5 U.S.C. § 8905 — Election of coverage
submitted 60 years ago by Pub. L. 89-554 to r/title-5-GOVERNMENT-ORGANIZATION-AND-EMPLOYEES · 1,711 words · no verdicts yet
This law explains who can enroll in a federal health plan and how. Employees can enroll as individuals, for self plus one, or for self and family. Annuitants, former spouses, and certain others may also qualify under specific rules. The law also covers open enrollment, spouse coverage, and children under court orders.
(a) An employee may enroll in an approved health benefits plan described in section 8903 or 8903a — as an individual, for self plus one, or for self and family.
(b) An annuitant who was enrolled in a chapter health plan at the time they became an annuitant — either (1) as an employee, for whichever period is shortest of: (A) the 5 years of service right before retirement; (B) the full period(s) of service between the end of their first chance to enroll (as OPM regulations define it) and becoming an annuitant; or (C) the full period(s) of service starting with an enrollment that began before January 1, 1965, and ending when they became an annuitant — or (2) as a family member of an employee or annuitant — may keep their enrollment going, under eligibility conditions OPM sets by regulation. OPM may, at its own discretion, waive these requirements for someone who does not meet them, if OPM decides that unusual circumstances make it unfair not to let them enroll as an annuitant.
(c)(1) A former spouse may enroll in an approved plan under section 8903 or 8903a — as an individual, or (per paragraph (2)) for self plus one or self and family — within 60 days after the marriage ends, or, if the marriage ended after the employee's retirement, within 60 days of the divorce or, if later, within 60 days after certain retirement elections under section 8339(j)(3) or 8417(b) are made for the former spouse. The former spouse must agree to pay the full subscription charge, including OPM's administrative and reserve amounts. They apply and pay through the agency that employed the spouse at the time of the divorce or annulment, or, if they already receive certain survivor annuity payments, through OPM. (2) Self-plus-one or self-and-family coverage under this subsection only covers: (A) the former spouse; and (B) unmarried, dependent natural or adopted children of the former spouse and employee (only 1 such child, for self-plus-one coverage) who are either under 22, or unable to support themselves because of a disability that began before age 22.
(d) Someone the Secretary of Defense determines is an eligible beneficiary under section 1108(b) of title 10 may enroll, as part of that section's demonstration project, in a chapter health plan — following the agreement between the Secretary and OPM and the applicable regulations.
(e) If an employee, annuitant, or other eligible person has a spouse who is also eligible, only one of them (not both) may enroll for self and family, or for self-plus-one coverage that covers the spouse. Otherwise, each spouse may enroll separately as an individual, or for self-plus-one coverage that does not cover the other spouse or a child already covered under the other spouse's enrollment. No one may be enrolled at the same time both as an eligible employee, annuitant, or other individual and as a covered family member.
(f) An employee, annuitant, former spouse, or person with continued coverage under section 8905a, who is enrolled in a chapter health plan, may change their own coverage or their family's by applying within 60 days of a family status change, or at other times and under other conditions OPM sets by regulation.
(g)(1) Under its own regulations, OPM must, before the start of any contract term in which rates or benefits change, a new plan is approved, or an existing plan ends, give enrolled employees, annuitants, former spouses, and people with continued coverage under section 8905a at least 3 weeks to transfer their enrollment to another plan or cancel it. (2) Besides that window, OPM may allow such transfers or cancellations at other times and under other conditions it sets by regulation. (3)(A) OPM's regulations must also make sure every employee eligible to enroll (whether enrolled or not) is notified in writing of their rights under section 8905a. (B) Employing agencies must give that notice before each period described in paragraph (1), so employees know their section 8905a rights when making enrollment decisions.
(h)(1) An unenrolled employee who is required by a court or administrative order to provide health coverage for one or more children who qualify under section 8901(5) may enroll for self-plus-one or self-and-family coverage, as needed to cover those children. If the employee fails to enroll appropriately in a plan that serves the child's area, and does not show that coverage exists some other way, the employing agency must enroll the employee in the lower-coverage option of the Service Benefit Plan, at the needed coverage level. (2) An employee already enrolled as an individual who becomes subject to such an order may change to self-plus-one or self-and-family coverage as needed. If they do not, and cannot show other coverage exists, the employing agency must change their coverage — to the needed level in their current plan, if it serves the child's area, and otherwise to the lower-coverage option of the Service Benefit Plan. (3) The employee cannot drop that required coverage while the court or administrative order remains in effect and the children still qualify under section 8901(5), unless the employee shows the coverage exists some other way.
(i) Any work by an officer or employee to enroll people in, or change the enrollment of people already in, a chapter health plan counts, for purposes of section 1342 of title 31, as an emergency service involving the safety of human life or the protection of property.
