Former Spouses
Information for Employees
Note:
This section provides information for Federal employees and annuitants on FEHB benefits available under the Spouse Equity provisions of FEHB law. In this section:
- "you" means the Federal employee or annuitant; and
- "divorce" includes certain annulments.
Spouse Equity Act
Law
The Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615) was enacted on November 8, 1984. Under this act, as amended, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.
Eligibility
Your former spouse is eligible to enroll under Spouse Equity provisions if:
- you were divorced during your employment or receipt of annuity;
- he/she was covered as a family member under an FEHB enrollment at least one day during the 18 months before your marriage ended (Note: This requirement is also met when both you and your former spouse have FEHB enrollments);
- he/she is entitled to a portion of your annuity or to a former spouse survivor annuity; and
- he/she has not remarried before age 55.
Your employing office will determine whether your former spouse is eligible to enroll.
Loss of Coverage as a Family Member
Your former spouse loses coverage as a family member upon your divorce, subject to a 31-day extension of coverage. However, his/her enrollment under the Spouse Equity provisions may not begin for several months after the divorce, depending on how long it takes to establish eligibility. To avoid a gap in coverage for this period, your former spouse may:
If your former spouse will seek coverage under Spouse Equity provisions, it is advisable to stay with the same plan.
If your former spouse acts promptly, he/she may request retroactive enrollment once the application for enrollment under the Spouse Equity provisions has been approved. For enrollment to be retroactive, the employing office must receive an appropriate request and satisfactory proof of eligibility within 60 days after the date of divorce.
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Enrollment
Enrolling under the Spouse Equity provisions is a three-step process. First, your former spouse must apply to enroll within the required time limit. Second, he/she must establish eligibility to enroll. Third, actual enrollment can take place only after the first two steps have been completed.
Type of Enrollment
Your former spouse may elect a Self Only or Self and Family enrollment. A Self and Family enrollment covers only your former spouse and any natural or adopted children of you and your former spouse.
Where Former Spouses Apply
If your marriage ends before your retirement, your former spouse must apply and pay premiums to the employing office of the agency for which you worked when your marriage ended. If the application is approved, this will be your former spouse's employing office until he/she begins receiving annuity payments, even if you transfer to another employing office.
Your former spouse must apply and pay premiums to the retirement system responsible for your annuity payment if:
- he/she is receiving a portion of your retirement benefit or a former spouse survivor annuity; or
- the divorce occurred after your retirement; or
- the divorce occurred before May 7, 1985, and you worked for the Central Intelligence Agency (CIA) or the Foreign Service.
OPM is your former spouse's employing office if you are receiving compensation from the Office of Workers' Compensation Programs (OWCP), and your health benefits enrollment had been transferred to OWCP before your marriage ended.
Application to Enroll
Your former spouse's application to enroll can either be a completed Health Benefits Election Form (SF 2809) or a written notice of intent to apply for health benefits. His/her own name, date of birth, and Social Security number is entered on Part A of the SF 2809. Your name and date of birth must be entered in the Remarks section.
If there is a mental or physical disability that prevents your former spouse from applying for benefits, a court appointed guardian may file the application.
Time Limit
Your former spouse must apply for health benefits coverage within:
- 60 days after your marriage ends;
- 60 days after the date of OPM's notice of his/her eligibility to enroll based on a qualifying court order awarding entitlement to a portion of your future annuity (see section 5A5.1-2 of the CSRS/FERS Handbook for Personnel and Payroll Offices), or to a former spouse survivor annuity; or
- 60 days after the date of the notice of his/her eligibility to enroll based on entitlement to a former spouse annuity under another retirement system for Government employees.
If your former spouse doesn't apply to the employing office in person, the employing office will use the postmark date on the application to determine if he/she meets the time limit.
Deferred Enrollment
Once your former spouse has applied to enroll within the required time limit, and has met all eligibility requirements, he/she may postpone actual enrollment indefinitely.
Determination of Entitlement to Future Annuity
When your former spouse applies to the employing office for benefits, it will advise him/her that he/she must send a written request to the retirement system for a determination of entitlement to either:
- a portion of your future retirement annuity, or
- a former spouse survivor annuity.
The request must include:
- a certified copy (not a photocopy of a certified copy) of the divorce decree, property settlement, and/or court order (if applicable);
- your name, date of birth, Social Security number, and last employing agency.
Unless you are subject to the CIA or Foreign Service retirement systems, OPM, not the agency, will make the former spouse annuity benefit determination based on the court order supplied. Your former spouse can not enroll until OPM makes its determination.
OPM will send your former spouse a written decision. If eligibility is determined, he/she will submit the decision to your employing office.
Retirement System Addresses
| Your Retirement System | Request for Review Sent to |
|---|
| CSRS or FERS |
Office of Personnel Management, Retirement and Insurance Service, Office of Retirement Programs, P.O. Box 17, Washington, D.C. 20044. |
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| CIA |
CIA Retirement and Disability System, Central Intelligence Agency, P.O. Box 1925, Washington, D.C. 20505. |
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| Foreign Service |
Foreign Service Retirement and Disability System, Department of State, Retirement Division, Room 1251, Washington, D.C. 20520. |
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| Any Other Retirement System |
Your former spouse must obtain that retirement system's certification of his/her eligibility to a portion of your future annuity or a former spouse survivor annuity, and must submit the certificate to OPM when applying for eligibility to enroll. |
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Determining a Former Spouse's Eligibility
When your former spouse applies for eligibility to enroll under the Spouse Equity provisions, his/her employing office must first verify that you were employed by the agency at the time of your divorce. If you separate from Federal service before becoming eligible for an immediate annuity, your former spouse is eligible to enroll only if your marriage ended before you left Federal service.
