IMPAIRED RELATIONSHIP (Continued)Temporary Employee's Change in Employment Status
If your employment status changes from a temporary employee enrolled under 5 U.S.C. 8906a to a position in which you become eligible to receive the Government contribution, your employing office will document the change on the Notice of Change in Health Benefits Enrollment (SF 2810). The SF 2810 documents the change in premium withholding and when your enrollment begins to count toward the requirement for continuation after retirement. (You may change your enrollment if you wish.)
Your employing office will complete parts A, G, and H of the SF 2810, and enter the following remark in Part G: "Employee has been converted/appointed to a position in which (he)(she) participates in a retirement system and is eligible for the Government contribution to the premium."
If your name changes but your enrollment does not, your employing office must report it to your carrier. Your employing office prepares a Notice of Change in Health Benefits Enrollment (SF 2810) and notes in the Remarks section the reason and date of the change (e.g., "Employee married [date])."
When your enrollment is reinstated, your employing office will complete parts A, D, and H of Notice of Change in Health Benefits Enrollment (SF 2810). It will note in the Remarks section the event permitting reinstatement (e.g., "Returned from military service", "Employee reinstated", or "Correction of erroneous termination of enrollment").
Your employing office will send you the enrollee copy, file a copy on the right side of the Official Personnel Folder, and send the carrier and payroll office copies to the payroll office for transmission to the carrier and posting to the payroll records, respectively.
Your enrollment and coverage continue without change when you transfer from one payroll office to another without a break in service of more than 3 days. Your employing office will promptly take action to transfer your enrollment. See "When You Transfer to a Different Payroll Office (Daily Proration Rule)" for information on each payroll office's responsibility for withholdings and contributions.
Your gaining employing office will perform a record check on SF 75 before you enter on duty to establish your current enrollment status, enrollment code number, and Social Security number.
When you enter on duty, your employing office will:
When you are part of a group of 25 or more employees enrolled in the same plan to be transferred on the same day from one payroll office to another payroll office, your employing office doesn't need to prepare a separate transfer-in Notice of Change in Health Benefits Enrollment (SF 2810) for each of you. The gaining employing office may make a list of all the employees involved in the transfer and attach several copies to only one SF 2810 documenting the mass transfer in. It will post the change in payroll office number on the latest SF 2809 in each of your Official Personnel Folders so that the payroll office number is up to date.
The gaining employing office will prepare the list in three columns, with column 1 for the employee's name, column 2 for the Social Security Number, and column 3 for the enrollment code number.
Voiding is appropriate only when an incorrect health benefits action must be withdrawn and your enrollment status must revert to what it was before the incorrect action was taken. Voiding has the effect of removing the incorrect action as though it never occurred.
To void an action, your employing office marks "VOID" in bold letters on the Official Personnel Folder and payroll office copies of the form on which the incorrect action was taken (either the SF 2809 or SF 2810), and explains the action in the Remarks section. Additional remarks are required when an erroneous enrollment is voided.
If your employing office had sent the carrier's copy of the form, it will send the voided payroll office copy to the carrier with the next regular transmittal. If the action being voided is a change in plan, it will send a copy of the voided SF 2809 to both the old and new carrier. Your employing office will keep a copy in your Official Personnel Folder (OPF). If a copy had not been sent to the carrier, it will destroy all but one copy to be retained in your OPF.
Your employing office must correct and report to your carrier erroneous information given on the Health Benefits Election Form (SF 2809) or Notice of Change in Health Benefits Enrollment form (SF 2810) that would affect your entitlement to benefits. Significant errors include errors in your name, enrollment code, Social Security number, the effective date of a health benefits action, or a listing of family members when there are none.
Your employing office will make a correction on SF 2809 or SF 2810 (depending on which of these forms contains the erroneous information), and clearly label the form "CORRECTION." The corrected form must give your name, Social Security number, and other identifying data. The form may show only the specific item(s) being corrected, or your employing office may substitute another complete corrected form for the one previously submitted. Your employing office will send the corrected form to your carrier with the next regular transmittal. If the erroneous information was sent to both the old and the new carriers, each will be sent a corrected form.
Title 6 of the General Accounting Office Manual for Guidance of Federal Agencies, which provides principles and standards for payroll office operations, delegates to OPM the authority to prescribe the principles and standards for the FEHB Program.
On at least a weekly basis, your payroll office will send copies of Health Benefits Election forms (SF 2809) and Notice of Change in Health Benefits Enrollment forms (SF 2810) to the appropriate carrier with the transmittal document. Your payroll office cannot accumulate health benefits forms for longer than one week.
Before transmitting a copy of a health benefits form to a carrier, your payroll office must verify that the payroll action required by the form can be taken (e.g., that you were in pay status during the pay period before the effective date, if it is a requirement for that action). A copy of the form can be released to the carrier before payroll action is completed to adjust the health benefits control or to note the individual pay record.
Your payroll office will prepare an original and two copies of the transmittal report. It will send the original and one copy to the carrier with the carrier copies of Health Benefits Election forms (SF 2809) and Notice of Change in Health Benefits Enrollment forms (SF 2810). It will hold the second copy until the carrier returns a certified copy.
