FEHB Handbook

Former Spouses Page 3 of 7

page: 1 2 3 4 5 6 7

---

---

INFORMATION FOR FORMER SPOUSES (Continued)

ENROLLMENT (Continued)

• Type of Enrollment
• Where You Apply
• Application to Enroll
• Time Limit
• Deferred Enrollment
• Determination of Future Entitlement to Annuity
• Retirement System Addresses
• Determining Your Eligibility
• Employing Office Decision
• Enrollment Procedures
• Certification
• Sample Certification
• Health Benefits File
• Effective Date

Retirement System Addresses

Employee's Retirement System:	Request for Review Sent to:
CSRS or FERS	Office of Personnel Management, Retirement and Insurance Service, Office of Retirement Programs, P.O. Box 17, Washington, D.C. 20044.
CIA	CIA Retirement and Disability System, Central Intelligence Agency, P.O. Box 1925, Washington, D.C. 20505.
Foreign Service	Foreign Service Retirement and Disability System, Department of State, Retirement Division, Room 1251, Washington, D.C. 20520.
Any Other Retirement System	You must obtain that retirement system's certification of your eligibility to a portion of the employee's future annuity or a former spouse survivor annuity, and must submit the certificate to OPM when applying for eligibility to enroll.

Determining Your Eligibility

When you apply for eligibility to enroll under the spouse equity provisions, the employing office must first verify that the employee was employed by the agency at the time of your divorce. If the employee separates from Federal service before becoming eligible for an immediate annuity, you are eligible to enroll only if your marriage ended before he/she left Federal service.

The employing office must then determine if you are eligible to enroll. To be eligible, you must meet all of the following requirements:

• You must not have remarried before age 55;
• You must have been covered as a family member in an FEHB plan at least one day during the 18 months before your marriage ended;
• You must provide documentation from OPM (or the CIA or Foreign Service retirement system, if applicable) of entitlement to a portion of the employee's future annuity, or a former spouse survivor annuity.

If the employee worked for the CIA, you could qualify to enroll based on his/her CIA employment, if you were married for at least 10 years during his/her CIA service, at least 5 years of which both of you spent outside the United States, and your marriage ended before May 7, 1985.

If the employee worked for the Foreign Service, you could also qualify to enroll based on his/her Foreign Service employment if you were married for at least 10 years during his/her Government service, and your marriage ended before May 7, 1985.

Employing Office Decision

If you are eligible for health benefits coverage, the employing office will send written confirmation of its decision to you and give you a premium payment schedule and a certification for you to sign and date stating the requirements for continued enrollment.

If you are not eligible for health benefits coverage, the employing office will notify you in writing and give the reason for the denial. It will also explain that you have a right to request that the employing office reconsider its decision.

Enrollment Procedures

If you didn't submit a Health Benefits Election Form (SF 2809) or other enrollment request as your application to enroll, you must complete one to enroll. You must put your own name, date of birth, and Social Security number on Part A of the SF 2809. The employee, former employee, or annuitant's name and date of birth must be entered in the Remarks section.

Certification

When you elect health benefits coverage under the Spouse Equity provisions, you must certify that you will notify the employing office within 31 days of an event that would terminate your eligibility. The employing office keeps the original certification in your health benefits file and gives you a copy.

Sample Certification

The employing office will require that you sign and date the following certification:

"I understand that I must notify the office maintaining my enrollment within 31 days after the occurrence of any of the following events that would end my eligibility for enrollment in the Federal Employees Health Benefits Program:

(1) The court order ceases to provide my entitlement to a portion of a retirement annuity or a former spouse survivor annuity under a retirement system for Government employees.

(2) I remarry before age 55.

(3) The employee on whose service my benefits are based dies and no former spouse survivor annuity is payable.

(4) The separated employee on whose service my benefits are based dies before meeting the requirements for a deferred annuity.

(5) The employee on whose service my benefits are based leaves Federal service before establishing title to an immediate annuity or a deferred annuity.

(6) The retirement system pays a refund of retirement contributions to the separated employee on whose service my health benefits are based."

Signature                                                                       Date

---

Health Benefits File

The employing office must establish and maintain a health benefits file for you, even when it has denied eligibility for coverage.

Effective Date

The effective date of your enrollment is the first day of the first pay period after the employing office receives the Health Benefits Election Form (SF 2809) and has approved eligibility.

If you request immediate coverage, and the employing office receives the Health Benefits Election Form (SF 2809) and satisfactory proof of eligibility within 60 days after the date of the divorce, the enrollment may be made effective on the same day that temporary continuation of coverage would otherwise take effect.

