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FEHB Handbook

Former Spouses Page 4 of 7

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INFORMATION FOR FORMER SPOUSES (Continued)

OPPORTUNITIES TO ENROLL OR CHANGE ENROLLMENT (Continued)

Move from an HMO's Service Area

If you are enrolled in an HMO and move or become employed outside the plan's service area (or, if already outside this area, move or become employed further away) you may change the enrollment. If a covered family member moves outside the HMO's service area (or if already outside this area, moves further away), you may also change the enrollment. The enrollment change is effective on the first day of the pay period beginning after the employing office receives the Health Benefits Election Form (SF 2809) or other enrollment request.

On Becoming Eligible for Medicare

You may change enrollment from one plan or option to another at any time beginning 30 days before becoming eligible for Medicare coverage. An enrollment change based on becoming eligible for Medicare may be made only once.

Annuity Insufficient to Pay Withholdings

If you are receiving an annuity and it is insufficient to pay the premiums for your health plan, your retirement system will provide you with information on lower cost plans and will give you the opportunity to either:

  • pay your premiums directly to the retirement system; or
  • enroll in a plan with a premium less than your annuity.

If you elect to change to a lower-cost plan, the change is effective immediately upon your loss of coverage in the prior plan.

If you are enrolled in the high option of a two-option plan, and don't make one of the elections noted above, your enrollment will be changed to the standard option of the same plan (unless your annuity won't cover the cost of the standard option). If you are enrolled in a one-option plan, and don't make one of the elections, your coverage will be terminated.

Former Spouses with Other FEHB Coverage

Once you have established eligibility for FEHB coverage, you may defer enrolling as a former spouse if you are already enrolled in FEHB.

When you lose regular coverage under FEHB, you may enroll as a former spouse from 31 days before to 60 days after the covering enrollment terminates, as long as you continue to meet the eligibility requirements. You may enroll in any available plan.

When Both You and Your Former Spouse Have FEHB Enrollments

If both you and your spouse have your own FEHB enrollments and become divorced, it is important for each of you to establish your eligibility for FEHB coverage under spouse equity provisions within the required time frame. In this way you can protect your future entitlement to FEHB coverage under spouse equity provisions if you lose your own FEHB coverage. You must apply to your former spouse's employing office for the determination, not your own employing office.

If you are enrolled as a Federal employee when your former spouse's employing office determines that you are eligible for coverage under spouse equity provisions, you must provide a copy of its determination to your current employing office. Your current employing office must note on your Individual Retirement Record that you are eligible for FEHB coverage under spouse equity provisions. Your former spouse's employing office must maintain a health benefits file for you and note that you are deferring your enrollment under spouse equity provisions until you lose enrollment as an employee.

When You Lose Coverage as an Employee and Enroll as a Former Spouse

When your enrollment as an employee terminates, your current employing office must terminate your enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810) and note the time limits for enrolling as a former spouse with other FEHB coverage. You then must notify the employing office responsible for your spouse equity enrollment of your intent to enroll as a former spouse. That employing office will verify that you are still eligible under spouse equity provisions, and if so, enroll you based on your submission of a Health Benefits Election Form (SF 2809). The employing office will also give you a certification to sign and date.

The employing office responsible for your spouse equity enrollment will note on the SF 2809 that you were previously covered as an employee and you are enrolling as a former spouse under the same Social Security number. Once your spouse equity coverage begins, you must pay both the employee and Government shares of the premium.

If the employing office determines that you are no longer eligible to enroll under spouse equity, it will deny your enrollment, explain your right to request reconsideration, and place a copy of your request for enrollment and its denial in your former spouse health benefits file.

When You are Covered as a Family Member and become Eligible as a Former Spouse

If you are covered as a family member under another person's FEHB enrollment when you are determined eligible for health benefits under spouse equity provisions, the employing office responsible for your spouse equity enrollment must note in your health benefits file that you are deferring the spouse equity enrollment until you lose coverage as a family member. When you lose the family member coverage and request enrollment, that employing office will process the spouse equity enrollment.

Cancellation of a Former Spouse Enrollment

You may cancel your spouse equity enrollment at any time. With one exception noted below, the cancellation is effective on the last day of the pay period in which the employing office receives the Health Benefits Election Form (SF 2809) cancelling the enrollment. You and your 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. You may not reenroll, unless 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).

If you suspend your 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. You must submit documentation of your new enrollment to the employing office from 31 days before to 31 days after the enrollment takes effect.

PREMIUM PAYMENTS

You must pay the employee and Government shares of the premium for every pay period during which you are enrolled. There is no Government contribution. The employing office will establish a premium payment schedule and is responsible for collecting the premiums.

When You Do Not Pay Your Premium

If the employing office doesn't receive a premium payment by the due date, it must notify you in writing that you must make payment within 15 days (45 days if you live overseas) after you receive the notice for your coverage to continue. The notice must state that if you don't make payment within this time frame, you are considered to have voluntarily canceled the enrollment.

