[Federal Register: August 26, 2008 (Volume 73, Number 166)]
[
Rules and Regulations]
[Page 50183-50188]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr26au08-2]
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OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 894
RIN 3206-AL03
Federal Employees Dental and Vision Insurance Program
AGENCY: Office of Personnel Management.
ACTION: Final rule.
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SUMMARY: The Office of Personnel Management (OPM) is issuing final
regulations to administer the Federal Employee Dental and Vision
Benefits Enhancement Act of 2004, signed into law December 23, 2004.
This law establishes dental and vision benefits programs for Federal
employees, annuitants, and their eligible family members.
DATES: September 25, 2008.
FOR FURTHER INFORMATION CONTACT: Nataya Battle, (202) 606-1874, or e-
mail at nataya.battle@opm.gov.
SUPPLEMENTARY INFORMATION:
Background
On December 23, 2004, Public Law 108-496, 118 Stat. 4001, was
signed into law. This law established a dental benefits and vision
benefits program for Federal employees, annuitants, and their eligible
family members. The first effective date of coverage was December 31,
2006.
On October 15, 2007, OPM published interim regulations in the
Federal Register (72 FR 58243-58248) to administer the Federal
Employees Dental and Vision Insurance Program (FEDVIP). Comments were
requested by December 15, 2007. OPM received comments from an employee
union, a participating health plan in the FEHB Program, and an
independent organization.
One comment addressed the role of the carriers and the
Administrator in the handling of the enrollment process. OPM contracts
with the Administrator which has agreed to handle all aspects of the
enrollment process on behalf of the carriers. Therefore the regulations
have been revised to substitute ``Administrator'' for ``carrier''
wherever there is a reference to the enrollment process.
Another comment addressed concerns that OPM does not review appeals
for denial of a claim. The dental and vision carriers conduct their own
disputed claims process and are required to use an independent third
party to conduct a final analysis of any dispute, upon appeal. This
process was established to ensure an independent evaluation is
conducted, but at minimal cost to Program enrollees.
A comment indicated that it was not clear whether enrollment or
coverage would be denied for preexisting dental conditions. Under this
Program, neither enrollment nor benefits coverage is denied due to a
preexisting dental condition. However, since the dental program was
established in order to provide benefits for dental services for teeth
and their surrounding tissues, a carrier may determine that coverage
does not extend to replacements for teeth missing before the effective
date of enrollment in the Program.
Another comment suggested revising the language in Sec. 894.601(a)
to remove the reference to coverage ending at the end of the pay period
``in which you were last eligible'' and in Sec. 894.601(b) to remove
the reference to coverage ending at the end of the pay period for which
the last premium allotment was made;
[[Page 50184]]
and replace them each with coverage ending ``at the end of the period
covered by your last premium payment.'' It is not our intention to
terminate an enrollment prior to the end of an enrollees' eligibility
for coverage. Therefore, we did not adopt this suggestion.
The regulations have also been revised at Sec. 894.602 to provide
for a Qualifying Life Event that allows cancellation of enrollment when
an enrollee or his or her spouse is called to active military service,
and at Sec. 894.704(d) to advise an annuitant if his or her
reemployment terminates, he or she must notify the Administrator within
30 days to have his or her FEDVIP allotments withheld from his or her
annuity payments. Otherwise, their FEDVIP coverage will terminate due
to non-payment of premiums.
Regulatory Flexibility Act
I certify that this regulation will not have a significant economic
impact on a substantial number of small entities because the regulation
only affects dental and vision benefits of Federal employees and
annuitants.
Executive Order 12866, Regulatory Review
This rule has been reviewed by the Office of Management and Budget
in accordance with Executive Order 12866.
Federalism
We have examined this rule in accordance with Executive Order
13132, Federalism, and have determined that this rule will not have any
negative impact on the rights, roles, and responsibilities of State,
local, or Tribal governments.
List of Subjects in 5 CFR Part 894
Administrative practice and procedure, Employee benefit plans,
Government employees, Reporting and recordkeeping requirements,
Retirement.
Office of Personnel Management.
Howard Weizmann,
Deputy Director.
0
For the reasons stated in the Preamble, OPM is revising part 894 to
title 5, Code of Federal Regulations, to read as follows:
PART 894--FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM
Subpart A--Administration and General Provisions
Sec.
894.101 Definitions.
894.102 If I have a preexisting dental or vision condition, may I
join FEDVIP?
