81_FR_87133 81 FR 86902 - Federal Employees Health Benefits Program: Removal of Ineligible Individuals From Existing Enrollments

81 FR 86902 - Federal Employees Health Benefits Program: Removal of Ineligible Individuals From Existing Enrollments

OFFICE OF PERSONNEL MANAGEMENT

Federal Register Volume 81, Issue 231 (December 1, 2016)

Page Range86902-86904
FR Document2016-28788

The United States Office of Personnel Management (OPM) is issuing a notice of proposed rulemaking to amend Federal Employees Health Benefits (FEHB) Program regulations to provide a process for removal from FEHB enrollments of certain identified individuals who are found not to be eligible as family members. This process would apply to individuals for whom there is a failure to provide adequate documentation of eligibility when requested.

Federal Register, Volume 81 Issue 231 (Thursday, December 1, 2016)
[Federal Register Volume 81, Number 231 (Thursday, December 1, 2016)]
[Proposed Rules]
[Pages 86902-86904]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-28788]



[[Page 86901]]

Vol. 81

Thursday,

No. 231

December 1, 2016

Part IV





 Office of Personnel Management





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5 CFR Part 890





 Federal Employees Health Benefits Program: Removal of Ineligible 
Individuals From Existing Enrollments; Proposed Rule

Federal Register / Vol. 81 , No. 231 / Thursday, December 1, 2016 / 
Proposed Rules

[[Page 86902]]


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OFFICE OF PERSONNEL MANAGEMENT

5 CFR Part 890

RIN 3206-AN09


Federal Employees Health Benefits Program: Removal of Ineligible 
Individuals From Existing Enrollments

AGENCY: Office of Personnel Management.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: The United States Office of Personnel Management (OPM) is 
issuing a notice of proposed rulemaking to amend Federal Employees 
Health Benefits (FEHB) Program regulations to provide a process for 
removal from FEHB enrollments of certain identified individuals who are 
found not to be eligible as family members. This process would apply to 
individuals for whom there is a failure to provide adequate 
documentation of eligibility when requested.

DATES: Comments are due on or before January 30, 2017.

ADDRESSES: Send written comments to Padma Shah, Senior Policy Analyst, 
Planning and Policy Analysis, U.S. Office of Personnel Management, Room 
4312, 1900 E Street NW., Washington, DC; or FAX to (202) 606-0004 Attn: 
Padma Shah. You may also submit comments using the Federal eRulemaking 
Portal: http://www.regulations.gov. Follow the instructions for 
submitting comments.

FOR FURTHER INFORMATION CONTACT: Padma Shah at (202) 606-0004.

