[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: 5CFR890.304]

[Page 455-457]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
                          Subpart C_Enrollment
 
Sec. 890.304  Termination of enrollment.

    (a) Employees. (1) An employee's enrollment terminates, subject to 
the temporary extension of coverage for conversion, at midnight of the 
earliest of the following dates:
    (i) The last day of the pay period in which he/she is separated from 
the service other than by retirement under conditions entitling him/her 
to continue his/her enrollment.
    (ii) The last day of the pay period in which he or she separates 
after meeting the requirements for an immediate annuity under Sec. 
842.204(a)(1) of this chapter, but postpones receipt of annuity as 
provided by Sec. 842.204(c).
    (iii) The last day of the pay period in which his employment status 
changes so that he is excluded from enrollment.
    (iv) The last day of the pay period in which he dies, unless he 
leaves a member of the family entitled to continue enrollment as a 
survivor annuitant.
    (v) The last day of the pay period which includes the day on which 
the continuation of enrollment under Sec. 890.303(e) expires, or, if 
he/she is not entitled to any further continuation because he/she has 
not had 4 consecutive months of pay status since exhausting his/her 365 
days' continuation of coverage in nonpay status, the last day of his/her 
last pay period in pay status.
    (vi) The day he or she is separated, furloughed, or placed on leave 
of absence to serve in the uniformed services under conditions entitling 
him or her to benefits under part 353 of this chapter, or similar 
authority, for the purpose of performing duty not limited to 30 days or 
less, provided the employee elects in writing to have the enrollment so 
terminated.
    (vii) For an employee who separates to serve in the uniformed 
services under conditions entitling him or her to benefits under part 
353 of this chapter, or similar authority, for the purpose of performing 
duty not limited to 30 days or less, the date that is 18 months after 
the date that the absence to serve in the uniformed services began or 
the date entitlement to benefits under part 353 of this chapter, or 
similar authority, ends, whichever is earlier, unless the enrollment is 
terminated under paragraph (a)(1)(vi) of this section.
    (viii) For an employee who is furloughed or placed on leave of 
absence under conditions entitling him or her to benefits under part 353 
of this chapter, or similar authority, the date that is 18 months after 
the date that the absence to serve in the uniformed services began or 
the date entitlement to benefits under part 353 of this chapter, or 
similar authority, ends, whichever is earlier, but not earlier than the 
date the enrollment would otherwise terminate under paragraph (a)(1)(v) 
of this section.
    (2) If the pay of a temporary employee eligible under 5 U.S.C. 8906a 
is insufficient to pay the withholdings for the plan in which the 
employee is enrolled, and the employee does not, or cannot, elect a plan 
under Sec. 890.301(l) at a cost to him or her not in excess of the pay, 
the employing office must terminate the employee's enrollment effective 
as of the end of the last period for which withholding was made. Each 
temporary employee whose enrollment is so terminated is entitled to a 
31-day extension of coverage for conversion.
    (b) Annuitants. (1) If the annuity of an annuitant is insufficient 
to pay the withholdings for the plan in which the annuitant is enrolled, 
the annuitant may elect one of the two opportunities offered under Sec. 
890.306(q) of this part (electing a plan with a withholding not in 
excess of the annuity; or, paying premiums directly to the retirement 
system in accordance with Sec. 890.502(f) of this part). The retirement 
system will

[[Page 456]]