The employing office must then determine if your former spouse is eligible to enroll. To be eligible, he/she must meet all of the following requirements:
- He/she must not have remarried before age 55;
- He/she must have been covered as a family member in an FEHB plan at least one day during the 18 months before your marriage ended;
- He/she must provide documentation from OPM (or the CIA or Foreign Service retirement system, if applicable) of entitlement to a portion of your future annuity, or a former spouse survivor annuity.
If you worked for the CIA, your former spouse could qualify to enroll based on your CIA employment, if you were married for at least 10 years during your CIA service, at least 5 years of which both of you spent outside the United States, and your marriage ended before May 7, 1985.
If you worked for the Foreign Service, your former spouse could also qualify to enroll based on your Foreign Service employment if you were married for at least 10 years during your Government service, and your marriage ended before May 7, 1985.
Effective Date
The effective date of your former spouse's enrollment is the first day of the first pay period after the employing office receives the Health Benefits Election Form (SF 2809), or an appropriate request, and satisfactory proof of eligibility.
If your former spouse requests immediate coverage, and the employing office receives the Health Benefits Election Form (SF 2809), or other appropriate request, and satisfactory proof of eligibility within 60 days after the date of the divorce, the enrollment may be made effective on the same day that temporary continuation of coverage would otherwise take effect.
When both You and Your Former Spouse have FEHB Enrollments
If both you and your spouse have your own FEHB enrollments and divorce, it is important for each of you to establish your eligibility for FEHB coverage under Spouse Equity provisions within the required time frame. In this way you can protect 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 this 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.
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Information for Former Spouses
Note:
This section provides information for Federal employees and annuitants on FEHB benefits available under the Spouse Equity provisions of FEHB law. In this section:
- "you" means the Federal employee or annuitant; and
- "divorce" includes certain annulments.
Spouse Equity Act
Law
The Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615) was enacted on November 8, 1984. Under this act, as amended, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.
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Eligibility
You are eligible to enroll under Spouse Equity provisions if:
- you are divorced from a Federal employee, annuitant, or a former Central Intelligence Agency (CIA) or Foreign Service employee during his/her employment or receipt of annuity;
- you were covered as a family member under an FEHB enrollment at least one day during the 18 months before your marriage ended (Note: This requirement is also met when both you and the Federal employee or annuitant have FEHB enrollments);
- you are entitled to a portion of the Federal employee's annuity or to a former spouse survivor annuity; and
- you have not remarried before age 55.
The employee or annuitant's employing office will determine whether you are eligible to enroll.
Loss of Coverage as a Family Member
When you lose coverage as a family member upon your divorce, you are entitled to a 31-day extension of coverage. However, your enrollment under the Spouse Equity provisions may not begin for several months after the divorce, depending on how long it takes to establish eligibility. To avoid a gap in coverage for this period, you have two options. You may:
If you will seek coverage under Spouse Equity provisions, it is advisable to stay with the same plan.
If you act promptly, you may request retroactive enrollment once your application for enrollment under the Spouse Equity provisions has been approved. For enrollment to be retroactive, the employing office must receive an appropriate request and satisfactory proof of eligibility within 60 days after the date of divorce.
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Enrollment
Enrolling under the Spouse Equity provisions is a three-step process. First, you must apply to enroll within the required time limit. Second, you must establish eligibility to enroll. Third, the actual enrollment can take place only after the first two steps have been completed.
Type of Enrollment
You may elect a Self Only or Self and Family enrollment. A Self and Family enrollment covers only you and any natural or adopted children of you and the Federal employee or annuitant on whose service your coverage is based.
Where You Apply
If your marriage ends before the employee's retirement, you must apply and pay premiums to the employing office of the agency for which the employee worked when your marriage ended. If your application is approved, this will be your employing office until you begin receiving annuity payments, even if the employee transfers to another employing office.
You must apply and pay premiums to the retirement system responsible for your annuity payment if:
- you are receiving a portion of a retirement benefit or a former spouse survivor annuity;
- the divorce occurred after the employee's retirement; or
- the divorce occurred before May 7, 1985, and the employee or former employee worked for the Central Intelligence Agency (CIA) or the Foreign Service.
OPM is your employing office if the employee or former employee is receiving compensation from the Office of Workers' Compensation Programs (OWCP), and his/her health benefits enrollment had been transferred to OWCP before your marriage ended.
Application to Enroll
Your application to enroll can either be a completed Health Benefits Election Form (SF 2809) or a written notice of intent to apply for health benefits. If you complete the SF2809, you must put your own name, date of birth, and Social Security number on Part A of the SF 2809. The employee, former employee, or annuitant's name and date of birth must be entered in the Remarks section.
If you have a mental or physical disability that prevents you from applying for benefits, a court-appointed guardian may file the application.
Time Limit
You must apply for health benefits coverage within:
- 60 days after your marriage ends;
- 60 days after the date of OPM's notice of your eligibility to enroll based on a qualifying court order awarding entitlement to a portion of the employee's future annuity (see section 5A5.1-2 of the CSRS/FERS Handbook for Personnel and Payroll Offices), or to a former spouse survivor annuity; or
- 60 days after the date of the notice of your eligibility to enroll based on entitlement to a former spouse annuity under another retirement system for Government employees.
If you don't apply to the employing office in person, the employing office will use the postmark date on your application to determine if you meet the time limit.
Deferred Enrollment
Once you have applied to enroll within the required time limit, you may postpone actual enrollment indefinitely.
Determination of Entitlement to Future Annuity
When you apply to the employing office for benefits, it will advise you that you must send a written request to the retirement system for a determination of entitlement to either:
- a portion of the employee's future retirement annuity, or
- a former spouse survivor annuity.
Your request must include:
- a certified copy (not a photocopy of a certified copy) of the divorce decree, property settlement, and/or court order (if applicable);
- the employee's name, date of birth, Social Security number, and last employing agency.