SUPPLEMENTARY INFORMATION: OPM is proposing to amend the Federal 
Employees Health Benefits (FEHB) Program regulations to (1) provide 
that proof of family member eligibility may be required for coverage 
under an FEHB Program self plus one or self and family enrollment and 
(2) to establish the circumstances under which individuals covered 
under an existing self plus one or self and family FEHB enrollment will 
be removed from such enrollment and the processes for removal, where 
the enrollee does not provide adequate documentation of eligibility. 
Currently, under Sec.  890.302 of title 5, all eligible family members 
are covered under a self and family enrollment. A family member's 
coverage terminates, subject to a temporary extension of coverage, on 
the day he or she ceases to be an eligible family member, as provided 
by Sec.  890.304. For example, if an enrollee's child reaches age 26, 
coverage terminates. Currently, the regulations do not address the 
removal of an erroneously-covered ineligible individual from an 
existing self plus one or self and family enrollment.
    The proposed regulation amends Sec.  890.302 to provide that proof 
of family member eligibility must be provided upon request by a 
carrier, employing office, or OPM. OPM plans to provide further 
guidance on requirements for proof of family member eligibility through 
sub-regulatory guidance, including Benefits Administration Letters and 
Carrier Letters.
    The proposed regulation also updates Sec.  890.308 of title 5 to 
provide processes for removal of individuals who are determined to be 
ineligible as family members. This change reflects OPM's enhanced 
effort to ensure that individuals covered under existing FEHB 
enrollments meet legal and regulatory eligibility requirements.
    The proposed process for removal of erroneously-covered ineligible 
family members from an existing enrollment is modeled on the process 
for removal of ineligible enrollees in Sec.  890.308(a). The proposed 
regulation allows the removal to be initiated by the FEHB insurance 
carrier that operates the enrollee's plan, OPM as administrator of the 
FEHB Program, or the enrollee's employing office. If an enrollee 
disagrees with an initial determination of ineligibility, the enrollee 
may request reconsideration and submit appropriate documentation of 
eligibility to either the employing office or OPM depending on the 
circumstances.
    In the case of a carrier-initiated removal, an enrollee's 
reconsideration request must be filed with the enrollee's employing 
office. The proposed rule provides that the employing office shall 
provide notice to the carrier that the enrollee is seeking 
reconsideration of the carrier's initial determination.
    The proposed regulation provides that if OPM, the employing office, 
or the carrier, as applicable, finds the documentation to establish 
eligibility, the individual will continue to be covered as a family 
member under the enrollment without a gap in coverage, as appropriate. 
The proposed regulation provides that appropriate documentation of an 
enrollment includes, but is not limited to, copies of birth 
certificates, marriage certificates and, if applicable, other proof 
such as that the individual lives with and is supported by the 
enrollee. OPM plans to provide more specific information on what 
constitutes adequate documentation in forthcoming sub-regulatory 
guidance. OPM solicits comments on what may constitute appropriate 
documentation of family member eligibility.
    If the enrollee does not submit appropriate documentation within 
the required timeframe, or the documentation is determined to be 
inadequate to establish eligibility, the removal of the family member 
will be prospective with limited exceptions. The proposed regulation 
provides that in the case of fraud or intentional misrepresentation of 
material fact on the part of the enrollee as prohibited by the terms of 
the FEHB plan, removals may be retroactive to the date of 
ineligibility.
    The regulation also provides that temporary extension of coverage 
and conversion and temporary continuation of coverage will be 
administered in accordance with Sec.  890.401 and Subparts H and K of 
this part and that any eligibility under these regulations will not 
extend beyond the date the entitlement would have ended if the 
individual had been removed on the date of loss of eligibility. 
Subparts H and K state that family members have 60 days from the date 
of the event causing the loss of coverage to enroll. Those timeframe 
are applicable to individuals who are removed from an enrollment under 
this regulation.
    The regulation also provides that if acceptable proof of 
eligibility of an individual removed under this regulation is 
subsequently provided and a family member is found to have been 
eligible, coverage will be reinstated retroactively so that there is no 
gap in coverage, as appropriate.
    Regulatory Impact Analysis: OPM has examined the impact of this 
proposed rule as required by Executive Order 12866 and Executive Order 
13563, which directs agencies to assess all costs and benefits of 
available regulatory alternatives and, if regulation is necessary, to 
select regulatory approaches that maximize net benefits (including 
potential economic, environmental, public, health, and safety effects, 
distributive impacts, and equity). A regulatory impact analysis must be 
prepared for major rules with economically significant effects of $100 
million or more in any 1 year. This rule is not considered a major rule 
because it provides a process for removal of erroneously enrolled 
ineligible and eligible family members from self and family 
enrollments, which we do not estimate to have widespread applicability 
under the FEHB Program.

Regulatory Flexibility Act

    I certify that this regulation will not have a significant economic 
impact on a substantial number of small entities because the regulation 
only affects health insurance benefits of Federal employees and 
annuitants.

[[Page 86903]]

Regulatory Review

    This rule has been reviewed by the Office of Management and Budget 
in accordance with Executive Orders 13563 and 12866.

Federalism

    We have examined this rule in accordance with Executive Order 
13132, Federalism, and have determined that this rule will not have any 
negative impact on the rights, roles, and responsibilities of State, 
local, or Tribal governments.

Paperwork Reduction Act

    The Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35; see 5 
CFR part 1320) requires that the U.S. Office of Management and Budget 
(OMB) approve all collections of information by a Federal agency from 
the public before they can be implemented. Respondents are not required 
to respond to any collection of information unless it displays a 
current valid OMB control number. OPM is not proposing any additional 
collections in this rule.

List of Subjects on 5 CFR Part 890

    Administrative practice and procedure, Government employees, Health 
insurance.

U.S. Office of Personnel Management.
Beth F. Cobert,
Acting Director.