send two notices to the annuitant, including one by certified mail 
return receipt requested. Continuation of coverage rests upon electing 
direct payment or new coverage within 15 days (45 days for annuitants 
residing overseas) after receipt of the final notice. Except as provided 
in paragraph (b)(3) of this section, the enrollment of an individual who 
fails to make an election within the specified time frame will be 
terminated. An annuitant whose enrollment is terminated because of 
failure to make an election may not reenroll or reinstate coverage, 
except as provided in paragraph (b)(2) of this section. Each annuitant 
whose enrollment is so terminated is entitled to a 31-day extension of 
coverage for conversion.
    (2) If the individual was prevented by circumstances beyond his or 
her control from making an election within the time limit after receipt 
of the final notice, he or she may request reinstatement of coverage by 
writing to the retirement system. The retirement system will determine 
if the individual is eligible for reinstatement of coverage; and, when 
the determination is affirmative, the individual's coverage may be 
reinstated retroactively to the date of termination or prospectively. If 
the determination is negative, the individual may request 
reconsideration of the decision from OPM.
    (3) If the annuitant does not make an election under paragraph 
(b)(1) of this section and is enrolled in the high option of a plan that 
has two options, the annuitant is deemed to have elected enrollment in 
the standard option of the same plan unless the annuity is insufficient 
to pay the withholdings for the standard option.
    (4) An annuitant's enrollment terminates, subject to the temporary 
extension of coverage for conversion, at midnight of the last day of the 
pay period in which he dies, unless he leaves a member of the family 
entitled to continue enrollment as a survivor annuitant, or, if his 
enrollment is not terminated by death, at midnight of the earliest of 
the following dates:
    (i) The last day of the last pay period for which he is entitled to 
annuity, unless he is eligible for continued enrollment as an employee 
in which case his enrollment continues without change.
    (ii) The last day of the pay period in which his title to 
compensation under subchapter I of chapter 81 of title 5, United States 
Code, terminates, or in which he is held by the Secretary of Labor to be 
able to return to duty, unless he is eligible for continued enrollment 
as an employee or as an annuitant under a retirement system for civilian 
employees in which case his enrollment continues without change.
    (iii) The day he enters on active duty in a uniformed service for 
the purpose of performing duty not limited to 30 days or less, provided 
the annuitant elects, in writing, to terminate the enrollment.
    (iv) The last day of the month preceding the month in which a 
survivor annuitant in receipt of basic employee death benefits under 5 
U.S.C. 8442(b)(1)(A) remarries before attaining age 55.
    (c) Coverage of family members. The coverage of a family member of 
an enrollee terminates, subject to the temporary extension of coverage 
for conversion, at midnight of the earlier of the following dates:
    (1) The day on which he or she ceases to be a family member;
    (2) The day the enrollee ceases to be enrolled, unless the family 
member is entitled, as a survivor annuitant, to continued enrollment, or 
is entitled to continued coverage under the enrollment of another.
    (d) Cancellation or suspension. (1)(i) An employee who participates 
in health insurance premium conversion as provided in part 892 of this 
chapter may cancel his or her enrollment only during an open season or 
because of and consistent with a qualifying life event defined in Sec. 
892.101 of this chapter.
    (ii) Subject to the provisions of paragraph (d)(iii) of this 
section, an enrollee who does not participate in premium conversion may 
cancel his or her enrollment at any time by filing an appropriate 
request with the employing office. The cancellation is effective at the 
end of the last day of the pay period in which the employing office 
receives the appropriate request canceling the enrollment.
    (iii) An employee who is subject to a court or administrative order 
as discussed in Sec. 890.301(g)(3), or an annuitant

[[Page 457]]

who was subject to such a court or administrative order at the time of 
his or her retirement, may not cancel or suspend his or her enrollment 
as long as the court or administrative order is still in effect and the 
enrollee has at least one child identified in the order who is still 
eligible under the FEHB Program, unless the employee or annuitant 
provides documentation to the agency that he or she has other coverage 
for the child or children.
    (2) An annuitant or survivor annuitant may suspend enrollment in 
FEHB for the purpose of enrolling in a Medicare-sponsored plan under 
sections 1833, 1876, or 1851 of the Social Security Act, or to enroll in 
the Medicaid program or a similar State-sponsored program of medical 
assistance for the needy, or to use CHAMPVA or TRICARE (including 
coverage provided by the Uniformed Services Family Health Plan) or 
TRICARE-for-Life instead of FEHB coverage. To suspend FEHB coverage, 
documentation of eligibility for coverage under the non-FEHB program 
must be submitted to the retirement system. If the documentation is 
received within the period beginning 31 days before and ending 31 days 
after the effective date of the enrollment in the Medicare-sponsored 
plan, or the Medicaid or similar program, or within 31 days before or 
after the day designated by the annuitant or survivor annuitant as the 
day he or she wants to suspend FEHB coverage to use CHAMPVA or TRICARE 
(including the Uniformed Services Family Health Plan) or TRICARE-for-
Life instead of FEHB coverage, then suspension will be effective at the 
end of the day before the effective date of the enrollment or the end of 
the day before the day designated. Otherwise, the suspension is 
effective the first day of the first pay period that begins after the 
date the retirement system receives the documentation.
    (3) The enrollee and covered family members are not entitled to the 
temporary extension of coverage for conversion or to convert to an 
individual contract for health benefits.
    (e) Temporary continuation of coverage. Employees and family members 
are entitled to temporary continuation of coverage only as provided 
under subpart K of this part.

[33 FR 12510, Sept. 4, 1968, as amended at 47 FR 30962, July 16, 1982; 
52 FR 39496, Oct. 22, 1987, and 53 FR 32368, Aug. 25, 1988; 53 FR 32369, 
Aug. 25, 1988; 54 FR 52338, Dec. 21, 1989; 55 FR 996, Jan. 11, 1990; 55 
FR 3564, Feb. 2, 1990; 55 FR 22891, June 5, 1990; 56 FR 25996, June 6, 
1991; 57 FR 48162, Oct. 22, 1992; 58 FR 47825, Sept. 13, 1993; 60 FR 
45658, Sept. 1, 1995; 62 FR 38437, July 18, 1997; 62 FR 49557, Sept. 22, 
1997; 64 FR 31487, June 11, 1999; 65 FR 44646, July 19, 2000; 66 FR 
49086, Sept. 26, 2001; 67 FR 41306, June 18, 2002; 68 FR 56524, Oct. 1, 
2003; 69 FR 56928, Sept. 23, 2004]