[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: 5CFR890.306]

[Page 458-463]
 
                    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. 890.306  When can annuitants or survivor annuitants change enrollment 
or reenroll and what are the effective dates?

    (a) Requirements to continue coverage. (1) To be eligible to 
continue coverage in a plan under this part, a former employee in 
receipt of an annuity must meet the statutory requirements under 5 
U.S.C. 8905(b) of having retired on an immediate annuity and having been 
covered by a plan under this part for the 5 years of service immediately 
before retirement, or if less than 5 years, for all service since his or 
her first opportunity to enroll, unless OPM waives the requirement under 
Sec. 890.108.
    (2) To be eligible to continue coverage in a plan under this part, a 
survivor annuitant must be covered as a family member when the employee 
or annuitant dies.
    (b) Effective date--generally. Except as otherwise provided, an 
annuitant's change of enrollment takes effect on the first day of the 
first pay period that begins after the date the employing office 
receives an appropriate request to change the enrollment.
    (c) Belated enrollment. When an employing office determines that an 
annuitant was unable, for cause beyond his or her control, to continue 
coverage by enrolling in his or her own name or change the enrollment 
within the time limits prescribed by this section, the annuitant may do 
so within 60 days after the employing office advises the annuitant of 
its determination.
    (d) Enrollment by proxy. Subject to the discretion of the employing 
office, an annuitant's representative, having written authorization to 
do so, may continue the annuitant's coverage by enrolling in the 
annuitant's own name, or change the enrollment for the annuitant.
    (e) Enrollment change to self only. (1) With one exception, an 
annuitant may change the enrollment from self and family to self only at 
any time. Exception: An annuitant who, as an employee, was subject to a 
court or administrative order as discussed in Sec. 890.301(g)(3) at the 
time he or she retired may not change to self only after retirement as 
long as the court or administrative order is still in effect and the 
annuitant has at least one child identified in the order who is still 
eligible under the FEHB Program, unless the annuitant provides 
documentation to the retirement system that he or she has other coverage 
for the child or children.
    (2) A change of enrollment to self only takes effect on the first 
day of the first pay period that begins after the date the employing 
office receives an appropriate request to change the enrollment, except 
that at the request of the annuitant and upon a showing satisfactory to 
the employing office that there was no family member eligible for 
coverage under the family enrollment, the employing office may make the 
change effective on the first day of the pay period following the one in 
which there was no family member.
    (f) Open season. (1) During an open season as provided by Sec. 
890.301(f)--
    (i) With one exception, an enrolled annuitant may change the 
enrollment from self only to self and family, may change from one plan 
or option to another, or may make any combination of these changes. 
Exception: An annuitant who, as an employee, was subject to a court or 
administrative order as discussed in Sec. 890.301(g)(3) at the time he 
or she retired may not cancel or suspend his or her enrollment, change 
to self only, or change to a comprehensive medical plan that does not 
serve the area where his or her children live after retirement as long 
as the court or administrative order is still in effect and the 
annuitant has at least one child identified in the order who is still 
eligible under the FEHB Program, unless the annuitant provides 
documentation to the retirement system that he or she has other coverage 
for the child or children.
    (ii) An annuitant or survivor annuitant who suspended enrollment 
under this part to enroll in a Medicare-sponsored plan under sections 
1833, 1876, or 1851 of the Social Security Act, or to enroll in a 
Medicaid or similar State-sponsored program of medical assistance for 
the needy, or to use CHAMPVA or TRICARE (including the Uniformed 
Services Family Health Plan) or TRICARE-for-Life coverage instead of 
FEHB coverage, may reenroll.

[[Page 459]]