    For the reasons set forth in the preamble, OPM proposes to amend 
part 890 of Title 5 of the Code of Federal Regulations as follows:

PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM

0
1. The authority citation for part 890 continues to read as follows:

    Authority: 5 U.S.C. 8913; Sec. 890.301 also issued under sec. 
311 of Public Law 111-03, 123 Stat. 64; Sec. 890.111 also issued 
under section 1622(b) of Public Law 104-106, 110 Stat. 521; Sec. 
890.112 also issued under section 1 of Public Law 110-279, 122 Stat. 
2604; 5 U.S.C. 8913; Sec. 890.803 also issued under 50 U.S.C. 403p, 
22 U.S.C. 4069c and 4069c-1; subpart L also issued under sec. 599C 
of 101, 104 Stat. 2064, as amended; Sec. 890.102 also issued under 
sections 11202(f), 11232(e), 11246(b) and (c) of Public Law 105-33, 
111 Stat. 251; and section 721 of Public Law 105-261, 112 Stat. 
2061; Public Law 111-148, as amended by Public Law 111-152.

0
2. In Sec.  890.302 revise paragraph (a)(1) to read as follows:


Sec.  890.302   Coverage of family members.

    (a)(1) An enrollment for self plus one includes the enrollee and 
one eligible family member. An enrollment for self and family includes 
all family members who are eligible to be covered by the enrollment. 
Proof of family member eligibility may be required, and must be 
provided upon request, to the carrier, the employing office or OPM. 
Except as provided in paragraph (a)(2) of this section, no employee, 
former employee, annuitant, child or former spouse may enroll or be 
covered as a family member if he or she is already covered under 
another person's self plus one or self and family enrollment in the 
FEHB Program.
* * * * *
0
3. Amend Sec.  890.308 by revising the section heading, adding headings 
to paragraphs (a), (b), (c), (d) and adding paragraphs (e), (f), and 
(g) to read as follows:


Sec.  890.308   Disenrollment and removal from enrollment.

    (a) Carrier Disenrollment: Enrollment Reconciliation. * * *
* * * * *
    (b) Carrier Disenrollment: Death of Enrollee. * * *
* * * * *
    (c) Carrier Disenrollment: Child Survivor Annuitant. * * *
* * * * *
    (d) Carrier Disenrollment: Separation from Federal Employment. * * 
*
* * * * *
    (e) Carrier Removal from Enrollment: Family Members (1) A carrier 
may request verification from the enrollee at any time of eligibility 
of an individual who is covered as a family member of the enrollee in 
accordance with Sec.  890.302. To verify eligibility, the carrier shall 
send the enrollee a request for appropriate documentation of the 
individual's relationship to the enrollee with a copy to the enrollee's 
employing office. The request shall contain a written notice that the 
individual will no longer be covered 60 calendar days after the date of 
the notice unless the enrollee or the employing office provides 
appropriate documentation as requested. If the carrier does not receive 
the requested documentation within the specified time frame or if based 
on the documentation provided the individual is found not to be 
eligible, written notice of removal must be sent to the enrollee, with 
a copy to the employing office, including an explanation of the process 
for seeking reconsideration. The time limit may be extended when the 
enrollee shows that he or she is prevented by circumstances beyond his 
or her control from providing timely documentation.
    (2) Appropriate documentation includes, but is not limited to, 
copies of birth certificates, marriage certificates, and, if 
applicable, other proof including that the individual lives with the 
enrollee and the enrollee is the individual's primary source of 
financial support.
    (3) The effective date of a removal shall be prospective unless the 
record shows that the enrollee or the individual has committed fraud or 
made an intentional misrepresentation of material fact as prohibited by 
the terms of the plan.
    (4) A request for reconsideration of the carrier's initial decision 
must be filed with the enrollee's employing office within 60 calendar 
days after the date of the initial decision. The employing office must 
notify the carrier when a request for reconsideration of the decision 
to remove the individual from the enrollment is made. The time limit 
for filing may be extended when the enrollee shows that he or she was 
not notified of the time limit and was not otherwise aware of it, or 
that he or she was prevented by circumstances beyond his or her control 
from making the request within the time limit. The request for 
reconsideration must be made in writing and must include the enrollee's 
name, address, Social Security Number or other personal identification 
number, the family member's name, the name of carrier, reason(s) for 
the request, and, if applicable, retirement claim number.
    (5) The employing office must issue a written notice of its final 
decision to the enrollee, and notify the carrier of the decision, 
within 30 days of receipt of the request for reconsideration. The 
notice must fully set forth the findings and conclusions on which the 
decision was based.
    (6) If an enrollee or individual provides acceptable proof of 
eligibility of an individual subsequent to removal, coverage under the 
enrollment shall be reinstated retroactively so that there is no gap in 
coverage, as appropriate.
    (f) Employing Office and OPM. (1) An enrollee's employing office or 
OPM may request verification of eligibility from the enrollee of an 
individual who is covered as a family member of the enrollee in 
accordance with Sec.  890.302 at any time. To verify eligibility, the 
employing office or OPM shall send a request for appropriate 
documentation of the individual's status to the enrollee. The request 
shall contain a written notice that the individual will no longer be 
covered 60 calendar days after the date of the notice unless the 
enrollee provides appropriate documentation as requested. If the 
employing office or OPM does not receive the requested documentation 
within the specified