Unless the employee is subject to the CIA or Foreign Service retirement systems, OPM, not the agency, will make the former spouse annuity benefit determination based on the court order you supplied. You can not enroll until OPM makes its determination.
OPM will send you a written decision. If you are eligible to enroll, you will submit the decision to the employing office.
Retirement System Addresses
| Employee's Retirement System | Request for Review Sent to |
|---|
| CSRS or FERS |
Office of Personnel Management, Retirement and Insurance Service, Office of Retirement Programs, P.O. Box 17, Washington, D.C. 20044. |
|---|
| CIA |
CIA Retirement and Disability System, Central Intelligence Agency, P.O. Box 1925, Washington, D.C. 20505. |
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| Foreign Service |
Foreign Service Retirement and Disability System, Department of State, Retirement Division, Room 1251, Washington, D.C. 20520. |
|---|
| Any Other Retirement System |
You must obtain that retirement system's certification of your eligibility to a portion of the employee's future annuity or a former spouse survivor annuity, and must submit the certificate to OPM when applying for eligibility to enroll. |
|---|
Determining Your Eligibility
When you apply for eligibility to enroll under the Spouse Equity provisions, the employing office must first verify that the employee was employed by the agency at the time of your divorce. If the employee separates from Federal service before becoming eligible for an immediate annuity, you are eligible to enroll only if your marriage ended before he/she left Federal service.
The employing office must then determine if you are eligible to enroll. To be eligible, you must meet all of the following requirements:
- You must not have remarried before age 55;
- You must have been covered as a family member in an FEHB plan at least one day during the 18 months before your marriage ended;
- You must provide documentation from OPM (or the CIA or Foreign Service retirement system, if applicable) of entitlement to a portion of the employee's future annuity, or a former spouse survivor annuity.
If the employee worked for the CIA, you could qualify to enroll based on his/her CIA employment, if you were married for at least 10 years during his/her CIA service, at least 5 years of which both of you spent outside the United States, and your marriage ended before May 7, 1985.
If the employee worked for the Foreign Service, you could also qualify to enroll based on his/her Foreign Service employment if you were married for at least 10 years during his/her Government service, and your marriage ended before May 7, 1985.
Employing Office Decision
If you are eligible for health benefits coverage, the employing office will write to you confirming its decision, give you a premium payment schedule, and provide you a certification form to sign and date stating the requirements for continued enrollment.
If you are not eligible for health benefits coverage, the employing office will notify you in writing and give the reason for the denial. The notice will also explain that you have a right to request that the employing office reconsider its decision.
Enrollment Procedures
If you didn't submit a Health Benefits Election Form (SF 2809) or other enrollment request as your application to enroll, you must complete one to enroll. You must put your own name, date of birth, and Social Security number on Part A of the SF 2809. The employee, former employee, or annuitant's name and date of birth must be entered in the Remarks section.
Certification
When you elect health benefits coverage under the Spouse Equity provisions, you must certify that you will notify the employing office within 31 days of an event that would terminate your eligibility. The employing office keeps the original certification in your health benefits file and gives you a copy.
Sample Certification
The employing office will require that you sign and date the following certification:
"I understand that I must notify the office maintaining my enrollment within 31 days after the occurrence of any of the following events that would end my eligibility for enrollment in the Federal Employees Health Benefits Program:
(1) The court order ceases to provide my entitlement to a portion of a retirement annuity or a former spouse survivor annuity under a retirement system for Government employees.
(2) I remarry before age 55.
(3) The employee on whose service my benefits are based dies and no former spouse survivor annuity is payable.
(4) The separated employee on whose service my benefits are based dies before meeting the requirements for a deferred annuity.
(5) The employee on whose service my benefits are based leaves Federal service before establishing title to an immediate annuity or a deferred annuity.
(6) The retirement system pays a refund of retirement contributions to the separated employee on whose service my health benefits are based."
Signature Date
Health Benefits File
The employing office must establish and maintain a health benefits file for you, even when it has denied eligibility for coverage.
Effective Date
The effective date of your enrollment is the first day of the first pay period after the employing office receives the Health Benefits Election Form (SF 2809) and has approved eligibility.
If you request immediate coverage, and the employing office receives the Health Benefits Election Form (SF 2809) and satisfactory proof of eligibility within 60 days after the date of the divorce, the enrollment may be made effective on the same day that temporary continuation of coverage would otherwise take effect.
Except as specified in this section, an enrollment change is effective on the first day of the first pay period beginning after the date the employing office receives the SF 2809.
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Opportunities to Enroll or Change Enrollment
When the employing office determines that you are eligible, you may enroll at any time.
Belated Enrollment
When the employing office determines that you weren't able to enroll or change enrollment within the required time frame for reasons beyond your control, you may do so within 60 days after the employing office advises you of its determination.
Enrollment by Proxy
The employing office may permit your representative to enroll or change your enrollment for you with your written authorization.
Change to Self Only
You may change your enrollment from Self and Family to Self Only at any time. A change to a Self Only enrollment is effective on the first day of the first pay period beginning after the employing office receives the Health Benefits Election Form (SF 2809). At your written request and with proof that there was no family member eligible for coverage, the employing office may make the change retroactive to the first day of the pay period following the one in which there were no remaining eligible family members.
Open Season
During Open Season, you may change your enrollment from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes. With a Self and Family enrollment, the only eligible family members are the natural or adopted children of you and the Federal employee or annuitant on whose service your coverage is based.
If 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); and
- later voluntarily disenroll,
you may reenroll under the Spouse Equity provisions during Open Season provided you:
If you involuntarily lose this coverage, you can immediately reenroll.
An Open Season reenrollment or change in enrollment is effective on the first day of the first pay period beginning in January of the following year. When the employing office accepts a belated Open Season reenrollment or change in enrollment it takes effect on the date it normally would have been effective if it had been received on time.
