5 U.S.C. § 8714d — Option to receive “living benefits”
submitted 32 years ago by Pub. L. 103-409 to r/title-5-GOVERNMENT-ORGANIZATION-AND-EMPLOYEES · 730 words · no verdicts yet
A person is “terminally ill” when a medical prognosis gives the person nine months or less to live. The person may take one irrevocable discounted lump-sum payment from basic life insurance, and the section sets the effect and application rules.
(a) A person is “terminally ill” if a medical prognosis gives the person a life expectancy of nine months or less. This section does not define that term further. (b) The Office must issue regulations allowing a terminally ill section 8704(a)-insured person to elect a lump sum equal to all, or a designated part under (d)(4), of the insurance otherwise payable after a valid claim. It is calculated using a regulatory date no later than 30 days after approval or deemed approval, assuming coverage continues, and reduced enough to avoid increasing the benefit’s actuarial value. (c)(1)(A) After a full election, no section 8704(a) or (b) insurance is payable because of the person’s death or loss. If only part was taken, the rest remains, but its basic amount is reduced by the percentage represented by the part taken, rounded to the nearest $1,000 or upward if exactly halfway, and is not adjusted again. (B) Sections 8707 deductions and withholdings and section 8708 contributions end, or are reduced consistently, for amounts due on or after payment. (2) A person taking a full or partial lump sum remains eligible for sections 8714a–8714c benefits if the person pays their full cost as those sections require. (d)(1) Regulations must specify the application form, manner, and review procedure. (2) An application must include required information and evidence, including an appropriate medical certification of the illness and nine-month prognosis. (3)(A) The reviewer may require a medical examination to test the opinion; the person does not pay its cost. (B) The decision, including the prognosis decision, is not subject to administrative review. (4)(A) The person may designate a limited part, stated in multiples of $1,000, of the otherwise allowable amount. (B) A person described in section 8706(b)(1) or (2) may not do so. (5) The election cannot be revoked, and each person may make only one. (6) Regulations must address section 8706(b)(3)(B) for an electing person who is 65 or older.
For the purpose of this section, an individual shall be considered to be “terminally ill” if such individual has a medical prognosis that such individual’s life expectancy is 9 months or less.
The Office of Personnel Management shall prescribe regulations under which any individual covered by group life insurance under section 8704(a) may, if such individual is terminally ill, elect to receive a lump-sum payment equal to—
the full amount of insurance under section 8704(a) (or portion thereof designated for this purpose under subsection (d)(4)) which would otherwise be payable under this chapter (on the establishment of a valid claim)—
computed based on a date determined under regulations of the Office (but not later than 30 days after the date on which the individual’s application for benefits under this section is approved or deemed approved under subsection (d)(3)); and
assuming continued coverage under this chapter at that time;
reduced by
an amount necessary to assure that there is no increase in the actuarial value of the benefit paid (as determined under regulations of the Office).
If a lump-sum payment is taken under this section—
no insurance under the provisions of section 8704(a) or (b) shall be payable based on the death or any loss of the individual involved, unless the lump-sum payment represents only a portion of the total benefits which could have been taken, in which case benefits under those provisions shall remain in effect, except that the basic insurance amount on which they are based—
shall be reduced by the percentage which the designated portion comprised relative to the total benefits which could have been taken (rounding the result to the nearest multiple of $1,000 or, if midway between multiples of $1,000, to the next higher multiple of $1,000); and
shall not be subject to further adjustment; and
deductions and withholdings under section 8707, and contributions under section 8708, shall be terminated with respect to such individual (or reduced in a manner consistent with the percentage reduction in the individual’s basic insurance amount, if applicable), effective with respect to any amounts which would otherwise become due on or after the date of payment under this section.
An individual who takes a lump-sum payment under this section (whether full or partial) remains eligible for optional benefits under sections 8714a–8714c (subject to payment of the full cost of those benefits in accordance with applicable provisions of the section or sections involved, to the same extent as if no election under this section had been made).
The Office’s regulations shall include provisions regarding the form and manner in which an application under this section shall be made and the procedures in accordance with which any such application shall be considered.
An application shall not be considered to be complete unless it includes such information and supporting evidence as the regulations require, including certification by an appropriate medical authority as to the nature of the individual’s illness and that the individual is not expected to live more than 9 months because of that illness.
In order to ascertain the reliability of any medical opinion or finding submitted as part of an application under this section, the covered individual may be required to submit to a medical examination under the direction of the agency or entity considering the application. The individual shall not be liable for the costs associated with any examination required under this subparagraph.
Any decision by the reviewing agency or entity with respect to an application for benefits under this section (including one relating to an individual’s medical prognosis) shall not be subject to administrative review.
An individual making an election under this section may designate that only a limited portion (expressed as a multiple of $1,000) of the total amount otherwise allowable under this section be paid pursuant to such election.
A designation under this paragraph may not be made by an individual described in paragraph (1) or (2) of section 8706(b).
An election to receive benefits under this section shall be irrevocable, and not more than one such election may be made by any individual.
The regulations shall include provisions to address the question of how to apply section 8706(b)(3)(B) in the case of an electing individual who has attained 65 years of age.
Source credit: (Added Pub. L. 103–409, § 2(a), Oct. 25, 1994, 108 Stat. 4230.)
- 1994Enacted · Pub. L. 103-409 · 108 Stat. 4230
A history note hasn’t been published yet. The record shows enactment by Pub. L. 103-409 on 1994-10-25.
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