5 U.S.C. § 8905a — Continued coverage
submitted 38 years ago by Pub. L. 100-654 to r/title-5-GOVERNMENT-ORGANIZATION-AND-EMPLOYEES · 2,302 words · no verdicts yet
This law lets certain people keep their federal health coverage after losing eligibility. Employees who leave their job may elect to continue coverage for a limited time. So can children who age out of family coverage and reservists called to active duty. They usually pay the full premium, though some groups get help from their former employer.
(a) Anyone described in subsection (b) may elect to continue their chapter health coverage under this section's rules.
(b) This section covers three groups. (1) An employee who is separated from service, voluntarily or not — except that if the separation is involuntary because of gross misconduct (as OPM regulations define it), this section does not apply — and who would not otherwise be eligible for any chapter benefits, ignoring any temporary coverage extension or nongroup-contract benefits. (2) Someone who stops qualifying as an unmarried dependent child under this chapter, who was covered the day before that as a family member of an employee or annuitant, and who would not otherwise be eligible for any chapter benefits (with the same exclusions as above). (3) An employee who is enrolled in a chapter health plan, is a member of a reserve component of the armed forces, is called to active duty in support of a contingency operation, is placed on leave without pay or separated from service to perform that duty, and serves more than 30 straight days.
(c)(1) OPM must issue regulations, and require carrier contracts to include terms, providing that: (A) for an employee becoming eligible due to separation from service, the separating agency must, before the end of the 30-day period after coverage (including any temporary extension) would otherwise end, notify the individual of their rights under this section; and (B) for a child of an employee or annuitant losing family-member eligibility, the employee or annuitant may give written notice of the child's change in status (with the child's name, address, and other required details) to the employing agency, or to OPM for an annuitant's child — and if that notice arrives within 60 days after the child first loses eligibility, the agency or OPM must notify the child of their rights within 14 days. (2) To get continued coverage, a written election must be made: (A) for someone basing it on separation from service, before the end of the 60-day period starting on the later of the separation's effective date or receiving the required notice; or (B) for someone basing it on losing unmarried-dependent-child status, before the end of the 60-day period starting on the later of losing that status or receiving the required notice — except that if a parent fails to give the required notice in time, the 60-day period still runs from the date the child lost eligibility, whether or not the child was ever notified.
(d) Payment rules. (1)(A) Except as covered in paragraphs (4) through (6), someone on continued coverage must currently pay into the Employees Health Benefits Fund an amount equal to: (i) the combined employee and agency contributions that would apply to an employee enrolled in the same plan and benefit level; plus (ii) an administrative charge OPM sets by regulation, capped at 2 percent of that combined amount. (B) These payments go through the agency that last employed the person, if based on separation — or, if based on a child losing eligibility, through OPM (if the child was covered as an annuitant's dependent) or through the employee's employing agency (if covered as an employee's dependent). (2) If someone elects continued coverage after their old coverage (plus any temporary extension) has already lapsed, but still within the allowed election window, their coverage is restored retroactively — with the right contributions and any claims — as if there had been no gap. (3) Someone electing coverage based on a child's status change may choose individual, self-plus-one, or self-and-family coverage, with family determined the same way as for an enrolled employee; this does not limit someone electing coverage based on separation from service to individual-only coverage. (4) For an involuntary separation, or voluntary separation from a surplus position, tied to a Department of Defense reduction in force, or a Department of Energy reduction in force from creating the National Nuclear Security Administration: the individual pays only the employee-level share, and the agency that last employed them pays the rest — for separations occurring between this paragraph's enactment and December 31, 2016 (or February 1, 2017, if the individual received specific separation notice before December 31, 2016). A "surplus position" here is one identified before the reduction in force as no longer needed and expected to be eliminated through formal reduction-in-force procedures. (5) A similar subsidized rule applies for an involuntary Department of Veterans Affairs reduction in force or title 38 staffing readjustment, or a voluntary or involuntary separation from a Department of Energy facility undergoing a closure project — the individual pays only the employee share, and the last employing agency pays the rest, for separations occurring on or after this paragraph's enactment. (6) A similar subsidized rule applies for separations tied to the Space Shuttle Program's termination at NASA — for an involuntary reduction-in-force separation, a declined reassignment or transfer, or a voluntary separation from a surplus position — the individual pays only the employee share, and NASA pays the rest, for separations occurring between this paragraph's enactment and December 31, 2010. A "surplus position" here means one identified before the reduction in force as no longer needed because of the Shuttle Program ending, or one NASA has certified is being eliminated for that reason.