894.103 How do I enroll?
894.104 Who makes enrollment decisions?
894.105 Who may correct an error in my enrollment?
Subpart B--Coverage and Types of Enrollment
894.201 What types of enrollments are available under FEDVIP?
894.202 If I enroll for self plus one, may I decide which family
member to cover?
894.203 If I have a self plus one enrollment, when may I change
which family member I want to cover or change to self only?
894.204 May I be enrolled in more than one dental or vision plan at
a time?
Subpart C--Eligibility
894.301 Am I eligible to enroll in FEDVIP?
894.302 What is an excluded position?
894.303 What happens to my enrollment if I transfer to an excluded
position?
894.304 Am I eligible to enroll if I'm retired or receiving workers'
compensation?
894.305 Am I eligible to enroll if I am a former spouse receiving an
apportionment of annuity?
894.306 Are foster children eligible as family members?
894.307 Are disabled children age 22 or over eligible as family
members?
Subpart D--Cost of Coverage
894.401 How do I pay premiums?
894.402 Do the premiums I pay reflect the cost of providing
benefits?
894.403 Are FEDVIP premiums paid on a pre-tax basis?
894.404 May I opt out of premium conversion?
894.405 What happens if I go into nonpay status or if my pay/annuity
is insufficient to cover the allotments?
Subpart E--Enrolling and Changing Enrollment
894.501 When may I enroll?
894.502 What are the Qualifying Life Events (QLEs) that allow me to
enroll?
894.503 Are belated enrollments or changes allowed?
894.504 When is my enrollment effective?
894.505 Are retroactive premiums paid with pre-tax dollars (premium
conversion)?
894.506 How often will there be open seasons?
894.507 After I'm enrolled, may I change from one dental or vision
plan or plan option to another?
894.508 When may I increase my type of enrollment?
894.509 What are the QLEs that are consistent with increasing my
type of enrollment?
894.510 When may I decrease my type of enrollment?
894.511 What are the QLEs that are consistent with decreasing my
type of enrollment?
894.512 What happens if I leave Government and then return?
Subpart F--Termination or Cancellation of Coverage
894.601 When does my FEDVIP coverage stop?
894.602 May I cancel my enrollment at any time?
894.603 Is there an extension of coverage and right to convert when
my coverage stops or when a covered family member loses eligibility?
Subpart G--Annuitants and Compensationers
894.701 May I keep my dental and/or vision coverage when I retire or
if I start receiving workers' compensation?
894.702 May I participate in open seasons and make changes to my
enrollment as an annuitant or compensationer?
894.703 How long does my coverage as an annuitant or compensationer
last?
894.704 What happens if I retire and then come back to work for the
Federal Government?
Subpart H--Benefits in Underserved Areas
894.801 Will benefits be available in underserved areas?
Authority: 5 U.S.C. 8962; 5 U.S.C. 8992.
Subpart A--Administration and General Provisions
Sec. 894.101 Definitions.
This part is written as if the reader were an applicant or
enrollee. Accordingly, the terms ``you,'' ``your,'' etc., refer, as
appropriate, to the applicant or enrollee.
Acquiring an eligible child means one of the following:
(1) Birth of a child;
(2) Adoption of a child;
(3) Acquisition of a foster child as described in Sec.
890.101(a)(8) of this chapter;
(4) Residence change of the enrollee's stepchild or recognized
natural child who moves in with the enrollee;
(5) Establishment of dependency of a recognized natural child as
described in Sec. 890.302(b) of this chapter; and
(6) An otherwise eligible child's loss of spouse due to divorce or
annulment of marriage, or death.
Administrator means the entity with which the Office of Personnel
Management contracts to manage the enrollment and premium payment
process for the Federal Employees Dental and Vision Insurance Program
(FEDVIP).
Annuitant means an individual defined at 5 U.S.C. 8901(3).
Generally, the term means a former employee who is entitled to an
immediate annuity or a disability annuity under a retirement system
established for employees. The term also generally includes those
receiving a survivor annuity due to the death of a Federal employee or
[[Page 50185]]
annuitant (survivor annuitants) and those receiving compensation from
the Office of Workers' Compensation Programs (compensationers). The
term does not include former employees who retire with a deferred
annuity under 5 U.S.C. 8413, or former spouses of annuitants.
Carrier means a company with which the Office of Personnel
Management contracts to provide dental and/or vision benefits.