    (2) An open season reenrollment or change of enrollment takes effect 
on the first day of the first pay period that begins in January of the 
next following year.
    (3) When a belated open season reenrollment or change of enrollment 
is accepted by the employing office under paragraph (c) of this section, 
it takes effect as required by paragraph (f)(2) of this section.
    (g) Change in family status. (1) An enrolled former employee in 
receipt of an annuity may change the enrollment from self only to self 
and family, from one plan or option to another, or make any combination 
of these changes when the annuitant's family status changes, including a 
change in martial status or any other change in family status. In the 
case of an enrolled survivor annuitant, a change in family status based 
on additional family members occurs only if the additional family 
members are family members of the deceased employee or annuitant. The 
annuitant must change the enrollment within the period beginning 31 days 
before the date of the change in family status, and ending 60 days after 
the date of the change in family status.
    (2) A change of enrollment made in conjunction with the birth of a 
child, or the addition of a child as a new family member in some other 
manner, takes effect on the first day of the pay period in which the 
child is born or becomes an eligible family member.
    (h) Reenrollment of annuitants or survivor annuitants who suspended 
enrollment to enroll in a Medicare-sponsored plan, or a Medicaid or 
similar State-sponsored program; or to use CHAMPVA or TRICARE (including 
the Uniformed Services Family Health Plan) or TRICARE-for-Life coverage 
instead of FEHB coverage.
    (1) An annuitant or survivor annuitant who had been enrolled (or was 
eligible to enroll) for coverage under this part and suspended the 
enrollment 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 the Uniformed Services Family Health Plan) or TRICARE-for-
Life coverage instead of the FEHB Program (as provided by Sec. 
890.304(d)), and who subsequently involuntarily loses coverage under one 
of these programs, may immediately reenroll in any available FEHB plan 
under this part at any time beginning 31 days before and ending 60 days 
after the loss of coverage. A reenrollment under this paragraph (h) of 
this section takes effect on the date following the effective date of 
the loss of coverage as shown on the documentation from the non-FEHB 
coverage. If the request to reenroll is not received by the retirement 
system within the time period specified, the annuitant must wait until 
the next available Open Season to reenroll.
    (2) An annuitant or survivor annuitant who suspended enrollment in 
the FEHB Program to enroll in a Medicare sponsored plan or the Medicaid 
or similar State-sponsored program of medical assistance for the needy, 
or to use CHAMPVA or TRICARE (including the Uniformed Services Family 
Health Plan) or TRICARE-for-Life, but now wants to reenroll in the FEHB 
Program for any reason other than an involuntary loss of coverage, may 
do so during the next available Open Season (as provided by paragraph 
(f) of this section).
    (i) [Reserved]
    (j) Annuitants who apply for postponed minimum retirement age plus 
10 years of service (MRA plus 10) annuity. (1) A former employee who 
meets the requirements for an immediate annuity under 5 U.S.C. 8412(g) 
and for continuation of coverage under 5 U.S.C. 8905(b) at the time of 
separation, and whose enrollment is terminated under Sec. 
890.304(a)(1)(ii) may enroll in a health benefits plan under this part 
within 60 days after OPM mails the former employee a notice of 
eligibility. If such former employee dies before the end of this 60-day 
election period, a survivor who is entitled to a survivor annuity may 
enroll in a health benefits plan under this part within 60 days after 
OPM mails the survivor a notice of eligibility.
    (2) The former employee's enrollment takes effect on the first day 
of the month following the month in which OPM receives the appropriate 
request

[[Page 460]]

or on the commencing date of annuity, whichever is later. A survivor's 
enrollment takes effect on the first day of the month following the 
month in which OPM receives the appropriate request.
    (k) Restoration of annuity or compensation payments. (1) A 
disability annuitant who was enrolled in a health benefits plan under 
this part immediately before his or her disability annuity was 
terminated because of restoration to earning capacity or recovery from 
disability, and whose disability annuity is restored under 5 U.S.C. 
8337(e) after December 31, 1983, or 8455(b), may enroll in a health 
benefits plan under this part within 60 days after OPM mails a notice of 
insurance eligibility. The enrollment takes effect on the first day of 
the month after the date OPM receives the appropriate request.
    (2) An annuitant who was enrolled in a health benefits plan under 
this part immediately before his or her compensation was terminated 
because OWCP determined that he or she had recovered from the job-
related injury or disease, and whose compensation is restored due to a 
recurrence of disability, may enroll in a health benefits plan under 
this part within 60 days after OWCP mails a notice of insurance 
eligibility. The enrollment takes effect on the first day of the pay 
period after the date OWCP receives the appropriate request.
    (3) A surviving spouse who was covered by a health benefits 
enrollment under this part immediately before his or her survivor 
annuity was terminated because of remarriage, and whose survivor annuity 
is later restored, may enroll in a health benefits plan under this part 
within 60 days after OPM mails a notice of eligibility. The enrollment 
takes effect on either--
    (i) The first day of the month after the date OPM receives the 
appropriate request; or
    (ii) The date of restoration of the survivor annuity or October 1, 
1976, whichever is later.
    (4) A surviving child who was covered by a health benefits 
enrollment under this part immediately before his or her survivor 
annuity was terminated because he or she ceased being a student, and 
whose survivor annuity is later restored, may enroll in a health 
benefits plan under this part within 60 days after OPM mails a notice of 
eligibility. The enrollment takes effect on the first day of the month 
after the date OPM receives the appropriate request or the date of 
restoration of the survivor annuity, whichever is later.
    (5) A surviving child who was covered by a health benefits 
enrollment under this part immediately before his or her survivor 
annuity was terminated because he or she married, and whose survivor 
annuity is later restored because the marriage ended, may enroll in a 
health benefits plan under this part within 60 days after OPM mails a 
notice of eligibility. The enrollment takes effect on the first day of 
the month after the date OPM receives the appropriate request or the 
date of restoration of the survivor annuity, whichever is later.
    (6) A surviving spouse who received a basic employee death benefit 
under 5 U.S.C. 8442(b)(1)(A) and who was covered by a health benefits 
enrollment under this part immediately before remarriage prior to age 
55, may enroll in a health benefits plan under this part upon 
termination of the remarriage. The survivor must provide OPM with a 
certified copy of the notice of death or the court order terminating the 
marriage. The surviving spouse must enroll within 60 days after OPM 
mails a notice of eligibility. The enrollment takes effect on the first 
day of the month after the date OPM receives the appropriate request and 
the notice of death or court order terminating the remarriage.
    (l) Loss of coverage under this part or under another group 
insurance plan. An annuitant who meets the requirements of paragraph (a) 
of this section, and who is not enrolled but is covered by another 
enrollment under this part may continue coverage by enrolling in his or 
her own name when the annuitant loses coverage under the other 
enrollment under this part. An enrolled annuitant may change the 
enrollment from self only to self and family, from one plan or option to 
another, or make any combination of these changes when the annuitant or 
an eligible family member of the annuitant loses coverage under this 
part or under another