(e)(1) Continued coverage cannot extend beyond: (A) for someone basing it on separation from service, 18 months after the separation's effective date; (B) for someone basing it on losing unmarried-dependent-child status, 36 months after they lost that status, subject to paragraph (2); or (C) for the reservist described in subsection (b)(3), 24 months after being placed on leave without pay or separated to perform active duty. (2) If a child loses dependent-child status while covered as the child of a former employee who is already on continued coverage based on that employee's own separation from service, and this happens within 18 months of that employee's separation, the child's extended coverage cannot run past 36 months after the former employee's separation date.
(f)(1) OPM must issue regulations extending continued coverage, where practical and upon written application, to: (A) someone who would count as a "former spouse" under section 8901(10) if that definition's subparagraphs (A) and (C) were ignored, but who would not otherwise qualify; and (B) someone whose coverage as a family member would otherwise end because of a legal separation. (2) These regulations' terms must include: (A) notice provisions consistent with subsection (c), with an election period of at least 60 days; (B) payment terms identical to subsection (d), except that contributions go through whatever agency OPM designates by regulation; (C) rules for when continued coverage ends, capped (subject to paragraph (3)) at 36 months after the date of the divorce, annulment, or legal separation; and (D) provisions making sure this coverage does not hurt any other coverage eligibility the person might otherwise have. (3) If someone's continued coverage under this subsection is based on a divorce, annulment, or legal separation from a person who — the day before that event — was already receiving continued coverage under this section based on their own separation from service, under a self-plus-one enrollment covering this person or a self-and-family enrollment, and the divorce, annulment, or legal separation happens within 18 months of that person's separation from service, then this individual's extended coverage cannot run past 36 months after that person's separation date.
Any individual described in subsection (b) may elect to continue coverage under this chapter in accordance with the provisions of this section.
This section applies with respect to—
any employee who—
is separated from service, whether voluntarily or involuntarily, except that if the separation is involuntary, this section shall not apply if the separation is for gross misconduct (as defined under regulations which the Office of Personnel Management shall prescribe); and
would not otherwise be eligible for any benefits under this chapter (determined without regard to any temporary extension of coverage and without regard to any benefits available under a nongroup contract);
any individual who—
ceases to meet the requirements for being considered an unmarried dependent child under this chapter;
on the day before so ceasing to meet the requirements referred to in subparagraph (A), was covered under a health benefits plan under this chapter as a member of the family of an employee or annuitant; and
would not otherwise be eligible for any benefits under this chapter (determined without regard to any temporary extension of coverage and without regard to any benefits available under a nongroup contract); and
any employee who—
is enrolled in a health benefits plan under this chapter;
is a member of a reserve component of the armed forces;
is called or ordered to active duty in support of a contingency operation (as defined in section 101(a)(13) of title 10);
is placed on leave without pay or separated from service to perform active duty; and
serves on active duty for a period of more than 30 consecutive days.
The Office shall prescribe regulations and provide for the inclusion of appropriate terms in contracts with carriers to provide that—
with respect to an employee who becomes (or will become) eligible for continued coverage under this section as a result of separation from service, the separating agency shall, before the end of the 30-day period beginning on the date as of which coverage (including any temporary extensions of coverage) would otherwise end, notify the individual of such individual’s rights under this section; and
with respect to a child of an employee or annuitant who becomes eligible for continued coverage under this section as a result of ceasing to meet the requirements for being considered a member of the employee’s or annuitant’s family—
the employee or annuitant may provide written notice of the child’s change in status (complete with the child’s name, address, and such other information as the Office may by regulation require)—
to the employee’s employing agency; or
in the case of an annuitant, to the Office; and
if the notice referred to in clause (i) is received within 60 days after the date as of which the child involved first ceases to meet the requirements involved, the employing agency or the Office (as the case may be) must, within 14 days after receiving such notice, notify the child of such child’s rights under this section.