If you don't make further payments, the employing office processes a cancellation 60 days (90 days if you live overseas) after the date of the notice.

Your employing office's notice will ask if you have obtained other coverage as described below. It will explain in the notice that you may resume coverage under spouse equity provisions when this other coverage ends only if you inform the employing office of the other coverage now. It will place a copy of the notice and your response in your health benefits file.

You must inform the employing office if you obtain FEHB coverage as an employee or as a family member under another person's FEHB enrollment, or have 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 your right to continue the spouse equity enrollment if you lose the other coverage.

Cancellation Because You Did Not Pay Premiums

If your coverage is canceled because you didn't pay premiums:

If you were unable to make timely payment for reasons beyond your control, you may write to the employing office to ask that your coverage be reinstated. This request must be filed within 30 calendar days from the cancellation date and must provide proof that nonpayment was beyond your control. The employing office determines if you are eligible for reinstatement of coverage. If the employing office decides to allow reinstatement, it will be restored retroactively to the cancellation date upon receipt of the back premiums. If the employing office denies the reinstatement request, you may request that the employing office reconsider its initial decision.

TERMINATION OF A FORMER SPOUSE ENROLLMENT

Your 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;
  • You remarry before age 55;
  • You die;
  • The employee on whose service your benefits are based dies and no survivor annuity is payable;
  • The separated employee on whose service your benefits are based dies before meeting the requirements for a deferred annuity;
  • The employee on whose service your 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 your benefits are based.

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

The employing office must give you a copy of the Notice of Change in Health Benefits Enrollment (SF 2810) terminating your enrollment as soon as possible. This will allow you to convert to individual coverage within the 31-day time limit. The employing office must also advise you that when your enrollment terminates, you cannot later reenroll under the Spouse Equity Act. If you were enrolled in an employee organization plan and the enrollment terminates because your membership in the sponsoring employee organization terminates, your employing office will allow you to change to another plan.

Belated Extension of Coverage

When you belatedly learn that your enrollment under spouse equity has terminated because:

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

you are allowed an extension of coverage of 31 days after the employing office's notice that coverage has terminated, during which you may convert to individual coverage.

You 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

You are eligible to enroll under temporary continuation of coverage (TCC) when your spouse equity enrollment terminates during the first 36 months after your divorce or annulment because:

  • there is no longer a qualifying court order; or
  • you remarry before reaching age 55.

Termination of Eligible Child's Coverage

An eligible child's coverage under your 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 your divorce.

If you cancel your spouse equity enrollment, the child's enrollment also ends on the same date with no extension of coverage or conversion rights.

REENROLLMENT

If you are enrolled under the spouse equity provisions and become covered under another FEHB enrollment (either as an employee or a family member), you may suspend the spouse equity enrollment while covered under the other enrollment. You may reenroll when the other FEHB coverage ends.

When You are Enrolled as a Former Spouse and become a Federal Employee

If you are enrolled as a former spouse and then become eligible to enroll as a Federal employee, you must notify the employing office responsible for your spouse equity enrollment that you are enrolling as a Federal employee. This employing office will terminate your spouse equity enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810), and note in the Remarks section that you are entitled to enrollment as a former spouse. It will file the Official Personnel Folder copy of the SF 2810 in your former spouse file and note that your spouse equity enrollment is being suspended while you are covered as a Federal employee.

Your current employing office will enroll you on the Health Benefits Election Form (SF 2809). It must note in the Remarks section that you were previously covered as a former spouse and are now enrolling as an employee under the same Social Security number. When your health benefits coverage as an employee terminates, you and the employing offices involved should follow the procedures in "When You Lose Coverage as an Employee and Enroll as a Former Spouse."

When You are Enrolled as a Former Spouse and become Covered as a Family Member

If you are enrolled under the spouse equity provisions and become covered as a family member under another person's FEHB enrollment, the employing office responsible for the spouse equity enrollment will terminate it on the Notice of Change in Health Benefits Enrollment (SF 2810). It will note in the Remarks section that the enrollment is being terminated because you are 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 you lose coverage as a family member. When you lose family member coverage and request reinstatement, the employing office that was previously responsible for the spouse equity enrollment will again be responsible for the enrollment.

When Coverage under Medicare Managed Care Plan or Medicaid Ends

If you postponed enrolling or 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), you may later reenroll under the spouse equity provisions if enrollment in the Medicare managed care plan or Medicaid ends and you still qualify for a spouse equity enrollment. You must have informed the employing office of your Medicare managed care plan or Medicaid enrollment when you postponed or suspended your spouse equity enrollment.

If your Medicare managed care plan or Medicaid enrollment ends involuntarily, you can immediately reenroll under the spouse equity provisions in any available plan at any time from 31 days before to 60 days after your 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 you voluntarily disenroll from the Medicare managed care plan or Medicaid, you may reenroll under the spouse equity provisions during the following Open Season.

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