB coverage. The suspension becomes effective on the day before
the effective date of the enrollment in the Medicare-sponsored plan, or
Medicaid or a similar program, or the day before the day designated by
the annuitant as the first day of using TRICARE (including the
Uniformed Services Family Health Plan) instead of FEHB coverage.
* * * * *
3. In Sec. 890.306 paragraphs (f)(1)(ii) and (f)(1)(iii) are
revised, paragraph (f)(1)(iv) is added and paragraphs (h) and (i) are
revised to read as follows:
[[Page 49087]]
890.306 Opportunities for annuitants to change enrollment or to
reenroll; effective dates.
* * * * *
(f) * * *
(1) * * *
(ii) An annuitant who suspended enrollment under this part for the
purpose of enrolling in a Medicare-sponsored plan under sections 1833,
1876, or 1851 of the Social Security Act, may reenroll.
(iii)An annuitant who suspended the enrollment under this part
because he or she furnished proof of eligibility for coverage under the
Medicaid program or similar State-sponsored program of medical
assistance for the needy, may reenroll.
(iv) An annuitant who suspended enrollment under this part for the
purpose of using TRICARE (including the Uniformed Services Family
Health Plan) coverage instead of FEHB coverage, may reenroll.
* * * * *
(h) Reenrollment of annuitants who suspended enrollment to enroll
in a Medicare-sponsored plan or to use TRICARE (including the Uniformed
Services Family Health Plan) coverage under title 10 U.S.C. instead of
FEHB coverage.
(1) An annuitant who had been enrolled (or was otherwise eligible
to enroll) for coverage under this part and suspended the enrollment
for the purpose of enrolling in a Medicare sponsored plan under
sections 1833, 1876, or 1851 of the Social Security Act, or to use the
TRICARE program (including the Uniformed Services Family Health Plan)
under title 10 U.S.C. instead of the FEHB Program (as provided by
Sec. 890.304(d)), and who is subsequently involuntarily disenrolled
from the Medicare sponsored plan or the TRICARE program (including the
Uniformed Services Family Health Plan), may immediately reenroll in any
available plan under this part at any time beginning 31 days before and
ending 60 days after the disenrollment. A reenrollment under this
paragraph (h) of this section takes effect on the date following the
effective date of the disenrollment as shown on the documentation from
the Medicare sponsored plan or the TRICARE program (including the
Uniformed Services Family Health Plan).
(2) An annuitant who voluntarily suspended enrollment in the FEHB
Program to enroll in a Medicare sponsored plan or to use TRICARE
(including the Uniformed Services Family Health Plan), but now wants to
reenroll in the FEHB Program for any reason other than an involuntary
loss of coverage, may do so during the next available Open Season (as
provided by paragraph (f) of this section).
(i) Reenrollment of annuitants who suspended enrollment because of
eligibility under Medicaid or a similar State-sponsored program of
medical assistance for the needy.
(1) An annuitant who had been enrolled (or was otherwise eligible
to enroll) for coverage under this part and suspended the enrollment
because he or she furnished proof of eligibility for coverage under the
Medicaid program or a similar State-sponsored program of medical
assistance for the needy (as provided by Sec. 890.304(d)), and who
involuntarily loses that coverage, may reenroll in any available plan
under this part at any time beginning 31 days before and ending 60 days
after the loss of Medicaid or similar State-sponsored coverage. A
reenrollment under this paragraph (i)(1) takes effect on the date
following the date of loss of Medicaid or similar State-sponsored
coverage.
(2) An annuitant who suspended his or her enrollment because he or
she furnished proof of eligibility for coverage under the Medicaid
program or a similar State-sponsored program of medical assistance for
the needy, and who wishes to reenroll in a plan under this part for any
reason, may do so during the next available Open Season as provided by
paragraph (f) of this section.
4. In Sec. 890.806 paragraphs (f)(1)(ii) and (f)(1)(iii) are
revised and (f)(1)(iv) is added and paragraphs (h) and (i) are revised
to read as follows:
Sec. 890.806 Opportunities for former spouses to enroll and change
enrollment; effective dates of enrollment.
* * * * *
(f) * * *
(1) * * *
(ii) A former spouse who suspended the enrollment under this part
for the purpose of enrolling in a Medicare sponsored plan under
sections 1833, 1876, or 1851 of the Social Security Act, may reenroll.
(iii) A former spouse who suspended the enrollment under this part
because he or she furnished proof of eligibility for coverage under the
Medicaid program or a similar State-sponsored program of medical
assistance for the needy, may reenroll.
