Leave Without Pay Status and Insufficient Pay
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When You Allow Your Enrollment to Terminate
Your enrollment will terminate if you:
- do not sign and return the written notice within 31 days of receiving the notice (45
days if you live overseas), or
- return the signed notice, electing to terminate your enrollment.
In either event, your employing office must terminate your enrollment on the Notice of
Change in Health Benefits Enrollment (SF 2810). It must note in the remarks section:
"Employee (did not timely return written notice)(elected to terminate the enrollment)
during a period of (leave without pay status)(insufficient pay)." The file copy of
the notice (or if you elected to terminate your enrollment, your signed notice) should be
attached to the SF 2810 and filed in the permanent side of the Official Personnel Folder.
Your employing office will distribute copies of the SF 2810 to your payroll office and
carrier.
The effective date of your enrollment termination is retroactive to the end of the last
pay period that premiums were withheld from your pay.
Effect of Termination
If you decide not to continue your coverage, your enrollment is terminated, not
canceled. This means that you are entitled to a 31-day extension of coverage and
conversion privilege. You do not have to wait until the next Open Season to reenroll.
A termination is not considered a break in the continuous enrollment necessary for continuing coverage during retirement.
You are not eligible for temporary
continuation of coverage (TCC) when your coverage terminates during leave without pay
status or insufficient pay. TCC is only available when your coverage terminates because of
separation from employment.
Retroactive
Reinstatement of Terminated Coverage
If you couldn't return the notice within the required time frame for reasons beyond
your control, you may ask your employing office to reinstate your coverage. You must file
the request within 30 calendar days from the date you were given notification of the
termination by your employing office. You must describe the circumstances that prevented
you from returning the notice on a timely basis and include the signed written notice
electing to continue coverage and agreeing to either pay the premium directly or incur a
debt.
If your employing office decides to reinstate your enrollment, it completes parts A, D,
and H of the Notice of Change in Health Benefits Enrollment (SF 2810); notes in the
remarks section "Employee reinstated"; and distributes copies of the SF 2810 to
your payroll office and carrier.
If your employing office rejects your reinstatement request, it must notify you of your
reconsideration rights.
When You may
Enroll after Termination
If you terminated your enrollment while you were in leave without pay status, you may
reenroll within 60 days of returning to pay status in a position in which you are eligible
for FEHB coverage.
If you terminated your enrollment while your pay was insufficient, you may reenroll
within 60 days after the end of the first pay period your pay becomes sufficient to cover
the premium.
Your reenrollment takes effect the first day of the first pay period after your
employing office receives your request to reenroll and that follows a pay period in which
you were in pay status for any part of that pay period.
You can reenroll in any plan or option available to you. You are not restricted to
enrolling into the same plan and option you had when your coverage terminated.
If you do not reenroll during the 60-day time period, you must wait for an Open Season
to enroll, unless another qualifying event occurs
before the next Open Season. This would be considered a break in the continuous coverage
necessary for continuing coverage into retirement.
Special Circumstances
Student Trainees
If you are a student trainee with a career or career-conditional appointment, your
enrollment continues during periods of leave without pay status as long as you are
participating in the Student Career Experience Program (5 CFR 213.3202(b)). If you want to
continue your enrollment during periods of leave without pay status, you must continue to pay the employee share of the premiums.
Active Duty Military
Service
Under the Uniformed Service Employment and Reemployment Rights Act of 1994 (USERRA), if
you enter active duty military service for more
than 30 days, you may continue your health benefits enrollment for up to 24 months,
unless you elect to have your enrollment terminated before you enter active
duty. (You
are considered to be on military furlough for health benefits purposes.) During the first
365 days in leave without pay status, you are required to pay only the employee share of
the premium and you may postpone
payment. After the first 365 days, you must pay both the employee and Government
shares plus a 2 percent administrative charge directly to your employing office on a current basis. Your eligibility under USERRA ends 24
months after your absence for service in the uniformed service began or 90 days after your
service ends, whichever is earlier.
While Receiving
Compensation
Your enrollment may continue
when you receive compensation under the Federal Employees' Compensation law for the
first 365 days while in leave without pay status. After that period, you must meet the
same participation requirements as for continuing an
enrollment after retirement. OWCP, not your employing office, is responsible for
determining your eligibility.
Part-time Employees
If you are a part-time
career employee who receives a prorated Government contribution, during periods of
leave without pay status you must pay the same health benefits premiums that are withheld
from your pay while you are in pay status in your regularly scheduled tour of duty.
Temporary Appointments
If you are a temporary employee enrolled
for FEHB coverage, during periods of leave without pay status you must continue to pay
both the employee and Government shares of the premiums.
If you accept a temporary position while your enrollment is continuing during leave
without pay status, your enrollment must be transferred to the employing office for your
temporary position.
If you are still in leave without pay status when your temporary employment ends, your
enrollment must be transferred back to your original employing office. The original
employing office must determine the remaining length of
time you are entitled to continued coverage while in leave without pay status. If you
are no longer being carried as an employee in your original position when your temporary
position expires, your enrollment must be terminated.