Change in Family Status
You may change from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes from 31 days before to 60 days after the birth or acquisition of a natural or adopted child of you and the Federal employee or annuitant on whose service your coverage is based. The change to Self and Family coverage is effective on the first day of the pay period in which the child is born or becomes an eligible family member.
Loss of Other FEHB Coverage or Coverage under Another Group Insurance Plan
You may change from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes when you or an eligible child loses other FEHB coverage or coverage under another group health benefits plan. Unless stated otherwise, you must change the enrollment from 31 days before to 60 days after the loss of coverage.
Examples of loss of coverage include:
- Loss of coverage under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to Self Only;
- Loss of coverage under another federally-sponsored health benefits program;
- Loss of coverage because membership in an employee organization sponsoring or underwriting an FEHB plan was terminated;
- Loss of coverage because an FEHB plan was discontinued in whole or in part. If the discontinuation is at the end of the contract year, you must change the enrollment during the Open Season, unless OPM sets a different time frame. If the discontinuation is at a time other than the end of the contract year, OPM will set the time and effective date for changing the enrollment. If the whole plan is discontinued and you don't change within the set time frame, you are considered to have canceled your enrollment. If only one option of a two-option plan is discontinued and you don't change within the set time frame, you are considered to be enrolled in the remaining plan option.
- Loss of coverage under the Medicaid program (or similar State-sponsored program of medical assistance for the needy);
- Loss of coverage under a non-Federal health plan.
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.
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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.
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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.
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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.
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Information for Employing Offices
Note:
This section provides information for Federal employing offices on determining eligibility for and servicing of former spouses of Federal employees and annuitants under the Spouse Equity provisions of FEHB law. In this section:
- "you" means the employing office personnelist; and
- "divorce" includes certain annulments.
Spouse Equity Act
Law
The Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615) was enacted on November 8, 1984. Under this act, as amended, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.
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Eligibility
A former spouse is eligible to enroll under Spouse Equity provisions if he/she:
- was divorced from a Federal employee or annuitant during employment or receipt of annuity;
- was covered as a family member under an FEHB enrollment at least one day during the 18 months before the marriage ended (Note: This requirement is also met when both spouses have FEHB enrollments);
- is entitled to a portion of the Federal employee's annuity or to a former spouse survivor annuity; and
- has not remarried before age 55.
Loss of Coverage as a Family Member
A former spouse loses coverage as a family member upon divorce, subject to a 31-day extension of coverage. However, enrollment under the Spouse Equity provisions may not begin for several months after the divorce, depending on how long it takes to establish eligibility. To avoid a gap in coverage for this period, the former spouse has two options. He/she may:
If the former spouse will seek coverage under Spouse Equity provisions, it is advisable for him/her to stay with the same plan.
A former spouse who acts promptly may request retroactive enrollment once you have approved the application for enrollment under the spouse equity provisions. For enrollment to be retroactive, you must receive an appropriate request and satisfactory proof of eligibility from the former spouse within 60 days after the date of divorce.
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Enrollment
Enrolling under the Spouse Equity provisions is a three-step process. First, the former spouse must apply to enroll within the required time limit. Second, he/she must establish eligibility to enroll. Third, the actual enrollment can occur only after the first two steps have been completed.
Type of Enrollment
The former spouse may elect a Self Only or Self and Family enrollment. A Self and Family enrollment covers only the former spouse and any natural or adopted children of the former spouse and the Federal employee or annuitant on whose service coverage is based.
Where Former Spouses Apply
If the marriage ends before the employee's retirement, the former spouse must apply and pay premiums to the employing office of the agency for which the employee worked when the marriage ended. If the application is approved, this will be the employing office until annuity payments begin, even if the employee transfers to another employing office.
The former spouse must apply and pay premiums to the retirement system responsible for his/her annuity payment if:
- he/she is receiving a portion of a retirement benefit or a former spouse survivor annuity;
- the divorce occurred after the employee's retirement; or
- the divorce occurred before May 7, 1985, and the employee or former employee worked for the Central Intelligence Agency (CIA) or the Foreign Service.
OPM is the employing office if the employee or former employee is receiving compensation from the Office of Workers' Compensation Programs (OWCP), and his/her health benefits enrollment had been transferred to OWCP before the marriage ended.
Application to Enroll
The former spouse's application to enroll can either be a completed Health Benefits Election Form (SF 2809) or a written notice of intent to apply for health benefits. The former spouse's name, date of birth, and Social Security number is entered on Part A of the SF 2809. The employee, former employee, or annuitant's name and date of birth must be entered in the Remarks section.
If the former spouse has a mental or physical disability that prevents him/her from applying for benefits, a court appointed guardian may file the application.
Time Limit
The former spouse must apply to the employing office in writing by the latest of:
- 60 days after the marriage ends;
- 60 days after the date of OPM's notice of his/her eligibility to enroll based on a qualifying court order awarding entitlement to a portion of the employee's future annuity (see section 5A5.1-2 of the CSRS/FERS Handbook for Personnel and Payroll Offices), or to a former spouse survivor annuity; or
- 60 days after the date of the notice of eligibility to enroll based on entitlement to a former spouse annuity under another retirement system for Government employees.
If the former spouse does not apply to the employing office in person, use the postmark date on the application to determine if the time limit is met.
Deferred Enrollment
Once the former spouse has applied to enroll within the required time limit, he/she may postpone actual enrollment indefinitely.
Determination of Entitlement to Future Annuity
When you receive an application for benefits, advise the former spouse that he/she must send a written request to the retirement system for a determination of entitlement to either:
- a portion of the employee's future retirement annuity, or
- a former spouse survivor annuity.
The request must include:
- a certified copy (not a photocopy of a certified copy) of the divorce decree, property settlement, and/or court order (if applicable);
- the employee's name, date of birth, Social Security number, and last employing agency.