[[Page 461]]

group health benefits plan. Except as otherwise provided, an annuitant 
must enroll or change the enrollment within the period beginning 31 days 
before the date of loss of coverage and ending 60 days after the date of 
loss of coverage. Losses of coverage include, but are not limited to--
    (1) Loss of coverage under another FEHB enrollment due to the 
termination, cancellation, or a change to self only, of the covering 
enrollment;
    (2) Loss of coverage under another federally-sponsored health 
benefits program;
    (3) Loss of coverage due to the termination of membership in an 
employee organization sponsoring or underwriting an FEHB plan;
    (4) Loss of coverage due to the discontinuance of an FEHB plan in 
whole or in part. For an annuitant who loses coverage under this 
paragraph (l)(4)--
    (i) If the discontinuance is at the end of a contract year, the 
annuitant must change the enrollment 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 must establish a time and 
effective date for the annuitant to change the enrollment;
    (ii) If a plan has only one option and is discontinued, an annuitant 
who does not change the enrollment is deemed to have enrolled in the 
standard option of the Blue Cross and Blue Shield Service Benefit Plan.
    (iii) If a plan has more than one option, and one or more options of 
the plan is discontinued, an annuitant who does not change the 
enrollment is considered to be enrolled in a remaining option of the 
plan. However, if OPM determines that there is no remaining option that 
reasonably approximates the terminating option, the annuitant will be 
considered to be enrolled in the standard option of the Blue Cross and 
Blue Shield Service Benefit Plan.
    (iv) If a plan has two options and both options are discontinued, an 
annuitant who does not change the enrollment is deemed to have enrolled 
in the corresponding option of the Blue Cross and Blue Shield Service 
Benefit Plan. If the annuitant is enrolled in a high option and his or 
her annuity is insufficient to pay the withholding for the high option, 
the annuitant is deemed to have enrolled in the standard option of the 
Blue Cross and Blue Shield Service Benefit Plan. The exemptions from 
debt collection procedures that are provided under Sec. Sec. 
831.1305(d)(2) and 845.205(d)(2) of this chapter apply to elections 
under this paragraph (1)(4)(iv);
    (5) Loss of coverage under the Medicaid program or similar State-
sponsored program of medical assistance for the needy.
    (6) Loss of coverage under a non-Federal health plan.
    (m) Move from comprehensive medical plan's area. An annuitant in a 
comprehensive medical plan who moves or becomes employed outside the 
geographic area from which the plan accepts enrollments, or, if already 
outside this area, moves or becomes employed further from this area, may 
change the enrollment upon notifying the employing office of the move or 
change of place of employment. Similarly, an annuitant whose covered 
family member moves outside the geographic area from which the plan 
accepts enrollments, or if already outside this area, moves further from 
this area, may change the enrollment upon notifying the employing office 
of the family member's move. The change of enrollment takes effect on 
the first day of the pay period that begins after the employing office 
receives an appropriate request.
    (n) Overseas post of duty. An annuitant may change the enrollment 
from self only to self and family, from one plan or option to another, 
or make any combination of these changes within 60 days after the 
retirement or death of the employee on whose service title to annuity is 
based, if the employee was stationed at a post of duty outside a State 
of the United States or the District of Columbia at the time of 
retirement or death.
    (o) On return from a uniformed service. An enrolled annuitant who 
enters on duty in a uniformed service for 31 days or more may change the 
enrollment within 60 days after separation from the uniformed service.