Child means one of the following:
(1)(i) A child born within marriage;
(ii) An adopted child;
(iii) A stepchild or foster child who lives with the enrollee in a
regular parent-child relationship; or
(iv) A recognized natural child.
(2) This definition does not include a grandchild (unless the
grandchild meets all the requirements of a foster child as stated in
Sec. 890.101(a)(8) of this chapter).
(3) The child must be unmarried and under age 22. A child age 22 or
over is eligible if the child is incapable of self-support because of a
physical or mental disability that existed before the child reached age
22.
Compensation has the same meaning as found under subchapter I of
chapter 81 of title 5, United States Code, which is payable because of
an on-the-job injury or disease.
Compensationer means an individual who is receiving compensation
and who the Department of Labor determines is unable to return to duty.
Covered position means a position in which an employee is not
excluded from FEDVIP eligibility by law or regulation.
Days means calendar days.
Dependent means an unmarried child who is living with or receiving
regular and substantial support from the enrollee.
Employee means an individual defined in 5 U.S.C. 8901. For the
purposes of this subpart, the term employee additionally means an
employee of the United States Postal Service and an employee of the
District of Columbia courts.
Enrollment reconsideration means the Administrator's review of its
initial enrollment decision to determine if it followed the law and
regulations correctly in making the initial decision concerning FEDVIP
eligibility.
Family member means a spouse (including a spouse under a valid
common law marriage) and/or unmarried dependent child(ren).
OPM means the Office of Personnel Management.
OWCP means the Office of Workers' Compensation Programs, U.S.
Department of Labor.
Premium conversion means the payment of FEDVIP premiums using pre-
tax dollars. See Sec. 892.102 of this chapter for a discussion of how
premium conversion works.
QLE means a qualifying life event.
Recognized natural child means a biological child born outside of
marriage. A recognized natural child is an eligible family member if
the child lives with the enrollee or receives financial support from
the enrollee.
Regular parent-child relationship means that the enrollee is
exercising parental authority, responsibility, and control over the
child; is caring for, supporting the child; and is making the decisions
about the child's education and medical care.
Type of enrollment means one of the following:
(1) Self only;
(2) Self plus one; or
(3) Self and family.
Sec. 894.102 If I have a pre-existing dental or vision condition, may
I join FEDVIP?
Yes. Pre-existing conditions do not exclude you from coverage under
FEDVIP. The Administrator may not deny an individual the right to
enroll solely because of a preexisting dental or vision condition.
Sec. 894.103 How do I enroll?
You may enroll through an Administrator contracted by OPM to
facilitate the enrollment process. Your Federal agency, retirement
system, or OWCP office will advise you of the enrollment process
available to you.
Sec. 894.104 Who makes enrollment decisions and reconsiderations?
The Administrator makes enrollment decisions and the Administrator
reviews requests for reconsideration of an enrollment decision. The
Administrator's initial enrollment decision denying enrollment or an
opportunity to change coverage must be in writing and must inform you
about your right to reconsideration.
Sec. 894.105 Who may correct an error in my enrollment?
(a) The Administrator may correct administrative errors about the
processing of your enrollment or changes in enrollment.
(b) OPM may order correction of an administrative error if it
receives evidence that it would be against equity (fairness) and good
conscience not to order the correction. This decision is made at the
discretion of OPM and is not subject to review.
(c) If the correction gives you retroactive coverage, you must pay
the premiums for all periods of the retroactive coverage. These
premiums will not be on a pre-tax basis (they are not subject to
premium conversion).
Subpart B--Coverage and Types of Enrollment
Sec. 894.201 What types of enrollments are available under FEDVIP?
FEDVIP has three types of enrollment:
(a) Self only, which covers only the enrolled employee or
annuitant;
(b) Self plus one, which covers the enrolled employee or annuitant
plus one eligible family member; and
(c) Self and family, which covers the enrolled employee or
annuitant and all eligible family members.
Sec. 894.202 If I enroll for self plus one, may I decide which family
member to cover?
Yes, if you enroll for self plus one, you must state at the time
you enroll which eligible family member you want to cover under your
enrollment.
Sec. 894.203 If I have a self plus one enrollment, when may I change
which family member I want to cover or change to self only?
You may change your covered family member under a self plus one
enrollment or change to self only coverage in the following situations:
(a) During the annual open season;
(b) If your covered family member dies during the year; or
(c) If your covered family member loses eligibility during the
year.
