[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR890.401]

[Page 465-466]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
        Subpart D_Temporary Extension of Coverage and Conversion
 
Sec. 890.401  Temporary extension of coverage and conversion.


    (a) Thirty-one day extension and conversion. (1) An enrollee whose 
enrollment is terminated other than by cancellation of the enrollment or 
discontinuance of the plan, in whole or part, and a covered family 
member whose coverage is terminated other than by cancellation of the 
enrollment or discontinuance of the plan, in whole or in part, is 
entitled to a 31-day extension of coverage for self alone or self and 
family, as the case may be, without contributions by the enrollee or the 
Government, during which period he or she is entitled to exercise the 
right of conversion provided for by this part. The 31-day extension of 
coverage and the right of conversion for any person ends on the 
effective date of a new enrollment under this part covering the person.
    (2) Termination of an enrollment under this subpart for failure to 
pay premiums is considered a cancellation of the enrollment for the 
purposes of this section.
    (b) Continuation of benefits. (1) Any person who has been granted a 
31-day extension of coverage in accordance with paragraph (a) of this 
section and who is confined in a hospital or other institution for care 
or treatment on the 31st day of the temporary extension is entitled to 
continuation of the

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benefits of the plan during the continuance of the confinement but not 
beyond the 60th day after the end of the temporary extension.
    (2) Except when a plan is discontinued in whole or in part or the 
Associate Director for Retirement and Insurance orders an enrollment 
change, a person whose enrollment has been changed from one plan to 
another, or from one option of a plan to the other option of that plan, 
and who is confined to a hospital or other institution for care or 
treatment on the last day of enrollment under the prior plan or option, 
is entitled to continuation of the benefits of the prior plan or option 
during the continuance of the confinement. Continuation of benefits 
shall not extend beyond the 91st day after the last day of enrollment in 
the prior plan or option. The plan or option to which enrollment has 
been changed shall not pay benefits with respect to that person while he 
or she is entitled to any inpatient benefits under the prior plan or 
option. The gaining plan or option shall begin coverage according to the 
limits of its FEHB Program contract on the day after the day all 
inpatient benefits have been exhausted under the prior plan or option or 
the 92nd day after the last day of enrollment in the prior plan or 
option, whichever is earlier. For the purposes of this paragraph, 
``exhausted'' means paid or provided to the maximum benefit available 
under the contract.
    (3) Exception. The limit on the number of confinement days allowed 
to be covered under the continuation of benefits specified by paragraph 
(b)(2) of this subpart does not apply to confinements in a hospital or 
other institution when the charges and benefit payments for the services 
provided are covered by the limit specified in subpart I of this part. 
In these cases, the benefits continue until the end of the confinement.
    (c)(1) The employing agency must notify the enrollee of the 
termination of the enrollment and of the right to convert to an 
individual policy within 60 days after the date the enrollment 
terminates.
    (2) The individual whose enrollment terminates must request 
conversion information from the losing carrier within 31 days of the 
date of the agency notice of the termination of the enrollment and of 
the right to convert.
    (3) When an agency fails to provide the notification required in 
paragraph (c)(1) of this section within 60 days of the date the 
enrollment terminates, or the individual fails for other reasons beyond 
his or her control to request conversion as required in paragraph (c)(2) 
of this section, he or she may request conversion to an individual 
policy by writing directly to the carrier. Such a request must be filed 
within 6 months after the individual became eligible to convert his or 
her group coverage and must be accompanied by verification of 
termination of the enrollment; e.g., an SF 50, showing the individual's 
separation from the service. In addition, the individual must show that 
he or she was not notified of the termination of the enrollment and of 
the right to convert, and was not otherwise aware of it, or that he or 
she was unable, for cause beyond his or her control, to convert. The 
carrier will determine if the individual is eligible to convert; and 
when the determination is affirmative, the individual may convert within 
31 days of the determination. If the determination by the carrier is 
negative, the individual may request a review of the carrier's 
determination from OPM.
    (4) When an individual converts his or her coverage anytime after 
the group coverage has ended, the individual plan coverage is 
retroactive to the day following the day the temporary extension of 
group coverage ended. The individual must pay the premiums due for the 
retroactive period.
    (5) An individual who fails to exercise his or her rights to convert 
to an individual policy within 31 days after receiving notice of the 
right to convert from the carrier is deemed to have declined the right 
to convert unless the carrier, or, upon review, OPM determines the 
failure was for cause beyond his or her control.

[33 FR 12510, Sept. 4, 1968, as amended at 52 FR 10217, Mar. 31, 1987; 
54 FR 52339, Dec. 21, 1989; 55 FR 22891, June 5, 1990; 57 FR 10609, Mar. 
27, 1992; 57 FR 21191, May 19, 1992]

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