On May 8, 2002, the National Finance Center (NFC) issued Title I, Bulletin 02-9, Changes Affecting Enrollment Under the Federal Employees Health Benefits (FEHB) Program. This bulletin specifically advised agency personnel offices of new responsibilities imposed by Public Law (P.L.) 106-394, The Federal Employees Health Benefits (FEHB) Children’s Equity Act of 2000. The programming to implement these regulatory changes into the NFC Payroll/Personnel System is now completed and will be effective with the processing of data for Pay Period 24 on December 9, 2002.

This new bulletin 02-18 updates Title 1, Bulletin 02-9, Changes Affecting Enrollment Under the Federal Employees Health Benefits (FEHB) Program. Please discard Title I, Bulletin 02-9 and replace with this bulletin.

Public Law 106-394

Currently, FEHB laws and regulations allow an employee to change enrollment after a change in family status. The issuance of a court or administrative order requiring an employee to provide health benefits for his/her child/children is considered under FEHB to be a change in family status allowing an enrollment change. However, FEHB law has never required an employee to make the court- or administratively-ordered change until recently.

Public Law 106-394, the Federal Employees Health Benefits Children’s Equity Act of 2000, enacted October 30, 2000, requires mandatory self and family coverage for FEHB-eligible employees who do not comply with a court or administrative order to provide health benefits coverage for their child/children. An employee subject to such an order must enroll in self and family coverage in a plan that provides full benefits to his/her child/children in the area where they live or provide documentation that he/she has other health coverage for the child/children. For additional information, refer to OPM Retirement and Insurance Service, Benefits Administration Letters, Numbers: 00-224, dated November, 21, 2000, and 02-203, dated April 3, 2002; OPM Retirement And Insurance Service, Payroll Office Letter, Number: P-00-36, dated December 14, 2000; and OPM Retirement and Insurance Service, Benefits Administration Letter, 01-202, dated January 29, 2001. Additional information may also be found at http://www.opm.gov/asd/index.htm.

Agency Personnel Office Responsibilities

When a court or administrative order is received for an individual, the agency personnel office must review the employee’s records to determine whether he/she is eligible for FEHB and, if so, whether he/she is enrolled in a self and family plan that provides full benefits in the location where the child/children live. Listed below are the specific actions that must be taken by the agency personnel office to ensure compliance with the court or administrative order.

If the employee has FEHB self and family coverage, notify the individual that a court or administrative order has been received requiring him/her to provide health benefits for his/her child/children. If the child/children named on the court or administrative order is not identified as a member of the employee’s self and family coverage, submit a copy of the individual’s SF-2809, Health Benefits Registration Form-Federal Employees Health Benefits Program, or Form SF-2810, Notice of Change in Health Benefits Enrollment, along with a copy of the court or administrative order to NFC. NFC will forward the appropriate documentation to the FEHB carrier to identify the additional family member being covered under the self and family enrollment. Inform the appropriate contact for the court or administrative order of the FEHB coverage and that action has been taken to ensure the child/children is covered.

If the employee has FEHB self-only coverage, notify the individual that a court or administrative order has been received requiring him/her to provide health benefits for his/her child/children. The individual has until the end of the pay period following the one in which he/she is given the notice to make a change from self only to self and family coverage. If the individual does not make a change to self and family coverage, the agency personnel office must enroll them in the Basic Option of the Blue Cross/Blue Shield Service Benefit Plan (Enrollment Code 112, Self and Family). The effective date of coverage is the first day of the pay period following the one in which the SF-2809 is completed or the effective date as stated on the court or administrative order. Submit a copy of the individual’s SF-2809 or SF-2810 along with a copy of the court or administrative order to NFC. NFC will forward all the appropriate documentation to the FEHB carrier identifying the family members being covered under the self and family enrollment. Authorized enrollment changes must be processed retroactively, if necessary, to comply with the effective date of the court or administrative order. Submit Form AD-343, Payroll Action Request, to NFC for processing of the retroactive FEHB personnel action indicating:

§         The enrollment is retroactive to the beginning of the pay period that includes the effective date, but no further back than 2 years.