Sec. 894.204 May I be enrolled in more than one dental or vision plan
at a time?
You may be enrolled in a FEDVIP dental plan and a separate FEDVIP
vision plan at the same time. But no one may enroll or be covered as a
family member in a FEDVIP dental or vision plan if he or she is covered
under another person's FEDVIP dental or vision self plus one or self
and family enrollment, except as provided under Sec. 890.302 (a)(2)
through (4) of this chapter, with respect to dual enrollments.
Subpart C--Eligibility
Sec. 894.301 Am I eligible to enroll in the FEDVIP?
You are eligible if you meet the definition of employee in 5 U.S.C.
8901(1), unless you are in an excluded position. You are eligible if
you are an employee of the United States Postal Service or the District
of Columbia courts.
Sec. 894.302 What is an excluded position?
Excluded positions are described in 5 U.S.C. 8901 (1)(I) and 5 CFR
890.102 (c), except that employees of the United
[[Page 50186]]
States Postal Service and District of Columbia courts are not excluded
positions.
You are in an excluded position if you are:
(a) An employee of a corporation supervised by the Farm Credit
Administration, if private interests elect or appoint a member of the
board of directors.
(b) An employee who is not a citizen or national of the United
States and your permanent duty station is outside the United States.
Exception: You are eligible if you met the definition of employee on
September 30, 1979, by service in an Executive agency, the United
States Postal Service, or the Smithsonian Institution in the area that
was then known as the Canal Zone.
(c) An employee of the Tennessee Valley Authority.
(d) An individual first employed by the Government of the District
of Columbia on or after October 1, 1987, except employees of the
District of Columbia Courts and those employees defined at Sec.
890.102 (c)(8) of this chapter.
(e) Serving under an appointment limited to 1 year or less.
Exceptions: You are eligible if:
(1) You are an acting postmaster;
(2) You are a Presidential appointee appointed to fill an unexpired
term;
(3) You are an employee with a provisional appointment, as defined
in Sec. 316.401 and Sec. 316.403 of this chapter; or
(4) You have completed 1 year of current continuous employment,
excluding any break in service of 5 days or less.
(f) You are expected to work fewer than 6 months in each year.
Exception: You are eligible if you are employed under an OPM-approved
career-related work-study program under Schedule B. To qualify, your
work-study program must last at least 1 year, and you must be expected
to be in pay status for at least one-third of the total period of time
from the date of your first appointment to the date you complete the
work-study program.
(g) An intermittent employee (a non-full-time employee without a
prearranged regular tour of duty).
(h) A beneficiary or patient employee in a Government hospital or
home.
(i) Paid on a contract or fee basis. Exception: You are eligible if
you are a United States citizen, and you are appointed by a contract
between you and the Federal employing authority. To qualify, your
contract must require your personal service, and you must be paid on
the basis of units of time.
(j) Paid on a piecework basis. Exception: You are eligible if your
work schedule provides for full-time or part-time service, and you have
a regularly scheduled tour of duty.
(k) The following positions are not excluded positions:
(1) An employee appointed to perform ``part-time career
employment,'' as defined in section 3401 (2) of title 5, U.S.C., and 5
CFR part 430, subpart B; or
(2) An employee serving under an interim appointment established
under Sec. 772.102 of this chapter.
Sec. 894.303 What happens to my enrollment if I transfer to an
excluded position?
(a) If you have FEDVIP coverage and you transfer to a position
excluded under Sec. 894.302(a) through (d), your enrollment stops.
(b) If you have FEDVIP coverage and you transfer to a position
excluded under Sec. 894.302(e) through (j) with no break in service of
more than 3 days, your enrollment is not affected. If you have a break
in service of more than 3 days, your enrollment stops.
(c) If you did not elect to enroll in FEDVIP and then transfer to
an excluded position, you lose all rights to enroll at that time.
Sec. 894.304 Am I eligible to enroll if I'm retired or receiving
workers' compensation?
If you are retired, receiving workers' compensation, or are a
survivor annuitant, you are eligible if you meet the definition of
annuitant in 5 U.S.C. 8901(3).
Sec. 894.305 Am I eligible to enroll if I am a former spouse
receiving an apportionment of annuity?
No. Former spouses receiving an apportionment of annuity are not
eligible to enroll in FEDVIP.
Sec. 894.306 Are foster children eligible as family members?