Unless the employee is subject to the CIA or Foreign Service retirement systems, OPM, not the agency, will make the annuity benefit determination based on the court order supplied. The former spouse can not enroll until OPM makes its determination.
OPM will send the former spouse a written decision. If the decision is favorable, he/she will submit the decision to you.
Retirement System Addresses
| Employee's Retirement System | Request for Review Sent to |
|---|
| CSRS or FERS |
Office of Personnel Management, Retirement and Insurance Service, Office of Retirement Programs, P.O. Box 17, Washington, D.C. 20044. |
|---|
| CIA |
CIA Retirement and Disability System, Central Intelligence Agency, P.O. Box 1925, Washington, D.C. 20505. |
|---|
| Foreign Service |
Foreign Service Retirement and Disability System, Department of State, Retirement Division, Room 1251, Washington, D.C. 20520. |
|---|
| Any Other Retirement System |
The former spouse must obtain that retirement system's certification of eligibility to a portion of the employee's future annuity or a former spouse survivor annuity, and must submit the certificate to OPM when applying for eligibility to enroll. |
|---|
Determining a Former Spouse's Eligibility
When the former spouse applies for eligibility to enroll under the Spouse Equity provisions, you must first verify that the employee was employed by your agency at the time of the divorce. If the employee separates from Federal service before becoming eligible for an immediate annuity, the former spouse is eligible to enroll only if the marriage ended before the employee left Federal service.
To be eligible to enroll, the former spouse must meet all of the following requirements:
- He/she must not have remarried before age 55;
- He/she must have been covered as a family member in an FEHB plan at least one day during the 18 months before the marriage ended;
- He/she must provide documentation from OPM (or the CIA or Foreign Service retirement system, if applicable) of entitlement to a portion of the employee's future annuity, or a former spouse survivor annuity.
If the employee worked for the CIA, the former spouse could qualify to enroll based on the employee's CIA employment, if they were married for at least 10 years during the employee's CIA service, at least 5 years of which both spouses spent outside the United States, and the marriage ended before May 7, 1985.
If the employee worked for the Foreign Service, the former spouse could also qualify to enroll based on the employee's Foreign Service employment if they were married for at least 10 years during the employee's Government service, and the marriage ended before May 7, 1985.
Employing Office Decision
If you determine that the former spouse is eligible for health benefits coverage, send the following to the former spouse:
- written confirmation of your decision;
- a premium payment schedule; and
- a certification stating the requirements for continued enrollment for the former spouse to sign and date.
If you determine that the former spouse is not eligible for health benefits coverage, send the former spouse a notification in writing and give the reason for the denial. Explain that he/she has a right to request reconsideration of your decision.
Enrollment Procedures
If the former spouse didn't submit a Health Benefits Election Form (SF 2809) or other enrollment request as an application to enroll, he/she must complete one to enroll. The former spouse's name, date of birth, and Social Security number is entered on Part A of the SF 2809. The employee, former employee, or annuitant's name and date of birth must be entered in the Remarks section.
Certification
When the former spouse elects health benefits coverage under the Spouse Equity provisions, the former spouse must certify that he/she will notify the employing office within 31 days of an event that would terminate his/her eligibility. You must keep the original certification in the former spouse's health benefits file. The former spouse should keep a copy.
Sample Certification
The former spouse must sign and date the following certification:
"I understand that I must notify the office maintaining my enrollment within 31 days after the occurrence of any of the following events that would end my eligibility for enrollment in the Federal Employees Health Benefits Program:
(1) The court order ceases to provide my entitlement to a portion of a retirement annuity or a former spouse survivor annuity under a retirement system for Government employees.
(2) I remarry before age 55.
(3) The employee on whose service my benefits are based dies and no former spouse survivor annuity is payable.
(4) The separated employee on whose service my benefits are based dies before meeting the requirements for a deferred annuity.
(5) The employee on whose service my benefits are based leaves Federal service before establishing title to an immediate annuity or a deferred annuity.
(6) The retirement system pays a refund of retirement contributions to the separated employee on whose service my health benefits are based."
Signature Date
Health Benefits File
You must establish and maintain a health benefits file for the former spouse, even when you have denied eligibility for coverage. The file must be set up in the former spouse's name and must be separate from the employee's Official Personnel Folder. The front cover of the file will show the name and date of birth of the employee on whose service the Spouse Equity benefits are based.
Disclosure of the contents of the health benefits file must be consistent with OPM regulations concerning access to the OPM/CENTRAL-1, Civil Service Retirement and Insurance Records, system of records under the Privacy Act of 1974 [5 CFR, part 297]. The System Manager for this system of records is: Associate Director of Retirement and Insurance, Office of Personnel Management, 1900 E Street, NW., Washington, DC 20415.
File Contents
You must keep the following documents in the former spouse's health benefits file:
Documentation that the former spouse applied in writing or in person (this may be a brief statement signed by the former spouse, with the receipt date noted by the employing office) within the 60-day time limit;
- A copy ( provided by the former spouse) of the court order used by the retirement system to determine eligibility;
- A copy of the retirement system's written notification verifying that the court order is acceptable;
- the employing office's letter approving or denying eligibility for health benefits coverage along with the documents it used to make its decision;
- the Official Personnel Folder copies of the Health Benefits Election Form (SF 2809) or other enrollment request for enrollment documenting the former spouse's enrollment, enrollment changes, or cancellation;
- the former spouse's certification that he/she will notify the employing office within 31 days of an event that terminates eligibility;
- the notice of premium amount and payment schedule;
- the Official Personnel Folder copy of the Notice of Change in Health Benefits Enrollment (SF 2810) terminating the enrollment;
- the employing office's copy of the letter transferring the enrollment to the retirement system;
- Any other correspondence regarding eligibility or enrollment, such as a letter requesting payment of overdue premium prior to terminating coverage; documentation of a child's disability existing before age 26; a court order terminating entitlement to a portion of a retirement annuity or a former spouse survivor annuity; a letter from the former spouse canceling enrollment; or a retirement system notice that a refund has been paid to the former employee or that he/she has died and no survivor annuity is payable.
