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FEHB Handbook

Former Spouses Page 7 of 7

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INFORMATION FOR EMPLOYING OFFICES (Continued)

OPPORTUNITIES TO ENROLL OR CHANGE ENROLLMENT (Continued)

Eligibility under Spouse Equity while Covered as a Family Member

If you determine that a former spouse is eligible for health benefits under spouse equity while he/she is covered as a family member under another person's FEHB enrollment, you must note in the former spouse's health benefits file that he/she is deferring the spouse equity enrollment until he/she loses coverage as a family member. You will process the spouse equity enrollment when he/she requests enrollment upon losing the family member coverage.

Cancellation of a Former Spouse Enrollment

The former spouse may cancel the spouse equity enrollment at any time and in the same manner as an employee. With one exception noted below, the cancellation is effective on the last day of the pay period in which you receive the Health Benefits Election Form (SF 2809) cancelling the enrollment. The former spouse and his/her family members are not entitled to the 31-day extension of coverage and may not convert to an individual contract when the enrollment is canceled. The former spouse may not reenroll, unless he/she suspended the 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).

If the former spouse suspends his/her enrollment to enroll in a Medicare managed care plan, the suspension is effective on the day before coverage under the Medicare managed care plan takes effect. The former spouse must submit documentation of his/her new enrollment to you from 31 days before to 31 days after the Medicare managed care plan enrollment takes effect.

PREMIUM PAYMENTS

You must collect the employee and Government shares of the premium from the former spouse for every pay period during which he/she is enrolled. There is no Government contribution. You must establish a premium payment schedule and you are responsible for collecting the premiums.

Employing Office Submission of Premiums

You submit premium payments collected from former spouses along with the regular health benefits payments to OPM.

When the Former Spouse Does Not Pay Premiums

If you don't receive a premium payment from the former spouse by the due date, you must notify the former spouse in writing that he/she must make payment within 15 days (45 days if residing overseas) after he/she receives the notice. The notice must state that if the former spouse doesn't make payment within this time frame, he/she is considered to have voluntarily canceled the enrollment.

If you don't receive any further payments, process a cancellation 60 days (90 days if residing overseas) after the date of the notice.

Your notice should ask if the former spouse has obtained other coverage as described below. Explain in the notice that he/she may resume coverage under spouse equity when this other coverage ends only if you receive information about the other coverage now. Place a copy of the notice and any response in the former spouse's health benefits file.

The former spouse must inform you if he/she obtains FEHB coverage as an employee or as a family member under another person's FEHB enrollment, or has coverage under a Medicare managed care plan or Medicaid (or a similar State-sponsored program of medical assistance for the needy). This notice will preserve his/her right to continue the spouse equity enrollment if he/she loses the other coverage.

Cancellation Because the Former Spouse Did Not Pay Premiums

If you cancel the former spouse's coverage because he/she didn't pay premiums, he/she:

If the former spouse was unable to make timely payment for reasons beyond his/her control, he/she may ask that you reinstate the coverage. This request must be filed within 30 calendar days from the cancellation date and must provide proof that nonpayment was beyond the former spouse's control. If you decide to allow reinstatement, you may restore coverage retroactively to the cancellation date upon receipt of the back premiums. If you deny the reinstatement request, you must notify the former spouse in writing, give the reason for the denial, and explain that he/she has a right to request reconsideration of your decision.

Actions to Complete Cancellation

If the former spouse does not make payment within the required time frame, you must cancel the enrollment on the Health Benefits Election Form (SF 2809). In part G, which would normally show the former spouse's signature, enter "Canceled due to nonpayment of premium." Enter "N/A" in item 2 of part H and enter the effective date of the cancellation in item 3. The effective date of the cancellation is 60 days (90 days for enrollees residing overseas) after the date of the notice advising that continuation of coverage depends on premium payment within 15 days (45 days for enrollees residing overseas). If the former spouse never made a payment, enter the enrollment effective date and state in the Remarks section: "This cancellation voids the prior SF 2809 enrolling this individual in your plan on the date in item 3."

TERMINATION OF A FORMER SPOUSE ENROLLMENT

A spouse equity enrollment terminates, subject to the 31-day extension of coverage, at midnight of the last day of the pay period in which:

  • A qualifying court order ceases to provide entitlement to a portion of a retirement annuity or a former spouse survivor annuity under a retirement system for Government employees;
  • The former spouse remarries before age 55;
  • The former spouse dies;
  • The employee on whose service benefits are based dies and no survivor annuity is payable;
  • The separated employee on whose service benefits are based dies before meeting the requirements for a deferred annuity;
  • The employee on whose service benefits are based leaves Federal service before establishing title to an immediate annuity or a deferred annuity; or
  • The retirement system pays a refund of retirement contributions to the separated employee on whose service benefits are based.

The enrollments of certain former spouses of CIA and Foreign Service employees can only be terminated if they die or remarry before reaching age 55.

Give the former spouse a copy of the Notice of Change in Health Benefits Enrollment (SF 2810) terminating the enrollment as soon as possible. This will allow the former spouse to convert to individual coverage within the 31-day time limit. Advise the former spouse that he/she cannot later reenroll under spouse equity provisions. If the former spouse was enrolled in an employee organization plan and the enrollment terminates because his/her membership in the sponsoring employee organization terminates, you must allow him/her to change to another plan.