Yes, foster children may be eligible for coverage as family members
under FEDVIP.
Sec. 894.307 Are disabled children age 22 or over eligible as family
members?
A child age 22 or over is an eligible family member if the child is
incapable of self-support because of a physical or mental disability
that existed before the child reached age 22.
Subpart D--Cost of Coverage
Sec. 894.401 How do I pay premiums?
(a) Employees pay premiums through payroll allotments.
(b) Annuitants and survivor annuitants pay premiums through annuity
allotments.
(c) Compensationers pay premiums through allotments from
compensation payments.
(d) In limited circumstances, individuals may make direct premium
payments. See Sec. 894.405.
Sec. 894.402 Do the premiums I pay reflect the cost of providing
benefits?
The premiums you pay shall reasonably and equitably reflect the
cost of the benefits provided.
Sec. 894.403 Are FEDVIP premiums paid on a pre-tax basis?
(a) Your FEDVIP premiums are paid on a pre-tax basis (called
premium conversion) if you are an active employee, your salary is
sufficient to make the premium allotments, and your agency is able to
make pre-tax allotments.
(b) Your FEDVIP premiums are not paid on a pre-tax basis if:
(1) You are an employee in nonpay status or an employee whose
salary is not high enough to make premium allotments, or your agency is
unable to make pre-tax allotments;
(2) You are an annuitant, a survivor annuitant, or a
compensationer;
(3) Your enrollment change was made effective retroactively which
resulted in additional premium withholdings, unless it is as a result
of birth or adoption of a child.
(4) You have been approved to pay premiums directly to the
Administrator.
Sec. 894.404 May I opt out of premium conversion?
No, all enrolled employees whose salary is sufficient to make
premium allotments and whose agency is able to make pre-tax allotments
must participate in premium conversion.
Sec. 894.405 What happens if I go into nonpay status or if my pay/
annuity is insufficient to cover the allotments?
(a) If your pay, annuity, or compensation is too low to cover the
premium allotments, or if you go into a nonpay status, contact the
Administrator to arrange to pay your premiums directly to the
Administrator.
(b) If you do not make the premium payments, your FEDVIP coverage
will stop. You will not be able to reenroll until the next open season
after:
(1) You are in pay status; or
(2) Your pay is sufficient to make the premium allotments.
[[Page 50187]]
Subpart E--Enrollment and Changing Enrollment
Sec. 894.501 When may I enroll?
You may enroll:
(a) During the annual open season;
(b) Within 60 days after you first become eligible as:
(1) A new employee;
(2) A previously ineligible employee who transfers to a covered
position; or
(3) A new survivor annuitant, if not already covered under FEDVIP.
(c) Within 60 days of when you return to service following a break
in service of at least 30 days; or
(d) Within 60 days of a QLE that allows you to enroll.
Sec. 894.502 What are the Qualifying Life Events (QLEs) that allow me
to enroll?
(a) You or an eligible family member lose other dental/vision
coverage;
(b) Your annuity or compensation is restored after having been
terminated; or
(c) You return to pay status after being on leave without pay due
to deployment to active military duty.
Sec. 894.503 Are belated enrollments or changes allowed?
(a) The time limit for enrolling or changing your enrollment may be
extended up to 3 months after the date you became newly eligible or had
a QLE or after the end of an open season. To qualify, you must
demonstrate to the Administrator that you were not able to enroll or
change your enrollment on time for reasons beyond your control.
(b) If the Administrator allows you to make a belated enrollment or
enrollment change, you must enroll or change within 30 days after the
Administrator notifies you of its determination.
Sec. 894.504 When is my enrollment effective?
(a) Open season enrollments are effective on the date set by OPM.
(b) If you enroll when you first become eligible your enrollment is
effective the 1st day of the pay period following the one in which the
Administrator receives your enrollment, but no earlier than December
31, 2006.
(c)(1) A belated open season enrollment is effective retroactive to
the date it would have been effective if you had made a timely
enrollment or request for a change.
(2) Any other belated enrollment or change is effective retroactive
to the 1st day of the pay period following the one in which you became
newly eligible or the date of your QLE.
(3) You are responsible for any retroactive premiums due to a
belated enrollment or request for a change.
Sec. 894.505 Are retroactive premiums paid with pre-tax dollars
(premium conversion)?