In order to obtain continued coverage under this section, an appropriate written election (submitted in such manner as the Office by regulation prescribes) must be made—
in the case of an individual seeking continued coverage based on a separation from service, before the end of the 60-day period beginning on the later of—
the effective date of the separation; or
the date the separated individual receives the notice required under paragraph (1)(A); or
in the case of an individual seeking continued coverage based on a change in circumstances making such individual ineligible for coverage as an unmarried dependent child, before the end of the 60-day period beginning on the later of—
the date as of which such individual first ceases to meet the requirements for being considered an unmarried dependent child; or
the date such individual receives notice under paragraph (1)(B)(ii);
except that if a parent fails to provide the notice required under paragraph (1)(B)(i) in timely fashion, the 60-day period under this subparagraph shall be based on the date under clause (i), irrespective of whether or not any notice under paragraph (1)(B)(ii) is provided.
Except as provided in paragraphs (4), (5), and (6), an individual receiving continued coverage under this section shall be required to pay currently into the Employees Health Benefits Fund, under arrangements satisfactory to the Office, an amount equal to the sum of—
the employee and agency contributions which would be required in the case of an employee enrolled in the same health benefits plan and level of benefits; and
an amount, determined under regulations prescribed by the Office, necessary for administrative expenses, but not to exceed 2 percent of the total amount under clause (i).
Payments under this section to the Fund shall—
in the case of an individual whose continued coverage is based on such individual’s separation, be made through the agency which last employed such individual; or
in the case of an individual whose continued coverage is based on a change in circumstances referred to in subsection (c)(2)(B), be made through—
the Office, if, at the time coverage would (but for this section) otherwise have been discontinued, the individual was covered as the child of an annuitant; or
if, at the time referred to in subclause (I), the individual was covered as the child of an employee, the employee’s employing agency as of such time.
If an individual elects to continue coverage under this section before the end of the applicable period under subsection (c)(2), but after such individual’s coverage under this chapter (including any temporary extensions of coverage) expires, coverage shall be restored retroactively, with appropriate contributions (determined in accordance with paragraph (1), (4), or (5), as the case may be) and claims (if any), to the same extent and effect as though no break in coverage had occurred.
An individual making an election under subsection (c)(2)(B) may, at such individual’s option, elect coverage either as an individual or, if appropriate, for self plus one or for self and family.
For the purpose of this paragraph, members of an individual’s family shall be determined in the same way as would apply under this chapter in the case of an enrolled employee.
Nothing in this paragraph shall be considered to limit an individual making an election under subsection (c)(2)(A) to coverage for self alone.
If the basis for continued coverage under this section is an involuntary separation from a position, or a voluntary separation from a surplus position, in or under the Department of Defense due to a reduction in force, or the Department of Energy due to a reduction in force resulting from the establishment of the National Nuclear Security Administration—
the individual shall be liable for not more than the employee contributions referred to in paragraph (1)(A)(i); and
the agency which last employed the individual shall pay the remaining portion of the amount required under paragraph (1)(A).
This paragraph shall apply with respect to any individual whose continued coverage is based on a separation occurring on or after the date of enactment of this paragraph and before—
December 31, 2016; or
February 1, 2017, if specific notice of such separation was given to such individual before December 31, 2016.
For the purpose of this paragraph, “surplus position” means a position which is identified in pre-reduction-in-force planning as no longer required, and which is expected to be eliminated under formal reduction-in-force procedures.