§         The total adjustment amount due.

§         The collection frequency for obtaining the amount due (e.g., a one-time payment or payment each pay period).

Inform the appropriate contact for the court or administrative order of the FEHB self and family coverage and that action has been taken to ensure the child/children is covered.

If the employee is not enrolled in an FEHB health plan that provides full benefits in the location where the child/children live, notify the individual that a court or administrative order has been received requiring him/her to provide health benefits for his/her child/children. The individual has until the end of the pay period following the one in which he/she is given the notice to enroll in a health plan or provide documentation that he/she has other health benefits for the child/children. If the individual does not enroll in a plan or provide documentation of coverage, enroll the child/children in the Basic Option of the Blue Cross/Blue Shield Service Benefit Plan (Enrollment Code 112, Self and Family). Complete an SF-2809 with remarks to identify that the employee is being enrolled for FEHB self and family coverage involuntarily under P.L. 106-394. The effective date of coverage is the first day of the pay period following the one in which the SF-2809 is completed or the effective date as stated on the court or administrative order. Submit the SF-2809 along with a copy of the court or administrative order to NFC. NFC will forward the appropriate documentation to the FEHB carrier to identify each family member being covered under self and family enrollment. Authorized enrollment changes must be processed retroactively, if necessary, to comply with the effective date of the court or administrative order. Inform the appropriate contact for the court or administrative order of the FEHB self and family coverage and that action has been taken to ensure the child/children is covered.

Non-Federal Health Benefits

Agencies that employ non-Federal employees who are eligible for FEHB coverage, should review P.L. 106-394 to determine the impact on their employees.

Employees In Nonpay Status

When an employee under a court or administrative order to provide FEHB coverage for his/her child/children is in a nonpay status, he/she must either make direct premium payments or incur a debt to the Federal Government to be repaid when he/she returns to pay status. Note: This applies only during the first year in nonpay status. Coverage terminates after 365 days in nonpay status, even for employees subject to a court or administrative order. For additional information, see 5 CFR 890.502(b).

Termination By Carrier

When an individual under court or administrative order to provide FEHB coverage for his/her child/children has FEHB coverage terminated by a FEHB carrier, it is the responsibility of the employee’s personnel office to ensure that the individual continues to provide self and family FEHB coverage under an alternative FEHB plan.

Restricted Enrollment Changes

During open season or when there is an event allowing an enrollment change, employees who are under court or administrative order are restricted as to the type of enrollment changes they may select while enrolled in FEHB. An employee who is under court or administrative order can change to a different fee-for-service plan or an HMO that provides full benefits where the child/children live. However, the employee cannot cancel enrollment, change to self-only, or change to an HMO that doesn’t provide coverage in the area where the child/children live, as long as the court or administrative order is still in effect and the child/children are eligible under FEHB. This applies whether the employee enrolled voluntarily or involuntarily. If an SF-2809 is received making such an enrollment change, do not process it. If the SF-2809 is processed by mistake, a corrective action must be processed immediately, even retroactively, if applicable. Notify the employee that he/she cannot make the change and that the existing self and family enrollment will remain in effect.

Exceptions To Restricted Enrollment Changes

The following exceptions are allowed for enrollment changes when an employee is under a court or administrative order.

§         For employees who participate in the HB-Premium Conversion (HB-PC), if a court or administrative order states that the FEHB coverage for the child/children must continue until a specific age below 22, an employee may cancel coverage or change to self-only (1) within 60 days after the date the last child turned 22, regardless of what the court or administrative order says (FEHB provides coverage until age 22); or (2) during the open season after the last child reaches the age stated in the court or administrative order.

§         For employees who waived HB-PC, the cancellation of coverage or change to self-only may occur any time after the last child reaches the age specified in the court or administrative order or age 22.

§         When a court or administrative order states that health coverage for the child/children must continue over age 22, the employee must provide proof of health benefits coverage either through Temporary Continuation of Coverage (TCC) or a private health plan. A child/children cannot be covered by FEHB beyond age 22, regardless of what the court or administrative order states unless the child/children meet the requirements for being incapable of self-support.

