Former Spouses
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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 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
If you are eligible 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 meet all 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 FEHB enrollments and become divorced, it is important each of you establish eligibility for FEHB coverage under spouse equity provisions within the required time frame. This protects 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 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 pay
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 terminates the enrollment 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 termination 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 termination 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.