Belated Extension of Coverage

When the former spouse belatedly learns that his/her enrollment under spouse equity has terminated because:

  • The employee on whose service benefits were based separates from service with no future entitlement to annuity; or
  • The separated employee on whose service benefits were based dies before becoming eligible for a deferred annuity;

the former spouse is allowed an extension of coverage of 31 days after your notice that coverage has terminated, during which he/she may convert to individual coverage.

The former spouse must pay the full premium during the extended period, except for the 31-day period following the notice.

Eligibility to Enroll under Temporary Continuation of Coverage

The former spouse is eligible to enroll under temporary continuation of coverage (TCC) when his/her spouse equity enrollment terminates during the first 36 months after the divorce or annulment because:

  • there is no longer a qualifying court order; or
  • he/she remarries before reaching age 55.

Termination of an Eligible Child's Coverage

An eligible child's coverage under a spouse equity enrollment terminates, subject to the 31-day extension of coverage and conversion rights, at midnight of:

The child is not eligible for temporary continuation of coverage (TCC) beyond the original 36-month period from the date of the divorce.

If the former spouse cancels his/her spouse equity enrollment, the child's enrollment also ends on the same date with no extension of coverage or conversion rights.

REENROLLMENT

If a former spouse enrolled under the spouse equity provisions becomes covered under another FEHB enrollment (either as an employee or a family member), he/she may suspend the spouse equity enrollment while covered under the other enrollment. The former spouse may reenroll when the other FEHB coverage ends.

When a Former Spouse becomes a Federal Employee

If a former spouse becomes eligible to enroll as a Federal employee, he/she must notify you that he/she is enrolling as a Federal employee. Terminate the spouse equity enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810), and note in the Remarks section that the former spouse is entitled to enrollment under spouse equity. File the Official Personnel Folder copy of the SF 2810 in the former spouse file and note that the spouse equity enrollment is being suspended while he/she is covered as a Federal employee.

The office where the former spouse is currently employed will enroll him/her on the Health Benefits Election Form (SF 2809). It must note in the Remarks section that he/she was previously covered as a former spouse and is now enrolling as an employee under the same Social Security number. When health benefits coverage as an employee terminates, both employing offices involved should follow the procedures in " When an Employee Loses Coverage and Enrolls as a Former Spouse."

When a Former Spouse Becomes Covered as a Family Member

If a former spouse enrolled under the spouse equity provisions becomes covered as a family member under another person's FEHB enrollment, terminate his/her enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810). Note in the Remarks section that the enrollment is being terminated because the former spouse is covered as a family member under another FEHB enrollment, and give the enrollee's name, Social Security number, and the effective date of coverage. The spouse equity enrollment is suspended until he/she loses coverage as a family member. When he/she loses family member coverage and requests reinstatement, you will again be responsible for the enrollment.

When Coverage under Medicare Managed Care Plan or Medicaid Ends

If a former spouse postponed or suspended the 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), he/she may later reenroll under the spouse equity provisions if enrollment in the Medicare managed care plan or Medicaid ends. He/she must have informed you about the Medicare managed care plan or Medicaid enrollment when he/she postponed or suspended the spouse equity enrollment and must still qualify for the spouse equity enrollment.

If the Medicare managed care plan or Medicaid enrollment ends involuntarily, the former spouse can immediately reenroll under the spouse equity provisions in any available plan at any time from 31 days before to 60 days after coverage in the Medicare managed care plan or Medicaid ends. The reenrollment is effective on the date following the involuntary loss of coverage as shown in documentation from the Medicare managed care plan or Medicaid.

If the former spouse voluntarily disenrolls from the Medicare managed care plan or Medicaid, he/she may reenroll under the spouse equity provisions during the following Open Season.

Notice to Retirement System of Former Spouse Enrollment

When the employee on whose service spouse equity benefits are based separates, transfers, or retires, you must document on his/her Individual Retirement Record (SF 2806 or 3100) that a spouse equity enrollment exists. Include on the employee's Individual Retirement Record the former spouse's name, date of birth, Social Security number, and the name and address of the office maintaining the health benefits file.

If the Individual Retirement Record has already been forwarded to the retirement system, use a retirement record supplement (such as the SF 2806-1 or SF 3101) to notify the retirement system of the spouse equity enrollment, cancellation, or termination of enrollment.

Retirement System Notice to Employing Office

If the employee's retirement record shows that a former spouse is eligible for health benefits coverage under spouse equity, the retirement system will notify you when a lump-sum benefit or annuity becomes payable.

If a refund is being paid to the former employee, and/or when no survivor annuity is payable to the former spouse, terminate the former spouse's enrollment and forward the health benefits file to the retirement system. The file must note the former employee's name and date of birth.

If any annuity benefit is payable to the former spouse, forward the health benefits file to the retirement system. Note the date through which premiums have been paid so the retirement system can know the effective date of the transfer of enrollment and when to begin withholding premiums.

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