[[Page 86904]]

time frame, or if based on the documentation provided the individual is 
found not to be eligible, the employing office or OPM shall direct the 
carrier to remove the individual from the enrollment and the employing 
office or OPM shall provide written notice to the enrollee including an 
explanation of the process for seeking reconsideration. The time limit 
may be extended when the enrollee shows that he or she is prevented by 
circumstances beyond his or her control from providing timely 
documentation.
    (2) Appropriate documentation includes, but is not limited to, 
copies of birth certificates, marriage certificates, and, if 
applicable, other proof including that the individual lives with the 
enrollee and that the enrollee is the individual's primary source of 
financial support.
    (3) The effective date of the removal shall be prospective unless 
the record shows that the enrollee or the individual has committed 
fraud or made an intentional misrepresentation of material fact as 
prohibited by the terms of the plan.
    (4) The enrollee may request reconsideration of an employing office 
or OPM's decision to remove the individual from the enrollment within 
60 days of the initial decision. The enrollee may request 
reconsideration of an employing office decision to the employing office 
or an OPM decision to OPM. The employing office or OPM must notify the 
carrier when a request for reconsideration of the decision to remove 
the individual from the enrollment is made. The time limit for filing 
may be extended when the enrollee shows that he or she was not notified 
of the time limit and was not otherwise aware of it, or that he or she 
was prevented by circumstances beyond his or her control from making 
the request within the time limit. The request for reconsideration must 
be made in writing and must include the enrollee's name, address, 
Social Security Number or other personal identification number, the 
family member's name, the name of carrier, reason(s) for the request, 
and, if applicable, retirement claim number. The employing office or 
OPM must notify the carrier when a request for reconsideration of the 
decision to remove the individual from the enrollment is made.
    (5) The employing office or OPM must issue a written notice of its 
final decision to the enrollee, and notify the carrier of the decision, 
within 30 days of receipt of the request for reconsideration. The 
notice must fully set forth the findings and conclusions on which the 
decision was based.
    (6) If an enrollee or family member provides acceptable proof of 
eligibility of an individual subsequent to removal, coverage under the 
enrollment shall be reinstated retroactively so that there is no gap in 
coverage, as appropriate.
    (g) If an individual is removed from an enrollment pursuant to 
paragraph (e) or (f) of this section, the individual may be eligible 
for a 31-day temporary extension of coverage, conversion and/or 
temporary continuation of coverage in accordance with Sec.  890.401 and 
subparts H and K of this part. Any entitlement to coverage under Sec.  
890.401 and subparts H and K shall not extend beyond the date that 
entitlement would have ended if the individual had been removed on the 
date of loss of eligibility.