If the basis for continued coverage under this section is an involuntary separation from a position in or under the Department of Veterans Affairs due to a reduction in force or a title 38 staffing readjustment, or a voluntary or involuntary separation from a Department of Energy position at a Department of Energy facility at which the Secretary is carrying out a closure project selected under section 44211 of the Atomic Energy Defense Act—
the individual shall be liable for not more than the employee contributions referred to in paragraph (1)(A)(i); and
the agency which last employed the individual shall pay the remaining portion of the amount required under paragraph (1)(A).
This paragraph shall only apply with respect to individuals whose continued coverage is based on a separation occurring on or after the date of the enactment of this paragraph.
If the basis for continued coverage under this section is, as a result of the termination of the Space Shuttle Program, an involuntary separation from a position due to a reduction-in-force or declination of a directed reassignment or transfer of function, or a voluntary separation from a surplus position in the National Aeronautics and Space Administration—
the individual shall be liable for not more than the employee contributions referred to in paragraph (1)(A)(i); and
the National Aeronautics and Space Administration shall pay the remaining portion of the amount required under paragraph (1)(A).
This paragraph shall only apply with respect to individuals whose continued coverage is based on a separation occurring on or after the date of enactment of this paragraph and before December 31, 2010.
For purposes of this paragraph, “surplus position” means a position which is—
identified in pre-reduction-in-force planning as no longer required, and which is expected to be eliminated under formal reduction-in-force procedures as a result of the termination of the Space Shuttle Program; or
encumbered by an employee who has received official certification from the National Aeronautics and Space Administration consistent with the Administration’s career transition assistance program regulations that the position is being abolished as a result of the termination of the Space Shuttle Program.
Continued coverage under this section may not extend beyond—
in the case of an individual whose continued coverage is based on separation from service, the date which is 18 months after the effective date of the separation;
in the case of an individual whose continued coverage is based on ceasing to meet the requirements for being considered an unmarried dependent child, the date which is 36 months after the date on which the individual first ceases to meet those requirements, subject to paragraph (2); or
in the case of an employee described in subsection (b)(3), the date which is 24 months after the employee is placed on leave without pay or separated from service to perform active duty.
In the case of an individual who—
ceases to meet the requirements for being considered an unmarried dependent child;
as of the day before so ceasing to meet the requirements referred to in subparagraph (A), was covered as the child of a former employee receiving continued coverage under this section based on the former employee’s separation from service; and
so ceases to meet the requirements referred to in subparagraph (A) before the end of the 18-month period beginning on the date of the former employee’s separation from service,
extended coverage under this section may not extend beyond the date which is 36 months after the separation date referred to in subparagraph (C).
The Office shall prescribe regulations under which, in addition to any individual otherwise eligible for continued coverage under this section, and to the extent practicable, continued coverage may also, upon appropriate written application, be afforded under this section—
to any individual who—
if subparagraphs (A) and (C) of paragraph (10) of section 8901 were disregarded, would be eligible to be considered a former spouse within the meaning of such paragraph; but
would not, but for this subsection, be eligible to be so considered; and
to any individual whose coverage as a family member would otherwise terminate as a result of a legal separation.
The terms and conditions for coverage under the regulations shall include—
consistent with subsection (c), any necessary notification provisions, and provisions under which an election period of at least 60 days’ duration is afforded;
terms and conditions identical to those under subsection (d), except that contributions to the Employees Health Benefits Fund shall be made through such agency as the Office by regulation prescribes;
provisions relating to the termination of continued coverage, except that continued coverage under this section may not (subject to paragraph (3)) extend beyond the date which is 36 months after the date on which the qualifying event under this subsection (the date of divorce, annulment, or legal separation, as the case may be) occurs; and
provisions designed to ensure that any coverage pursuant to this subsection does not adversely affect any eligibility for coverage which the individual involved might otherwise have under this chapter (including as a result of any change in personal circumstances) if this subsection had not been enacted.