An employee may enroll in an approved health benefits plan described in section 8903 or 8903a—
as an individual;
for self plus one; or
for self and family.
An annuitant who at the time he becomes an annuitant was enrolled in a health benefits plan under this chapter—
as an employee for a period of not less than—
the 5 years of service immediately before retirement;
the full period or periods of service between the last day of the first period, as prescribed by regulations of the Office of Personnel Management, in which he is eligible to enroll in the plan and the date on which he becomes an annuitant; or
the full period or periods of service beginning with the enrollment which became effective before January 1, 1965, and ending with the date on which he becomes an annuitant;
whichever is shortest; or
as a member of the family of an employee or annuitant;
may continue his enrollment under the conditions of eligibility prescribed by regulations of the Office. The Office may, in its sole discretion, waive the requirements of this subsection in the case of an individual who fails to satisfy such requirements if the Office determines that, due to exceptional circumstances, it would be against equity and good conscience not to allow such individual to be enrolled as an annuitant in a health benefits plan under this chapter 1
A former spouse may—
within 60 days after the dissolution of the marriage, or
in the case of a former spouse of a former employee whose marriage was dissolved after the employee’s retirement, within 60 days after the dissolution of the marriage or, if later, within 60 days after an election is made under section 8339(j)(3) or 8417(b) of this title for such former spouse by the retired employee,
enroll in an approved health benefits plan described by section 8903 or 8903a of this title as an individual or for 2 for self plus one or self and family as provided in paragraph (2) of this subsection, subject to agreement to pay the full subscription charge of the enrollment, including the amounts determined by the Office to be necessary for administration and reserves pursuant to section 8909(b) of this title. The former spouse shall submit an enrollment application and make premium payments to the agency which, at the time of divorce or annulment, employed the employee to whom the former spouse was married or, in the case of a former spouse who is receiving annuity payments under section 8341(h), 8345(j), 8445, or 8467 of this title, to the Office of Personnel Management.
Coverage for self plus one or for self and family under this subsection shall be limited to—
the former spouse; and
unmarried dependent natural or adopted children (or, in the case of self plus one coverage, not more than 1 such child) of the former spouse and the employee who are—
under 22 years of age; or
incapable of self-support because of mental or physical disability which existed before age 22.
An individual whom the Secretary of Defense determines is an eligible beneficiary under subsection (b) of section 1108 of title 10 may enroll, as part of the demonstration project under such section, in a health benefits plan under this chapter in accordance with the agreement under subsection (a) of such section between the Secretary and the Office and applicable regulations under this chapter.
If an employee, annuitant, or other individual eligible to enroll in a health benefits plan under this chapter has a spouse who is also eligible to enroll, either spouse, but not both, may enroll for self and family, or for a self plus one enrollment that covers the spouse, or each spouse may enroll as an individual or for a self plus one enrollment that does not cover the other spouse or a child who is covered under the enrollment of the other spouse. However, an individual may not be enrolled both as an employee, annuitant, or other individual eligible to enroll and as a member of the family.
An employee, annuitant, former spouse, or person having continued coverage under section 8905a of this title enrolled in a health benefits plan under this chapter may change his coverage or that of himself and members of his family by an application filed within 60 days after a change in family status or at other times and under conditions prescribed by regulations of the Office.
Under regulations prescribed by the Office, the Office shall, before the start of any contract term in which—
an adjustment is made in any of the rates charged or benefits provided under a health benefits plan described by section 8903 or 8903a of this title,
a newly approved health benefits plan is offered, or
an existing plan is terminated,
provide a period of not less than 3 weeks during which any employee, annuitant, former spouse, or person having continued coverage under section 8905a of this title enrolled in a health benefits plan described by such section shall be permitted to transfer that individual’s enrollment to another such plan or to cancel such enrollment.
In addition to any opportunity afforded under paragraph (1) of this subsection, an employee, annuitant, former spouse, or person having continued coverage under section 8905a of this title enrolled in a health benefits plan under this chapter shall be permitted to transfer that individual’s enrollment to another such plan, or to cancel such enrollment, at such other times and subject to such conditions as the Office may prescribe in regulations.
In addition to any informational requirements otherwise applicable under this chapter, the regulations shall include provisions to ensure that each employee eligible to enroll in a health benefits plan under this chapter (whether actually enrolled or not) is notified in writing as to the rights afforded under section 8905a of this title.
Notification under this paragraph shall be provided by employing agencies at an appropriate point in time before each period under paragraph (1) so that employees may be aware of their rights under section 8905a of this title when making enrollment decisions during such period.