Retroactive premiums are not paid under premium conversion, except
when you are changing your enrollment retroactively as a result of
birth or adoption of a child. Any additional withholdings for
retroactive premiums that are due must be made with after-tax dollars.
The Administrator will bill you directly for any retroactive premiums
that must be paid with after-tax dollars.
Sec. 894.506 How often will there be open seasons?
There will be an annual open season for FEDVIP at the same time as
the annual Federal Benefits Open Season.
Sec. 894.507 After I'm enrolled, may I change from one dental or
vision plan or plan option to another?
(a) You may change from one dental and/or vision plan to another
plan or one plan option to another option in that same plan during the
annual open season.
(b)(1) If you are enrolled in a dental or vision plan with a
geographically restricted service area, and you or a covered eligible
family member move out of the service area, you may change to a
different dental or vision plan that serves that area.
(2) You may make this change at any time before or after the move,
once you or a covered eligible family member has a new address.
(3) The enrollment change is effective the first day of the pay
period following the pay period in which you make the change.
(4) You may not change your type of enrollment unless you also have
a QLE that allows you to change your type of enrollment.
Sec. 894.508 When may I increase my type of enrollment?
(a) You may increase your type of enrollment:
(1) during the annual open season; or
(2) If you have a QLE that is consistent with increasing your type
of enrollment.
(b) Increasing your type of enrollment means going from:
(1) Self only to self plus one;
(2) Self only to self and family; or
(3) Self plus one to self and family.
(c) You may increase your type of enrollment during the time period
beginning 31 days before the QLE and ending 60 days after the QLE.
(d) Your new type of enrollment is effective the 1st day of the pay
period following the pay period in which you make the change.
(e) You may not change from one dental or vision plan to another,
except as stated in Sec. 894.507(b).
Sec. 894.509 What are the QLEs that are consistent with increasing my
type of enrollment?
(a) Marriage;
(b) Acquiring an eligible child; or
(c) Loss of other dental or vision coverage by an eligible family
member.
Sec. 894.510 When may I decrease my type of enrollment?
(a) You may decrease your type of enrollment
(1) during the annual open season; or
(2) If you have a QLE that is consistent with decreasing your type
of enrollment,
(b) Decreasing your type of enrollment means going from:
(1) Self and family to self plus one;
(2) Self and family to self only; or
(3) Self plus one to self only.
(c) You may decrease your type of enrollment during the time period
beginning 31 days before your QLE and ending 60 days after your QLE.
(d) Your new type of enrollment is effective the 1st day of the pay
period following the one in which you make the change.
(e) You may not change from one dental or vision plan or option to
another, except as stated in Sec. 894.507(b).
Sec. 894.511 What are the QLEs that are consistent with decreasing my
type of enrollment?
(a) Loss of an eligible family member due to:
(1) Divorce;
(2) Death; or
(3) Loss of eligibility of a previously enrolled child.
(b) Your spouse deploys to active military service.
Sec. 894.512 What happens if I leave Federal Government and then
return?
(a) Your FEDVIP coverage terminates at the end of the pay period in
which you separate from government service. Exception: If you separate
for retirement or while in receipt of workers' compensation as defined
in Sec. 894.701, your FEDVIP coverage continues.
(b)(1) If you return to Federal service after a break in service of
fewer than 30 days, and you were not previously enrolled in FEDVIP, you
may not enroll until the next open season or unless you have a QLE that
allows you to enroll.
(2) If you return to Federal service after a break in service of
fewer than 30 days, and you were previously enrolled in FEDVIP, you may
reenroll in the same plan(s) and plan option and with the same type of
enrollment you had before you separated. Exceptions:
(i) If you were enrolled in a dental or vision plan with a
restricted geographic service area, and you have since moved out of the
plan's service area, you may
[[Page 50188]]
change to a different dental or vision plan that serves that area.
(ii) If you have since gained or lost an eligible family member,
you may change your type of enrollment consistent with the change in
the number of eligible family members.
(3) If you return to Federal service as a new hire after a break in
service of 30 days or more, you may enroll if you were not previously
enrolled, change your dental or vision plan, and/or change your type of
enrollment.
Subpart F--Termination or Cancellation of Coverage
Sec. 894.601 When does my FEDVIP coverage stop?
(a) If you no longer meet the definition of an eligible employee or
annuitant, your FEDVIP coverage stops at the end of the pay period in
which you were last eligible.