File Disposition
You must keep the former spouse's health benefits file for as long as you maintain his/her Spouse Equity enrollment. (If he/she becomes a Federal employee eligible for an employee enrollment, his/her employing office maintains the enrollment as an employee, and you will continue to maintain the inactive former spouse enrollment.)
If the former spouse did not qualify for coverage under the Spouse Equity provisions, you must keep the file containing the records for at least one year from the date of notice stating that he/she did not qualify. You may then either destroy the file contents or return it to the former spouse.
Transfer to Retirement System
You will transfer the former spouse's health benefits file to the appropriate retirement system when:
- the former spouse cancels the enrollment;
- you terminate his/her enrollment;
- he/she begins receiving an annuity payment (a portion of the employee's retirement annuity or a former spouse survivor annuity). At that time the retirement system begins to withhold premiums from the annuity check and becomes the former spouse's employing office.
You will send the former spouse's health benefits file to the applicable retirement system address shown below:
| Retirement System | Address |
|---|
| Civil Service Retirement |
SystemOffice of Personnel Management, Retirement and Insurance Service, Office of Retirement Programs, P.O. Box 45, Boyers, PA 16017 |
|---|
| Federal Employees Retirement System |
Federal Employees Retirement System, P.O. Box 200, Boyers, PA 16017 |
|---|
| Foreign Service Retirement and Disability System |
Department of State, Retirement Division, Room 1251, Washington, DC 20520 |
|---|
| CIA Retirement and Disability System |
Central Intelligence Agency, P.O. Box 1925, Washington, DC 20505 |
|---|
Effective Date
The effective date of the former spouse's enrollment is the first day of the first pay period after you receive the Health Benefits Election Form (SF 2809) and you have approved eligibility.
If the former spouse requests immediate coverage, and you receive the Health Benefits Election Form (SF 2809) and satisfactory proof of eligibility within 60 days after the date of the divorce, you may make the enrollment effective on the same day that temporary continuation of coverage would otherwise take effect.
Except as specified in this section, an enrollment change is effective on the first day of the first pay period beginning after the date you receive the SF 2809.
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Opportunities to Enroll or Change Enrollment
When you determine that the former spouse is eligible, he/she may enroll at any time.
Belated Enrollment
When you determine that the former spouse wasn't able to enroll or change enrollment within the required time frame for reasons beyond his/her control, you may permit the former spouse to do so within 60 days after your determination.
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Enrollment by Proxy
The former spouse's representative may enroll or change enrollment for the former spouse with his/her written authorization.
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Change to Self Only
The former spouse may change enrollment from Self and Family to Self Only at any time. A change to a Self Only enrollment is effective on the first day of the first pay period beginning after you receive the Health Benefits Election Form (SF 2809). At the former spouse's written request and with proof that there was no family member eligible for coverage, you may make the change retroactive to the first day of the pay period following the one in which there were no remaining eligible family members.
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Open Season
During Open Season, the former spouse may change enrollment from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes. With a Self and Family enrollment, the only eligible family members are the natural or adopted children of the former spouse and the Federal employee or annuitant on whose service coverage is based.
If the former spouse:
- previously informed you that he/she suspended the 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); and
- later voluntarily disenrolls,
he/she may reenroll under the Spouse Equity provisions during Open Season provided he/she still qualifies for a Spouse Equity enrollment. (If the former spouse involuntarily loses the Medicare managed care plan or Medicaid coverage, he/she can immediately reenroll.)
An Open Season reenrollment or change in enrollment is effective on the first day of the first pay period beginning in January of the following year. When you accept a late Open Season reenrollment or change in enrollment it takes effect on the date it normally would have been effective if it had been received on time.
Change in Family Status
The former spouse may change from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes from 31 days before to 60 days after the birth or acquisition of a natural or adopted child of the former spouse and the Federal employee or annuitant on whose service coverage is based. The change to Self and Family coverage is effective on the first day of the pay period in which the child is born or becomes an eligible family member.
Loss of Other FEHB Coverage or Coverage under Another Group Insurance Plan
The former spouse may change from Self Only to Self and Family, from one plan or option to another, or make any combination of these changes when the former spouse or an eligible child loses other FEHB coverage or coverage under another group health benefits plan. Unless stated otherwise, he/she must change the enrollment from 31 days before to 60 days after the loss of coverage.
Examples of loss of coverage include:
- Loss of coverage under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to Self Only;
- Loss of coverage under another federally-sponsored health benefits program;
- Loss of coverage because membership in an employee organization sponsoring or underwriting an FEHB plan was terminated;
- Loss of coverage because an FEHB plan was discontinued in whole or in part. If the discontinuation is at the end of the contract year, he/she must change the enrollment during the Open Season, unless OPM sets a different time frame. If the discontinuation is at a time other than the end of the contract year, OPM will set the time and effective date for changing the enrollment. If the whole plan is discontinued and he/she doesn't change within the set time frame, he/she is considered to have canceled the enrollment. If only one option of a two-option plan is discontinued and he/she doesn't change within the set time frame, he/she is considered to be enrolled in the remaining plan option.
- Loss of coverage under the Medicaid program (or similar State-sponsored program of medical assistance for the needy);
- Loss of coverage under a non-Federal health plan.
Move from an HMO's Service Area
If the former spouse is enrolled in an HMO and moves or becomes employed outside the plan's service area (or, if already outside this area, moves or becomes employed further away) he/she may change the enrollment. If a covered family member moves outside the plan's service area (or if already outside this area, moves further away), the former spouse may also change the enrollment. The enrollment change is effective on the first day of the pay period beginning after you receive the Health Benefits Election Form (SF 2809) or other enrollment request.
