FEHB Handbook

Former Spouses Page 5 of 7

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• SPOUSE EQUITY ACT
• ELIGIBILITY
• ENROLLMENT
• OPPORTUNITIES TO ENROLL OR CHANGE ENROLLMENT
• PREMIUM PAYMENTS
• TERMINATION OF A FORMER SPOUSE ENROLLMENT
• REENROLLMENT

This section provides information for Federal employing offices on determining eligibility for and servicing of former spouses of Federal employees and annuitants under the Spouse Equity provisions of FEHB law. In this section:

• "you" means the employing office personnelist; and
• "divorce" includes certain annulments.

SPOUSE EQUITY ACT

Law

The Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615) was enacted on November 8, 1984. Under this act, as amended, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.

ELIGIBILITY

A former spouse is eligible to enroll under spouse equity provisions if he/she:

• was divorced from a Federal employee or annuitant during employment or receipt of annuity;
• was covered as a family member under an FEHB enrollment at least one day during the 18 months before the marriage ended (Note: This requirement is also met when both spouses have FEHB enrollments);
• is entitled to a portion of the Federal employee's annuity or to a former spouse survivor annuity; and
• has not remarried before age 55.

Loss of Coverage as a Family Member

A former spouse loses coverage as a family member upon divorce, subject to a 31-day extension of coverage. However, enrollment under the spouse equity provisions may not begin for several months after the divorce, depending on how long it takes to establish eligibility. To avoid a gap in coverage for this period, the former spouse has two options. He/she may:

• convert to an individual contract during the 31-day extension of coverage; or
• continue FEHB coverage under the Temporary Continuation of Coverage (TCC) provisions of the FEHB law.

If the former spouse will seek coverage under spouse equity provisions, it is advisable for him/her to stay with the same plan.

If the former spouse act promptly, he/she may request retroactive enrollment once you have approved the application for enrollment under the spouse equity provisions. For enrollment to be retroactive, you must receive an appropriate request and satisfactory proof of eligibility from the former spouse within 60 days after the date of divorce.

ENROLLMENT

• Type of Enrollment
• Where Former Spouses Apply
• Application to Enroll
• Time Limit
• Deferred Enrollment
• Determination of Future Entitlement to Annuity
• Retirement System Addresses
• Determining a Former Spouse's Eligibility
• Employing Office Decision
• Enrollment Procedures
• Certification
• Sample Certification
• Health Benefits File
• File Contents
• File Disposition
• Transfer to Retirement System
• Effective Dates

Enrolling under the spouse equity provisions is a three-step process. First, the former spouse must apply to enroll within the required time limit. Second, he/she must establish eligibility to enroll. Third, the actual enrollment can take place only after the first two steps have been completed.

Type of Enrollment

The former spouse may elect a self only or self and family enrollment. A self and family enrollment covers only the former spouse and any unmarried dependent natural or adopted children of the former spouse and the Federal employee or annuitant on whose service coverage is based.

Where Former Spouses Apply

If the marriage ends before the employee's retirement, the former spouse must apply and pay premiums to the employing office of the agency for which the employee worked when the marriage ended. If the application is approved, this will be the employing office until he/she begins receiving annuity payments, even if the employee transfers to another employing office.

The former spouse must apply and pay premiums to the retirement system responsible for his/her annuity payment if:

• he/she is receiving a portion of a retirement benefit or a former spouse survivor annuity;
• the divorce occurred after the employee's retirement; or
• the divorce occurred before May 7, 1985, and the employee or former employee worked for the Central Intelligence Agency (CIA) or the Foreign Service.

OPM is the employing office if the employee or former employee is receiving compensation from the Office of Workers' Compensation Programs (OWCP), and his/her health benefits enrollment had been transferred to OWCP before the marriage ended.

Application to Enroll

The former spouse's application to enroll can either be a completed Health Benefits Election Form (SF 2809) or a written notice of intent to apply for health benefits. The former spouse's name, date of birth, and Social Security number is entered 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.

If the former spouse has a mental or physical disability that prevents him/her from applying for benefits, a court appointed guardian may file the application.

Time Limit

The former spouse must apply to the employing office in writing by the latest of:

• 60 days after the marriage ends;
• 60 days after the date of OPM's notice of his/her eligibility to enroll based on a qualifying court order awarding entitlement to a portion of the employee's future annuity (see section 5A5.1-2 of the CSRS/FERS Handbook for Personnel and Payroll Offices), or to a former spouse survivor annuity; or
• 60 days after the date of the notice of eligibility to enroll based on entitlement to a former spouse annuity under another retirement system for Government employees.

If the former spouse does not apply to the employing office in person, use the postmark date on the application to determine if the time limit is met.

Deferred Enrollment

Once the former spouse has applied to enroll within the required time limit, he/she may postpone actual enrollment indefinitely.

Determination of Entitlement to Future Annuity

When you receive an application for benefits, advise the former spouse that he/she must send a written request to the retirement system for a determination of entitlement to either:

• a portion of the employee's future retirement annuity, or
• a former spouse survivor annuity.

The request must include:

• a certified copy (not a photocopy of a certified copy) of the divorce decree, property settlement, and/or court order (if applicable);
• the employee's name, date of birth, Social Security number, and last employing agency.

Unless the employee is subject to the CIA or Foreign Service retirement systems, OPM, not the agency, will make the annuity benefit determination based on the court order supplied. The former spouse can not enroll until OPM makes its determination.

OPM will send the former spouse a written decision. If the decision is favorable, he/she will submit the decision to you.

Retirement System Addresses

Determining a Former Spouse's Eligibility

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

To be eligible to enroll, the former spouse must meet all of the following requirements:

• He/she must not have remarried before age 55;
• He/she must have been covered as a family member in an FEHB plan at least one day during the 18 months before the marriage ended;
• He/she 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, the former spouse could qualify to enroll based on the employee's CIA employment, if they were married for at least 10 years during the employee's CIA service, at least 5 years of which both spouses spent outside the United States, and the marriage ended before May 7, 1985.

If the employee worked for the Foreign Service, the former spouse could also qualify to enroll based on the employee's Foreign Service employment if they were married for at least 10 years during the employee's Government service, and the marriage ended before May 7, 1985.

Employing Office Decision

If you determine that the former spouse is eligible for health benefits coverage, send the following to the former spouse:

• written confirmation of your decision;
• a premium payment schedule; and
• a certification stating the requirements for continued enrollment for the former spouse to sign and date.

If you determine that the former spouse is not eligible for health benefits coverage, send the former spouse a notification in writing and give the reason for the denial. Explain that he/she has a right to request reconsideration of your decision.

Enrollment Procedures

If the former spouse didn't submit a Health Benefits Election Form (SF 2809) or other enrollment request as an application to enroll, he/she must complete one to enroll. The former spouse's name, date of birth, and Social Security number is entered 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 the former spouse elects health benefits coverage under the spouse equity provisions, the former spouse must certify that he/she will notify the employing office within 31 days of an event that would terminate his/her eligibility. You must keep the original certification in the former spouse's health benefits file. The former spouse should keep a copy.

Sample Certification

The former spouse must 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

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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