Except as specified in this section, an enrollment change is effective on the first day of the first pay period beginning after the date the employing office receives the SF 2809.

OPPORTUNITIES TO ENROLL OR CHANGE ENROLLMENT

• Belated Enrollment
• Enrollment by Proxy
• Change to Self Only
• Open Season
• Change in Family Status
• Loss of Other FEHB Coverage or Coverage under Another Group Insurance Plan
• Move from an HMO's Service Area
• On Becoming Eligible for Medicare
• Annuity Insufficient to Pay Withholdings
• Former Spouses with Other FEHB Coverage
• When Both You and Your Former Spouse have FEHB Enrollments
• When You Lose Coverage as an Employee and Enroll as a Former Spouse
• When You are Covered as a Family Member and become Eligible as a Former Spouse
• Cancellation of a Former Spouse Enrollment

When the employing office determines that you are eligible, you may enroll at any time.

Belated Enrollment

When the employing office determines that you weren't able to enroll or change enrollment within the required time frame for reasons beyond your control, you may do so within 60 days after the employing office's determination.

Enrollment by Proxy

The employing office may permit your representative to enroll or change your enrollment for you with your written authorization.

Change to Self Only

You may change your enrollment from self and family to self only at any time. A change to a self only enrollment is effective on the first day of the first pay period beginning after the employing office receives the Health Benefits Election Form (SF 2809). At your written request and with proof that there was no family member eligible for coverage, the employing office may make the change retroactive to the first day of the pay period following the one in which there were no remaining eligible family members.

Open Season

During Open Season, you may change your enrollment from self only to self and family, from one plan or option to another, or make any combination of these changes. With a self and family enrollment, the only eligible family members are the natural or adopted children of you and the Federal employee or annuitant on whose service your coverage is based.

If you:

• suspended your spouse equity enrollment to enroll in a Medicare managed care plan or Medicaid (or a similar State-sponsored program of medical assistance for the needy); and
• later voluntarily disenroll,

you may reenroll under the spouse equity provisions during Open Season provided you:

• still qualify for a spouse equity enrollment; and
• you had informed the employing office of the other enrollment when you suspended the FEHB enrollment.

If you involuntarily lose this coverage, you can immediately reenroll.

An Open Season reenrollment or change in enrollment is effective on the first day of the first pay period beginning in January of the following year. When the employing office accepts a belated Open Season reenrollment or change in enrollment it takes effect on the date it normally would have been effective if it had been received on time.

Change in Family Status

You may change from self only to self and family, from one plan or option to another, or make any combination of these changes from 31 days before to 60 days after the birth or acquisition of a natural or adopted child of you and the Federal employee or annuitant on whose service your coverage is based. The change to self and family coverage is effective on the first day of the pay period in which the child is born or becomes an eligible family member.

Loss of Other FEHB Coverage or Coverage under Another Group Insurance Plan

You may change from self only to self and family, from one plan or option to another, or make any combination of these changes when you or an eligible child loses other FEHB coverage or coverage under another group health benefits plan. Unless stated otherwise, you must change the enrollment from 31 days before to 60 days after the loss of coverage.

Examples of loss of coverage include:

• Loss of coverage under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to self only;
• Loss of coverage under another federally-sponsored health benefits program;
• Loss of coverage because membership in an employee organization sponsoring or underwriting an FEHB plan was terminated;
• Loss of coverage because an FEHB plan was discontinued in whole or in part. If the discontinuation is at the end of the contract year, you must change the enrollment during the Open Season, unless OPM sets a different time frame. If the discontinuation is at a time other than the end of the contract year, OPM will set the time and effective date for changing the enrollment. If the whole plan is discontinued and you don't change within the set time frame, you are considered to have canceled your enrollment. If only one option of a two-option plan is discontinued and you don't change within the set time frame, you are considered to be enrolled in the remaining plan option.
• Loss of coverage under the Medicaid program (or similar State-sponsored program of medical assistance for the needy);
• Loss of coverage under a non-Federal health plan.

page: 1 2 3 4 5 6 7

---

Handbook Contents

• Introduction
• Cost of Insurance
• Health Plans
• Eligibility for Health Benefits
• Enrollment
• Leave Without Pay Status and Insufficient Pay
• Termination, Conversion, and Temporary Continuation of Coverage
• Annuitants and Compensationers
• Military Service
• Family Members
• Former Spouses

Appendices

• Forms and Brochures
• Glossary
• Table of Permissible Changes
• Chapter 89 of title 5, United States Code
• Part 890 of title 5, Code of Federal Regulations

Other

• Search the Handbook
• Handbook Changes