On Becoming Eligible for Medicare
The former spouse 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 the former spouse's employing office is a retirement system:
If the former spouse's annuity is insufficient to pay the premiums, you must provide him/her with information and give the former spouse to either:
- pay premiums directly to the retirement system; or
- enroll in a plan with a premium less than the annuity amount.
If the former spouse elects to change to a lower cost plan, make the change effective immediately upon loss of coverage in the prior plan.
If the former spouse is enrolled in the high option of a two-option plan and does not make one of the elections noted above, change the enrollment to the standard option of the same plan (unless the annuity won't cover the full cost of the standard option). If the former spouse is enrolled in a one-option plan, and doesn't make one of the elections, terminate the enrollment.
Former Spouses with Other FEHB Coverage
Once the former spouse has established eligibility for FEHB coverage, he/she may defer enrolling under Spouse Equity provisions if he/she is already enrolled in FEHB.
When the former spouse loses regular coverage under FEHB, he/she may enroll under Spouse Equity provisions from 31 days before to 60 days after the covering enrollment terminates, as long as he/she continues to meet the eligibility requirements. The former spouse may enroll in any available plan.
When Both Spouses have FEHB Enrollments
If both spouses have their own FEHB enrollments and divorce, it is important for each to establish his/her eligibility for FEHB coverage under Spouse Equity provisions within the required time frame. In this way each can protect a future entitlement to FEHB coverage under Spouse Equity provisions if one loses his/her own FEHB coverage. Each spouse must apply to his/her former spouse's employing office for the determination, not his/her own employing office.
If you determine that a Federal employee is eligible for coverage under Spouse Equity provisions, advise the employee that he/she must provide a copy of your determination to his/her current employing office. The current employing office must note on his/her Individual Retirement Record that he/she is eligible for FEHB coverage under Spouse Equity provisions. You must maintain a health benefits file for the former spouse and note that he/she is deferring enrollment under Spouse Equity provisions until he/she loses enrollment as an employee.
When an Employee Loses Coverage and Enrolls as a Former Spouse
When the former spouse's enrollment as an employee terminates, the current employing office must terminate his/her 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. The former spouse then must notify you of his/her intent to enroll under Spouse Equity provisions. If he/she is still eligible as a former spouse, accept the enrollment based on the submission of a Health Benefits Election Form (SF 2809). Give the former spouse a certification to sign and date and a premium payment schedule.
Note on the SF 2809 that the former spouse was previously covered as an employee and is now enrolling under the same Social Security number under Spouse Equity provisions. Once the Spouse Equity coverage begins, you must collect both the employee and Government shares of the premium from the former spouse.
If you determine that the former spouse is no longer eligible to enroll under spouse equity provisions, deny the enrollment, explain his/her right to request reconsideration, and place a copy of the request for enrollment and your denial in the former spouse's health benefits file.
Eligibility under Spouse Equity while Covered as a Family Member
If you determine that a former spouse is eligible for health benefits under Spouse Equity while he/she is covered as a family member under another person's FEHB enrollment, you must note in the former spouse's health benefits file that he/she is deferring the Spouse Equity enrollment until he/she loses coverage as a family member. You will process the Spouse Equity enrollment when he/she requests enrollment upon losing the family member coverage.
Cancellation of a Former Spouse Enrollment
The former spouse may cancel the Spouse Equity enrollment at any time and in the same manner as an employee. With one exception noted below, the cancellation is effective on the last day of the pay period in which you receive the Health Benefits Election Form (SF 2809) canceling the enrollment. The former spouse and his/her 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. The former spouse may not reenroll, unless he/she suspended the 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 the former spouse suspends his/her 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. The former spouse must submit documentation of his/her new enrollment to you from 31 days before to 31 days after the Medicare managed care plan enrollment takes effect.
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Premium Payments
You must collect the employee and Government shares of the premium from the former spouse for every pay period during which he/she is enrolled. There is no Government contribution. You must establish a premium payment schedule and you are responsible for collecting the premiums.
Employing Office Submission of Premiums
You submit premium payments collected from former spouses along with the regular health benefits payments to OPM.
When the Former Spouse Does Not Pay Premiums
If you don't receive a premium payment from the former spouse by the due date, you must notify the former spouse in writing that he/she must make payment within 15 days (45 days if residing overseas) after he/she receives the notice. The notice must state that if the former spouse doesn't make payment within this time frame, he/she is considered to have voluntarily canceled the enrollment.
If you don't receive any further payments, process a cancellation 60 days (90 days if residing overseas) after the date of the notice.
Your notice should ask if the former spouse has obtained other coverage as described below. Explain in the notice that he/she may resume coverage under Spouse Equity when this other coverage ends only if you receive information about the other coverage now. Place a copy of the notice and any response in the former spouse's health benefits file.
The former spouse must inform you if he/she obtains FEHB coverage as an employee or as a family member under another person's FEHB enrollment, or has 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 his/her right to continue the Spouse Equity enrollment if he/she loses the other coverage.
Cancellation Because the Former Spouse Did Not Pay Premiums
If you cancel the former spouse's coverage because he/she didn't pay premiums, he/she:
If the former spouse was unable to make timely payment for reasons beyond his/her control, he/she may ask that you reinstate the coverage. This request must be filed within 30 calendar days from the cancellation date and must provide proof that nonpayment was beyond the former spouse's control. If you decide to allow reinstatement, you may restore coverage retroactively to the cancellation date upon receipt of the back premiums. If you deny the reinstatement request, you must notify the former spouse in writing, give the reason for the denial, and explain that he/she has a right to request reconsideration of your decision.