(b) If you go into a period of nonpay or insufficient pay, and you
do not make direct premium payments, your FEDVIP coverage stops at the
end of the pay period for which your agency, retirement system, or OWCP
last made a premium allotment from your pay.
(c) If you are making direct premium payments, and you stop making
the payments, your FEDVIP coverage stops at the end of the pay period
for which you last made a payment.
(d) If you cancel your enrollment during an open season, your
FEDVIP coverage stops at midnight of the day before the effective date
of an open season change as set by OPM.
(e) If you are enrolled with a combination dental and vision
carrier with a restricted service area, and you move outside the
carrier's service area to a service area that does not offer a
combination carrier and you change to a dental only or vision only
carrier, your existing combination plan coverage will stop at midnight
of the day before the effective date of your new plan coverage.
(f) If your FEDVIP carrier discontinues participation in the
program at the end of the contract year, then you must change to
another carrier during the open season, unless OPM establishes a
different time. If the discontinuance is at a time other than the end
of the contract year, OPM will establish a time and effective date for
you to change your carrier. If you do not change your carrier within
the time set by OPM, your coverage will stop at midnight of the day
before the effective date set by OPM for coverage with another carrier.
Sec. 894.602 May I cancel my enrollment at any time?
No. You may only cancel your enrollment during an open season.
Exceptions: You may cancel your dental and/or vision enrollment if you
transfer to an eligible position with a Federal agency that provides
dental and/or vision coverage with 50 percent or more employer-paid
premiums. You may also cancel upon your deployment or your spouse's
deployment to active military duty. These cancellations will become
effective at the end of the pay period that you submit your request.
Sec. 894.603 Is there an extension of coverage and right to convert
when my coverage stops or when a covered family member loses
eligibility?
No. There is no extension of coverage or right to convert to an
individual policy or Temporary Continuation of Coverage (TCC) when your
FEDVIP coverage stops or when a family member loses eligibility under
the Program.
Subpart G--Annuitants and Compensationers
Sec. 894.701 May I keep my dental and/or vision coverage when I
retire or start receiving workers' compensation?
(a) Your FEDVIP coverage continues if you retire on an immediate
annuity or on a disability annuity, or start receiving compensation
from OWCP.
(b) If you retire on a Minimum Retirement Age +10 annuity that you
elect to postpone in accordance with 5 U.S.C. 8412(g), your FEDVIP
coverage will stop when you separate from service. However, you may
enroll again within 60 days of when your annuity starts.
(c) If you retire on a deferred annuity in accordance with 5 U.S.C.
8413, your FEDVIP coverage stops and you are not eligible to enroll.
Sec. 894.702 May I participate in open season and make changes to my
enrollment as an annuitant or compensationer?
Yes. Annuitants and compensationers may participate in open season
and make enrollment changes under the same circumstances as active
employees.
Sec. 894.703 How long does my coverage as an annuitant or
compensationer last?
Your coverage as an annuitant or compensationer continues as long
as you continue receiving an annuity or compensation and pay your
premiums, unless you cancel your coverage during an open season or
terminate coverage due to insufficient annuity or compensation.
Sec. 894.704 What happens if I retire and then come back to work for
the Federal Government?
(a) If you have FEDVIP coverage as an annuitant, and you become
reemployed in an eligible position in Federal service, you must contact
the Administrator so it can send the request for allotments to your
agency so your agency can start making the allotments from your pay.
(b) If you did not enroll in FEDVIP coverage as an annuitant and
become reemployed in an eligible Federal position, you have 60 days to
enroll in FEDVIP.
(c) If you enroll as an employee the Administrator will stop
sending requests for allotments from your annuity.
(d) If your reemployment terminates, you must notify the
Administrator within 30 days to have your allotments withheld from your
annuity payments. Otherwise, your FEDVIP coverage will terminate due to
non-payment of premiums.
Subpart H--Benefits in Underserved Areas
Sec. 894.801 Will benefits be available in underserved areas?
(a) Dental and vision plans under FEDVIP will include underserved
areas in their service areas and provide benefits to enrollees in
underserved areas.
(b) In any area where a FEDVIP dental or vision plan does not meet
OPM access standards, including underserved areas, enrollees may
receive services from non-network providers.
(c) Contracts under FEDVIP shall include access standards as
defined by OPM and payment levels for services to non-network providers
in areas that do not meet access standards.
[FR Doc. E8-19761 Filed 8-25-08; 8:45 am]
BILLING CODE 6325-39-P