Carrier addresses for fee-for-service plans and HMOs are provided to payroll offices by OPM before the start of each annual open season. The carrier code is the first two characters of the carrier's enrollment code number.
Each agency payroll office that reports FEHB withholdings and contributions uses a unique eight digit identification number. The first two digits represent the agency (assigned by the U.S. Treasury Department) and the last six digits identify the payroll office within the agency. Agency headquarters must notify OPM of any establishment of or change in payroll office number.
The payroll office number must be provided on every health benefits form (SF 2809, 2810, and transmittal document). In most cases, the agency office that maintains the Retirement and Insurance Transfer System (RITS) also maintains the FEHB enrollment. When different offices are responsible for maintaining RITS and FEHB enrollment, OPM maintains a payroll office directory, containing the addresses and phone numbers of agency offices that prepare RITS and FEHB enrollment information. It is important that agencies promptly report changes to OPM so this directory is kept current. Carriers must also be notified of changes so they can update their records. This is done in the same way as a mass transfer.
Your payroll office must enter a report number on each Transmittal Report that it prepares. The first two digits designate the calendar year and the remaining digits run in numerical sequence, starting with number 1. Thus, 99-1 is the number of the first transmittal sent on or after January 1, 1999; 99-2 is the number of the second transmittal in that year, etc. A new series starting with number 1 begins each calendar year.
Your payroll office will enter the transmittal report number in the appropriate space on each Health Benefits Election Form (SF 2809) and Notice of Change in Health Benefits Enrollment form (SF 2810) sent with that transmittal and on the corresponding payroll office copies.
Your payroll office will show the number of Health Benefits Election Forms (SF 2809) and Notice of Change in Health Benefits Enrollment forms (SF 2810) sent with that transmittal to carrier in the space provided.
OPM does not require a specific enrollment records system for carriers. Carriers must maintain their records in a way that allows for easy determination of the number and identity of enrollees served by individual payroll offices for control and statistical reporting and for reconciliations.
OPM requires the quarterly reconciliation of carrier enrollment records with agency personnel and payroll records. These reconciliations are critical to ensure that enrollees receive the health benefits to which they are entitled.
Each payroll office will reconcile the names and numbers of enrollees in a particular plan with the carrier's records. OPM urges payroll offices and carriers to fully cooperate to maintain accurate and up-to-date enrollment files.
Each payroll office is required to generate a quarterly report for each plan that lists enrollee names, enrollment code, and total money (withholdings and contributions) submitted to OPM for each enrollee. This quarterly report includes enrollment data for the payroll paid during the 1st through the 15th of the last month in each quarter. If two payrolls are paid during that period, enrollment data for the last payroll paid is reported.
The carrier has the responsibility for initiating reconciliations and doing the actual matching of names, but the payroll office must be responsive and cooperate with the carrier. When the carrier finds individual names on its enrollment records that are not on the employing office's enrollment report, the carrier must ask the employing office for documentation to resolve the discrepancy. If the carrier cannot reconcile its records or does not receive the requested information within 31 days of the request, it may proceed with disenrolling the individual.
If the carrier and the payroll office agree, the payroll office may do the detailed reconciliation. The carrier must keep the reconciliation results and workpapers for inspection by OPM and the General Accounting Office.
Your carrier is required to use your Social Security number to reconcile enrollments. Social Security numbers must be clearly shown on any Health Benefits Election forms (SF 2809) and Notice of Change in Health Benefits Enrollment forms (SF 2810) processed and forwarded to the carriers. Social Security numbers must be available for use in the reconciliation process either within the payroll office or during the joint payroll office-carrier reconciliations.
If you object to giving your carrier your Social Security number, your employing office may make special provisions to accommodate your wishes. However, it may be difficult for the carrier to pay your claims or provide services without using your Social Security number as an identifier.
When a carrier can not reconcile its records of your enrollment with the employing office's enrollment records, or when it does not receive the necessary documentation from the employing office to resolve the discrepancy within 31 days from its request, the carrier may proceed with your disenrollment.
The carrier must provide you with written notice that the employing office of record does not show you as enrolled in the carrier's plan and that you will be disenrolled 31 calendar days after the date of the notice unless you can provide documentation of your enrollment. This documentation may include:
After receiving your documentation, the carrier must notify you and your employing office of its decision on your information. If the carrier does not receive documentation of your enrollment within 31 calendar days from its notice, you will be disenrolled from its plan, without further notice.
You may request that your employing office reconsider the carrier's disenrollment decision. Your reconsideration request must be filed within 60 calendar days of the date of the carrier's disenrollment notice. Your employing office must notify the carrier when it receives such a request.
If, at any time after disenrollment, your employing office or OPM determines that you should be enrolled under another coverage provision, or if the carrier receives appropriate documentation showing that you should be enrolled, the disenrollment is void and coverage is reinstated retroactively.
A carrier also has the right to disenroll:
Notice of disenrollment must be provided to a child survivor annuitant or a former employee. The notice must be provided to the child survivor annuitant prior to the disenrollment date.
A child survivor annuitant has the right to request that the retirement system reconsider the disenrollment decision.
If, at any time after disenrollment, the employing office or OPM determines that coverage should be extended under another coverage provision, or if the carrier receives appropriate documentation of the enrollment, the disenrollment is void and coverage is reinstated retroactively.