Actions to Complete Cancellation
If the former spouse does not make payment within the required time frame, you must cancel the enrollment on the Health Benefits Election Form (SF 2809). In part G, which would normally show the former spouse's signature, enter "Canceled due to nonpayment of premium." Enter "N/A" in item 2 of part H and enter the effective date of the cancellation in item 3. The effective date of the cancellation is 60 days (90 days for enrollees residing overseas) after the date of the notice advising that continuation of coverage depends on premium payment within 15 days (45 days for enrollees residing overseas). If the former spouse never made a payment, enter the enrollment effective date and state in the Remarks section: "This cancellation voids the prior SF 2809 enrolling this individual in your plan on the date in item 3."
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Termination of a Former Spouse Enrollment
A 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;
- The former spouse remarries before age 55;
- The former spouse dies;
- The employee on whose service benefits are based dies and no survivor annuity is payable;
- The separated employee on whose service benefits are based dies before meeting the requirements for a deferred annuity;
- The employee on whose service 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 benefits are based.
The enrollments of certain former spouses of CIA and Foreign Service employees can only be terminated if they die or remarry before reaching age 55.
Give the former spouse a copy of the Notice of Change in Health Benefits Enrollment (SF 2810) terminating the enrollment as soon as possible. This will allow the former spouse to convert to individual coverage within the 31-day time limit. Advise the former spouse that he/she cannot later reenroll under spouse equity provisions. If the former spouse was enrolled in an employee organization plan and the enrollment terminates because his/her membership in the sponsoring employee organization terminates, you must allow him/her to change to another plan.
Belated Extension of Coverage
When the former spouse belatedly learns that his/her enrollment under Spouse Equity has terminated because:
- The employee on whose service benefits were based separates from service with no future entitlement to annuity; or
- The separated employee on whose service benefits were based dies before becoming eligible for a deferred annuity;
the former spouse is allowed an extension of coverage of 31 days after your notice that coverage has terminated, during which he/she may convert to individual coverage.
The former spouse 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
The former spouse is eligible to enroll under temporary continuation of coverage (TCC) when his/her Spouse Equity enrollment terminates during the first 36 months after the divorce or annulment because:
- there is no longer a qualifying court order; or
- he/she remarries before reaching age 55.
Termination of an Eligible Child's Coverage
An eligible child's coverage under a 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 the divorce.
If the former spouse cancels his/her Spouse Equity enrollment, the child's enrollment also ends on the same date with no extension of coverage or conversion rights.
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Reenrollment
If a former spouse enrolled under the Spouse Equity provisions becomes covered under another FEHB enrollment (either as an employee or a family member), he/she may suspend the Spouse Equity enrollment while covered under the other enrollment. The former spouse may reenroll when the other FEHB coverage ends.
When a Former Spouse becomes a Federal Employee
If a former spouse becomes eligible to enroll as a Federal employee, he/she must notify you that he/she is enrolling as a Federal employee. Terminate the Spouse Equity enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810), and note in the Remarks section that the former spouse is entitled to enrollment under Spouse Equity. File the Official Personnel Folder copy of the SF 2810 in the former spouse file and note that the spouse equity enrollment is being suspended while he/she is covered as a Federal employee.
The office where the former spouse is currently employed will enroll him/her on the Health Benefits Election Form (SF 2809). It must note in the Remarks section that he/she was previously covered as a former spouse and is now enrolling as an employee under the same Social Security number. When health benefits coverage as an employee terminates, both employing offices involved should follow the procedures in " When an Employee Loses Coverage and Enrolls as a Former Spouse."
When a Former Spouse Becomes Covered as a Family Member
If a former spouse enrolled under the Spouse Equity provisions becomes covered as a family member under another person's FEHB enrollment, terminate his/her enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810). Note in the Remarks section that the enrollment is being terminated because the former spouse is 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 he/she loses coverage as a family member. When he/she loses family member coverage and requests reinstatement, you will again be responsible for the enrollment.
When Coverage under Medicare Managed Care Plan or Medicaid Ends
If a former spouse postponed or suspended the 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), he/she may later reenroll under the Spouse Equity provisions if enrollment in the Medicare managed care plan or Medicaid ends. He/she must have informed you about the Medicare managed care plan or Medicaid enrollment when he/she postponed or suspended the Spouse Equity enrollment and must still qualify for the Spouse Equity enrollment.
If the Medicare managed care plan or Medicaid enrollment ends involuntarily, the former spouse can immediately reenroll under the Spouse Equity provisions in any available plan at any time from 31 days before to 60 days after 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 the former spouse voluntarily disenrolls from the Medicare managed care plan or Medicaid, he/she may reenroll under the Spouse Equity provisions during the following Open Season.
Notice to Retirement System of Former Spouse Enrollment
When the employee on whose service Spouse Equity benefits are based separates, transfers, or retires, you must document on his/her Individual Retirement Record (SF 2806 or 3100) that a Spouse Equity enrollment exists. Include on the employee's Individual Retirement Record the former spouse's name, date of birth, Social Security number, and the name and address of the office maintaining the health benefits file.
If the Individual Retirement Record has already been forwarded to the retirement system, use a retirement record supplement (such as the SF 2806-1 or SF 3101) to notify the retirement system of the Spouse Equity enrollment, cancellation, or termination of enrollment.
Retirement System Notice to Employing Office
If the employee's retirement record shows that a former spouse is eligible for health benefits coverage under Spouse Equity, the retirement system will notify you when a lump-sum benefit or annuity becomes payable.
If a refund is being paid to the former employee, and/or when no survivor annuity is payable to the former spouse, terminate the former spouse's enrollment and forward the health benefits file to the retirement system. The file must note the former employee's name and date of birth.
If any annuity benefit is payable to the former spouse, forward the health benefits file to the retirement system. Note the date through which premiums have been paid so the retirement system can know the effective date of the transfer of enrollment and when to begin withholding premiums.
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