The two employing offices involved must coordinate these actions so that withholdings
and contributions are made timely. The employing office that first becomes aware of the
situation must contact the other employing office and arrange for transfer of the
enrollment, if appropriate.
Family and Medical Leave
Under the Family and Medical Leave Act (FMLA) of 1993 (Public Law 103-3), you are
entitled to up to 12 weeks of unpaid leave for certain medical and family needs. See www.opm.gov\oca\leave and 5 CFR Part 630 for
information about family and medical leave.
FMLA leave usually runs concurrently with the 365 day period of coverage during leave
without pay status allowed under the FEHB law. In these cases the regular rules for coverage during periods in leave without
pay status apply. If you are granted leave under FMLA that exceeds the 365 days of
continued coverage allowed under the FEHB law, you must pay your share of premiums directly
to your employing office on a current basis during
the period that exceeds 365 days. (This may happen if you have already used an extensive
amount of leave without pay before you invoke your rights under FMLA).
If your coverage is terminated for nonpayment during FMLA leave, you may reenroll when
you return to pay and duty status.
Appointments
to Employee Organizations
If you go into leave without pay status to serve as a full-time officer or employee of
an employee organization, you may elect to continue health benefits coverage within 60
days from the start of the leave without pay status.
The health benefits coverage continues for the length of the appointment, even if the
leave without pay status lasts longer than 365 days. You must pay to your employing office
the full cost of your health plan premiums. There is no Government contribution. You must
pay your premiums to your employing office before, during, or within three months after
the end of each pay period. You will be eligible for premium conversion if the employee organization adopts the OPM premium conversion plan.
Your employing office must keep you informed of all developments that affect health
benefits. It must also adjust your share of the premium and the agency contributions when
appropriate.
Your coverage will terminate if you do not pay your premiums within this time frame,
subject to the 31-day extension of coverage
and conversion right. Your coverage cannot
resume until you enter in pay and duty status in Federal service. Exception: your
coverage will be restored retroactively if your employing office finds that you were
unable to make the premium payments for reasons beyond your control and you make the
payments at the first opportunity.
Appointment
to State or Local Governments or Institutions of Higher Education, Indian Tribal
Government, or other Organizations
If you go into leave without pay status while assigned to a State or local government,
institution of higher education, Indian tribal government, or certain other organizations
specified in 5 CFR Part 334 , you are entitled to continue health benefits coverage for
the length of the assignment, even if the leave without pay status lasts longer than 365
days.
You must elect to continue your health benefits coverage and pay the employee share of
your premiums to your employing office before, during, or within three months after the
end of each pay period. Your employing office must continue to pay its contributions as
long as you make your payments.
Your employing office must keep you informed of all developments that affect health
benefits. It must also adjust your share of the premium and the agency contributions when
appropriate. Your coverage will terminate if you do not pay your premiums, subject to the 31-day
extension of coverage and conversion right.
Your coverage cannot resume until you enter on pay and duty status in Federal service. Exception:
your coverage will be restored retroactively if your employing office finds that you were
unable to make the premium payments for reasons beyond your control and you made the
payments at the first opportunity.
If you elect to be covered under a State or local government's health benefits program
that OPM determines to be similar to the FEHB Program, you are not entitled to continue
coverage under the FEHB Program. Send your request for OPM's determinations to Office of
Personnel Management, Retirement and Insurance Service, Office of Insurance Programs, P.O.
Box 436, Washington, D.C. 20044.
Transfers
to International Organizations
You may continue health benefits coverage if you are transferred to an international
organization as provided in 5 U.S.C. 3582. You must elect to continue health benefits
coverage and pay the employee share of your premiums to your employing office before,
during, or within three months after the end of each pay period. Your employing office
must continue to pay its contributions as long as you make your payments. You will be eligible for premium conversion if the organization agrees to adopt the OPM premium conversion plan.
Your employing office must keep you informed of all developments that affect health
benefits. It must also adjust your share of the premium and the agency contributions when
appropriate.
Your coverage will terminate if you do not pay your premiums, subject to the 31-day extension of coverage and conversion right. Your coverage cannot resume
until you enter on pay and duty status in Federal service. Exception: your
coverage will be restored retroactively if your employing office finds that you were
unable to make the premium payments for reasons beyond your control and you made the
payments at the first opportunity.
If you do not elect to continue your health benefits enrollment, you are not considered
to be a Federal employee for health benefits purposes while employed by the international
organization.
Regulations governing these transfers are in 5 CFR part 352.
If You Pay
Your FEHB Premiums over less than 12 Months
If your annual salary is normally paid over a period of less than 12 months (such as a
teacher on a 10-month contract), your employing office will prorate your annual health
benefits contributions over the number of salary installments during the year, so that you
don't pay any additional premiums during your expected nonpay period. If you enter a leave
without pay status during your normal working period, you must pay premiums for that
period the same as other employees in leave without pay status.