Payroll/Personnel Entry System Changes

Effective with the processing of transactions for Pay Period 24, the following changes will be implemented in the Entry, Processing, Inquiry, and Correction System, (EPIC), Personnel Action Processing System (PACT), Front-End System Interface (FESI), and Personnel Edit Subsystem  (PINE) to ensure the Payroll/Personnel System correctly reflects the court or administrative order status and provide controls for the processing of change transactions.

FEHB Coverage Codes

FEHB coverage codes are used when processing personnel actions to identify the employee’s eligibility for participation in the FEHB program, and if eligible, whether they are participating. The following new FEHB coverage codes will be used to process FEHB personnel actions for employees who are required by a court or administrative order to provide health benefits coverage for their child/children:

§         6 - Court Order – Enrolled

§         7 - Court Order – Eligible-Pending Family Coverage

§         8 - Court Order – Self-Only - Pending Family Coverage

Nature of Action Code/Authority Codes

Nature of Action Code (NOAC) 916, Court Ordered FEHB Change, has been added for use in indicating the court- or administratively-ordered FEHB changes.

The following new authority codes have been established for use with NOAC 916.

§         BEG - The Beginning Effective Date authority should be used to reflect that an FEHB court-ordered action is in effect for the employee.

§         END - The Ending Effective Date authority should be used to reflect that an FEHB court-ordered action is no longer in effect for an employee.

Remarks Codes

The following remark codes will be generated automatically with NOAC 916 for processing court- or administratively-ordered FEHB actions:

§         FE1 – FEHB Family Coverage Required By P.L. 106-394

§         FE2 – Employee’s FEHB Coverage Is No Longer Subject To P.L. 106-394

The messages for Remarks Codes FE1 and FE2 will be reflected on Form SF-50B, Notification of Personnel Action, when a court- or administratively-ordered FEHB action is processed.

Personnel Edit Subsystem (PINE) Edit Messages

The following new PINE edit messages have been established for correcting an FEHB personnel action for an employee who is required by a court or administrative order to provide health benefits coverage for his/her child/children.

Document Type 063, Personnel Action Input

§         825 – NOA 916 Must Have Authority Code BEG Or END

§         826 – Employee Currently Ineligible For FEHB

§         827 – NOA 916 Coverage Code Must Be 6, 7, 8

§         828 – Employee Not Enrolled In Federal FEHB

§         829 – Employee Not Enrolled In Family FEHB

§         830 – Employee Already Enrolled In FEHB

§         831 – Employee Already Enrolled In Family FEHB

§         832 – FEHB Coverage Code Invalid For NOA 916 BEG

§         833 – FEHB Coverage Code Invalid For NOA 916 END

§         834 – Employee Must Return To FEHB Enrolled Status

§         835 – Employee Must Return To FEHB Elig-Pending Status

Document Type 180, Federal Employees Health Benefits

§         055 – Court Ordered – Cannot Waive Or Cancel Enrollment

§         057 – Court Ordered – Must Elect Family Coverage

Payroll/Personnel Procedures

The EPIC, PACT, and PINE procedures which are available online at the NFC Web site, are being updated to include the information in this bulletin. The Latest Update Information section at the beginning of each procedure will provide a summary of the update. To view and/or print these procedures, go to the NFC home page (www.nfc.usda.gov) and click the Pub & Forms icon. At the Pub & Forms page left-hand menu, click List by Title/Chapter and search for the appropriate chapter on the list provided. If you prefer a printed copy and are unable to print from the Web, you can request a printed copy by submitting Form AD-1083, Request for Action for Procedures/Reports, to the address or fax number printed on the form.

Inquiries

For questions about policy/regulations, contact your Agriculture Payroll/Personnel User Group (AGPUG) representative or Committee for Agriculture Payroll/Personnel System (CAPPS) representative. Please refer questions about NFC processing to the Payroll Operations Branch at 504-255-4630. Refer questions about this bulletin to the Directives And Analysis Branch at 504-255-5322 or nfc.pvct@usda.gov.


RODERICK KEITH, Director
Government Employees Services Division