(iv) A former spouse who suspended enrollment under this part for
the purpose of using TRICARE coverage (including the Uniformed Services
Family Health Plan) instead of FEHB coverage, may reenroll.
* * * * *
(h) Reenrollment of former spouses who suspended enrollment to
enroll in a Medicare sponsored plan or to use TRICARE coverage
(including the Uniformed Services Family Health Plan) under title 10
U.S.C. instead of FEHB coverage.
(1) A former spouse who had been enrolled for coverage under this
part and suspended enrollment for the purpose of enrolling in a
Medicare sponsored plan under sections 1833, 1876, or 1851 of the
Social Security Act, or to use the TRICARE program (including the
Uniformed Services Family Health Plan) under title 10 U.S.C. instead of
FEHB (as provided in Sec. 890.807(e)), or who meets the eligibility
requirements of Sec. 890.803 and the application time limitation
requirements of Sec. 890.805, but postponed enrollment for this
purpose, and who is subsequently involuntarily disenrolled from the
Medicare sponsored plan or the TRICARE program (including the Uniformed
Services Family Health Plan), may immediately reenroll in any available
plan under this part at any time beginning 31 days before and ending 60
days after the disenrollment. A reenrollment under this paragraph (h)
of this section takes effect on the date following the effective date
of the disenrollment as shown on the documentation from the Medicare
sponsored plan or TRICARE program (including the Uniformed Services
Family Health Plan).
(2) A former spouse who suspended coverage in the FEHB Program to
enroll in a Medicare sponsored plan, or to use TRICARE (including the
Uniformed Services Family Health Plan), but now wants to reenroll in
the FEHB Program for any reason other than an involuntary loss of
coverage, may do so during the next available Open Season (as provided
by paragraph (f) of this section).
(i) Reenrollment of former spouses who suspended enrollment because
of eligibility under Medicaid or a similar State-sponsored program of
medical assistance for the needy.
(1) A former spouse who had been enrolled for coverage under this
part and suspended the enrollment because he or she furnished proof of
eligibility for coverage under the Medicaid program or a similar State-
sponsored program of medical assistance for the needy (as provided in
Sec. 890.807(e)), or who meets the eligibility requirements of
Sec. 890.803 and the application time limitation requirements of
Sec. 890.805, but postponed enrollment for this reason, and who
involuntarily loses that coverage, may reenroll in any available plan
under this part at any time
[[Page 49088]]
beginning 31 days before and ending 60 days after the loss of Medicaid
or similar State-sponsored coverage. A reenrollment under this
paragraph (i)(1) of this section takes effect on the date following the
date of loss of Medicaid or similar State-sponsored coverage.
(2) A former spouse who suspended enrollment in the FEHB Program
because he or she furnished proof of eligibility for coverage under the
Medicaid program or a similar State-sponsored program of medical
assistance for the needy, and who wishes to reenroll in a plan under
this part for reasons other than an involuntary loss of that coverage,
may do so during the next available Open Season as provided by
paragraph (f) of this section.
5. In Sec. 890.807 paragraphs (e)(2) and (e)(4) are revised to read
as follows:
Sec. 890.807 Termination of enrollment.
* * * * *
(e) * * *
(2) A former spouse may suspend enrollment in FEHB for the purpose
of enrolling in Medicare sponsored plan under sections 1833, 1876, or
1851 of the Social Security Act, or to enroll in the Medicaid program
or a similar State-sponsored program of medical assistance for the
needy, or for the purpose of using TRICARE coverage (including the
Uniformed Services Family Health Plan) under title 10 U.S.C. instead of
FEHB coverage. To suspend FEHB coverage, documentation must be
submitted to the employing office or retirement system within the
period beginning 31 days before and ending 31 days after the effective
date of the enrollment in the Medicare sponsored plan, or the Medicaid
or similar program, or the first day of using TRICARE (including the
Uniformed Services Family Health Plan) instead of FEHB coverage. The
suspension becomes effective on the day before the effective date of
the enrollment in the Medicare sponsored plan, or the Medicaid or
similar program, or the day before the day designated by the former
spouse as the first day of using TRICARE (including the Uniformed
Services Family Health Plan) instead of FEHB coverage.
* * * * *
(4) A former spouse who cancels his or her enrollment for any
reason may not later reenroll in the FEHB Program.
[FR Doc. 01-24108 Filed 9-25-01; 8:45 am]
BILLING CODE 6325-50-P