In the case of an individual—
who becomes eligible for continued coverage under this subsection based on a divorce, annulment, or legal separation from a person who, as of the day before the date of the divorce, annulment, or legal separation (as the case may be) was receiving continued coverage under this section based on such person’s separation from service under a self plus one enrollment that covered the individual or under a self and family enrollment; and
whose divorce, annulment, or legal separation (as the case may be) occurs before the end of the 18-month period beginning on the date of the separation from service referred to in subparagraph (A),
extended coverage under this section may not extend beyond the date which is 36 months after the date of the separation from service, as referred to in subparagraph (A).
Source credit: (Added Pub. L. 100–654, title II, § 201(a)(1), Nov. 14, 1988, 102 Stat. 3841; amended Pub. L. 102–484, div. D, title XLIV, § 4438(a), Oct. 23, 1992, 106 Stat. 2725; Pub. L. 103–337, div. A, title III, § 341(d), Oct. 5, 1994, 108 Stat. 2720; Pub. L. 104–106, div. A, title X, § 1036, Feb. 10, 1996, 110 Stat. 431; Pub. L. 106–65, div. A, title XI, § 1104(c), div. C, title XXXII, § 3244, Oct. 5, 1999, 113 Stat. 777, 965; Pub. L. 106–117, title XI, § 1106, Nov. 30, 1999, 113 Stat. 1598; Pub. L. 107–314, div. A, title XI, § 1103, Dec. 2, 2002, 116 Stat. 2661; Pub. L. 107–314, div. D, title XLVI, § 4603(h), formerly Pub. L. 106–398, § 1 [div. C, title XXXI, § 3136(h)], Oct. 30, 2000, 114 Stat. 1654, 1654A–459, renumbered § 4603(h) of Pub. L. 107–314 by Pub. L. 108–136, div. C, title XXXI, § 3141(i)(4)(A)–(C), Nov. 24, 2003, 117 Stat. 1777; Pub. L. 108–136, div. C, title XXXI, § 3141(m)(3), Nov. 24, 2003, 117 Stat. 1787; Pub. L. 108–375, div. A, title XI, § 1101(a), Oct. 28, 2004, 118 Stat. 2072; Pub. L. 109–163, div. A, title XI, § 1101, Jan. 6, 2006, 119 Stat. 3447; Pub. L. 110–422, title VI, § 615, Oct. 15, 2008, 122 Stat. 4800; Pub. L. 111–242, § 151, as added Pub. L. 111–322, title I, § 1(a)(2), Dec. 22, 2010, 124 Stat. 3519; Pub. L. 112–81, div. A, title XI, § 1123, Dec. 31, 2011, 125 Stat. 1617; Pub. L. 113–67, div. A, title VII, § 706(b), Dec. 26, 2013, 127 Stat. 1194.)
- 1988Enacted · Pub. L. 100-654 · 102 Stat. 3841
- 1992Amended · Pub. L. 102-484 · 106 Stat. 2725
- 1994Amended · Pub. L. 103-337 · 108 Stat. 2720
- 1996Amended · Pub. L. 104-106 · 110 Stat. 431
- 1999Amended · Pub. L. 106-65 · 113 Stat. 777, 965
- 1999Amended · Pub. L. 106-117 · 113 Stat. 1598
- 2002Amended · Pub. L. 107-314 · 116 Stat. 2661
- 2000Amended · Pub. L. 107-314 · 114 Stat. 1654, 1654
- 2003Amended · Pub. L. 108-136 · 117 Stat. 1787
- 2004Amended · Pub. L. 108-375 · 118 Stat. 2072
- 2006Amended · Pub. L. 109-163 · 119 Stat. 3447
- 2008Amended · Pub. L. 110-422 · 122 Stat. 4800
- 2010Amended · Pub. L. 111-242 · 124 Stat. 3519
- 2011Amended · Pub. L. 112-81 · 125 Stat. 1617
- 2013Amended · Pub. L. 113-67 · 127 Stat. 1194
A history note hasn’t been published yet. The record shows enactment by Pub. L. 100-654 on 1988-11-14.
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