[[Page 462]]

    (p) On becoming eligible for Medicare. An annuitant may change the 
enrollment from one plan or option to another at any time beginning on 
the 30th day before becoming eligible for coverage under title XVIII of 
the Social Security Act (Medicare). A change of enrollment based on 
becoming eligible for Medicare may be made only once.
    (q) Annuity insufficient to pay withholdings. (1) If an annuity is 
insufficient to pay the withholdings for the plan that the annuitant is 
enrolled in, the retirement system must provide the annuitant with 
information regarding the available plans and written notification of 
the opportunity to either--
    (i) Pay the premium directly to the retirement system in accordance 
with Sec. 890.502(d); or
    (ii) Enroll in any plan in which the annuitant's share of the 
premium is less than the amount of annuity. If the annuitant elects to 
change to a lower cost enrollment, the change takes effect immediately 
upon loss of coverage under the prior enrollment.
    (2) If the annuitant is enrolled in the high option of a plan that 
has two options, and does not change the enrollment to a plan in which 
the annuitant's share of the premium is less than the amount of annuity 
or does not elect to pay premiums directly, the annuitant is deemed to 
have enrolled in the standard option of the same plan, unless the 
annuity is insufficient to pay the withholdings for the standard option.
    (3) An annuitant whose enrollment was terminated because the amount 
of annuity was insufficient to cover the enrollee's share of the premium 
may apply to be reinstated in any available plan or option.
    (4) An annuitant who can show evidence that he or she previously 
changed to a lower cost option, plan, or to a self-only enrollment prior 
to May 29, 1990, because the annuity was insufficient to cover the 
withholdings for the plan in which he or she was enrolled, may apply to 
change the enrollment to any available plan or option in which the 
enrollee's share of the total premium exceeds his or her monthly 
annuity.
    (5) The effective date of the reinstatement of enrollment of an 
annuitant whose enrollment was terminated, or the change of enrollment 
of an annuitant who previously changed enrollment because his or her 
annuity was insufficient to cover the annuitant's share of the total 
premium, and who elects to pay premiums directly to the retirement 
system in accordance with Sec. 890.502(f) is either--
    (i) The first day of the first pay period that begins after the 
appropriate request is received by the retirement system; or,
    (ii) The later of the date the enrollment was terminated or changed, 
or May 29, 1990.
    (6) Retroactive reinstatement or change of enrollment is contingent 
upon payment of appropriate contributions retroactive to the effective 
date of the reinstatement or the change of enrollment. For the purpose 
of this paragraph (q)(6), a previous cancellation of enrollment because 
of insufficient annuity to cover the full amount of the withholdings is 
deemed to be a termination of enrollment.
    (r) Sole survivor. When an employee or annuitant enrolled for self 
and family dies, leaving a survivor annuitant who is entitled to 
continue the enrollment, and it is apparent from available records that 
the survivor annuitant is the sole survivor entitled to continue the 
enrollment, the office of the retirement system which is acting as 
employing office must change the enrollment from self and family to self 
only, effective on the commencing date of the survivor annuity. On 
request of the survivor annuitant made within 31 days after the first 
installment of annuity is paid, the office of the retirement system 
which is acting as employing office must rescind the action retroactive 
to the effective date of the change to self only, with corresponding 
adjustment in withholdings and contributions.
    (s) Election between survivor annuities. A surviving spouse, 
irrespective of whether his or her survivor annuity continued or was 
terminated upon remarriage, who was covered by an enrollment under this 
part immediately before the remarriage, may elect to continue an 
enrollment under this part

[[Page 463]]

acquired as a dependent by virtue of the remarriage or to enroll in his 
or her own right (by virtue of entitlement to the original survivor 
annuity) in any plan or option under this part within 60 days after the 
termination of the remarriage and entitlement to a survivor annuity.

[62 FR 38437, July 18, 1997, as amended at 66 FR 49086, Sept. 26, 2001; 
67 FR 41306, June 18, 2002; 68 FR 56525, Oct. 1, 2003; 69 FR 31722, June 
7, 2004; 69 FR 56928, Sept. 23, 2004]