An unenrolled employee who is required by a court or administrative order to provide health insurance coverage for 1 or more children who meets the requirements of section 8901(5) may enroll for self plus one or self and family coverage, as necessary to provide health insurance coverage for each child who is covered under the order, in a health benefits plan under this chapter. If such employee fails to enroll for self plus one or self and family coverage, as necessary to provide health insurance coverage for each child who is covered under the order, in a health benefits plan that provides full benefits and services in the location in which the child or children reside, and the employee does not provide documentation showing that such coverage has been provided through other health insurance, the employing agency shall enroll the employee in a self plus one or self and family enrollment, as necessary to provide health insurance coverage for each child who is covered under the order, in the option which provides the lower level of coverage under the Service Benefit Plan.
An employee who is enrolled as an individual in a health benefits plan under this chapter and who is required by a court or administrative order to provide health insurance coverage for 1 or more children who meets the requirements of section 8901(5) may change to a self plus one or self and family enrollment, as necessary to provide health insurance coverage for each child who is covered under the order, in the same or another health benefits plan under this chapter. If such employee fails to change to a self plus one or self and family enrollment, as necessary to provide health insurance coverage for each child who is covered under the order, and the employee does not provide documentation showing that such coverage has been provided through other health insurance, the employing agency shall change the enrollment of the employee to a self plus one or self and family enrollment, as necessary to provide health insurance coverage for each child who is covered under the order, in the plan in which the employee is enrolled if that plan provides full benefits and services in the location where the child or children reside. If the plan in which the employee is enrolled does not provide full benefits and services in the location in which the child or children reside, or, if the employee fails to change to a self plus one or self and family enrollment, as necessary to provide health insurance coverage for each child who is covered under the order, in a plan that provides full benefits and services in the location where the child or children reside, the employing agency shall change the coverage of the employee to a self plus one or self and family enrollment, as necessary to provide health insurance coverage for each child who is covered under the order, in the option which provides the lower level of coverage under the Service Benefits Plan.
The employee may not discontinue the self plus one or self and family enrollment, as necessary to provide health insurance coverage for each child who is covered under the order, in a plan that provides full benefits and services in the location in which the child or children reside for so long as the court or administrative order remains in effect and the child or children continue to meet the requirements of section 8901(5), unless the employee provides documentation showing that such coverage has been provided through other health insurance.
Any services by an officer or employee under this chapter relating to enrolling individuals in a health benefits plan under this chapter, or changing the enrollment of an individual already so enrolled, shall be deemed, for purposes of section 1342 of title 31, services for emergencies involving the safety of human life or the protection of property.
Source credit: (Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 603; Pub. L. 95–454, title IX, § 906(a)(2), (3), Oct. 13, 1978, 92 Stat. 1224; Pub. L. 98–615, § 3(4), Nov. 8, 1984, 98 Stat. 3203; Pub. L. 99–53, § 2(a), (c), June 17, 1985, 99 Stat. 94; Pub. L. 99–251, title I, §§ 103, 104(a), Feb. 27, 1986, 100 Stat. 14; Pub. L. 99–335, title II, § 207(m), June 6, 1986, 100 Stat. 598; Pub. L. 100–654, title II, §§ 201(c), (d), 202(c), Nov. 14, 1988, 102 Stat. 3845; Pub. L. 102–378, § 2(77), Oct. 2, 1992, 106 Stat. 1355; Pub. L. 105–261, div. A, title VII, § 721(b)(1), Oct. 17, 1998, 112 Stat. 2065; Pub. L. 106–394, § 2, Oct. 30, 2000, 114 Stat. 1629; Pub. L. 113–67, div. A, title VII, § 706(a), Dec. 26, 2013, 127 Stat. 1193; Pub. L. 116–92, div. A, title XI, § 1110(a), Dec. 20, 2019, 133 Stat. 1600.)
- 1966Enacted · Pub. L. 89-554 · 80 Stat. 603
- 1978Amended · Pub. L. 95-454 · 92 Stat. 1224
- 1984Amended · Pub. L. 98-615 · 98 Stat. 3203
- 1985Amended · Pub. L. 99-53 · 99 Stat. 94
- 1986Amended · Pub. L. 99-251 · 100 Stat. 14
- 1986Amended · Pub. L. 99-335 · 100 Stat. 598
- 1988Amended · Pub. L. 100-654 · 102 Stat. 3845
- 1992Amended · Pub. L. 102-378 · 106 Stat. 1355
- 1998Amended · Pub. L. 105-261 · 112 Stat. 2065
- 2000Amended · Pub. L. 106-394 · 114 Stat. 1629
- 2013Amended · Pub. L. 113-67 · 127 Stat. 1193
- 2019Amended · Pub. L. 116-92 · 133 Stat. 1600
A history note hasn’t been published yet. The record shows enactment by Pub. L. 89-554 on 1966-09-06.
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