[FR Doc. 2016-28788 Filed 11-30-16; 8:45 am]
BILLING CODE 6325-63-P



                                                     86902                Federal Register / Vol. 81, No. 231 / Thursday, December 1, 2016 / Proposed Rules

                                                     OFFICE OF PERSONNEL                                     erroneously-covered ineligible                           If the enrollee does not submit
                                                     MANAGEMENT                                              individual from an existing self plus one             appropriate documentation within the
                                                                                                             or self and family enrollment.                        required timeframe, or the
                                                     5 CFR Part 890                                             The proposed regulation amends                     documentation is determined to be
                                                                                                             § 890.302 to provide that proof of family             inadequate to establish eligibility, the
                                                     RIN 3206–AN09
                                                                                                             member eligibility must be provided                   removal of the family member will be
                                                     Federal Employees Health Benefits                       upon request by a carrier, employing                  prospective with limited exceptions.
                                                     Program: Removal of Ineligible                          office, or OPM. OPM plans to provide                  The proposed regulation provides that
                                                     Individuals From Existing Enrollments                   further guidance on requirements for                  in the case of fraud or intentional
                                                                                                             proof of family member eligibility                    misrepresentation of material fact on the
                                                     AGENCY:  Office of Personnel                            through sub-regulatory guidance,                      part of the enrollee as prohibited by the
                                                     Management.                                             including Benefits Administration                     terms of the FEHB plan, removals may
                                                     ACTION: Proposed rule.                                  Letters and Carrier Letters.                          be retroactive to the date of ineligibility.
                                                                                                                The proposed regulation also updates                  The regulation also provides that
                                                     SUMMARY:    The United States Office of                 § 890.308 of title 5 to provide processes             temporary extension of coverage and
                                                     Personnel Management (OPM) is issuing                   for removal of individuals who are                    conversion and temporary continuation
                                                     a notice of proposed rulemaking to                      determined to be ineligible as family                 of coverage will be administered in
                                                     amend Federal Employees Health                          members. This change reflects OPM’s                   accordance with § 890.401 and Subparts
                                                     Benefits (FEHB) Program regulations to                  enhanced effort to ensure that                        H and K of this part and that any
                                                     provide a process for removal from                      individuals covered under existing                    eligibility under these regulations will
                                                     FEHB enrollments of certain identified                  FEHB enrollments meet legal and                       not extend beyond the date the
                                                     individuals who are found not to be                     regulatory eligibility requirements.                  entitlement would have ended if the
                                                     eligible as family members. This process                   The proposed process for removal of                individual had been removed on the
                                                     would apply to individuals for whom                     erroneously-covered ineligible family                 date of loss of eligibility. Subparts H
                                                     there is a failure to provide adequate                  members from an existing enrollment is                and K state that family members have 60
                                                     documentation of eligibility when                       modeled on the process for removal of                 days from the date of the event causing
                                                     requested.                                              ineligible enrollees in § 890.308(a). The             the loss of coverage to enroll. Those
                                                     DATES: Comments are due on or before                    proposed regulation allows the removal                timeframe are applicable to individuals
                                                     January 30, 2017.                                       to be initiated by the FEHB insurance                 who are removed from an enrollment
                                                     ADDRESSES: Send written comments to
                                                                                                             carrier that operates the enrollee’s plan,            under this regulation.
                                                     Padma Shah, Senior Policy Analyst,                      OPM as administrator of the FEHB                         The regulation also provides that if
                                                     Planning and Policy Analysis, U.S.                      Program, or the enrollee’s employing                  acceptable proof of eligibility of an
                                                                                                             office. If an enrollee disagrees with an              individual removed under this
                                                     Office of Personnel Management, Room
                                                                                                             initial determination of ineligibility, the           regulation is subsequently provided and
                                                     4312, 1900 E Street NW., Washington,
                                                                                                             enrollee may request reconsideration                  a family member is found to have been
                                                     DC; or FAX to (202) 606–0004 Attn:
                                                                                                             and submit appropriate documentation                  eligible, coverage will be reinstated
                                                     Padma Shah. You may also submit
                                                                                                             of eligibility to either the employing                retroactively so that there is no gap in
                                                     comments using the Federal
                                                                                                             office or OPM depending on the                        coverage, as appropriate.
                                                     eRulemaking Portal: http://
                                                                                                             circumstances.                                           Regulatory Impact Analysis: OPM has
                                                     www.regulations.gov. Follow the                            In the case of a carrier-initiated                 examined the impact of this proposed
                                                     instructions for submitting comments.                   removal, an enrollee’s reconsideration                rule as required by Executive Order
                                                     FOR FURTHER INFORMATION CONTACT:                        request must be filed with the enrollee’s             12866 and Executive Order 13563,
                                                     Padma Shah at (202) 606–0004.                           employing office. The proposed rule                   which directs agencies to assess all costs
                                                     SUPPLEMENTARY INFORMATION: OPM is                       provides that the employing office shall              and benefits of available regulatory
                                                     proposing to amend the Federal                          provide notice to the carrier that the                alternatives and, if regulation is
                                                     Employees Health Benefits (FEHB)                        enrollee is seeking reconsideration of                necessary, to select regulatory
                                                     Program regulations to (1) provide that                 the carrier’s initial determination.                  approaches that maximize net benefits
                                                     proof of family member eligibility may                     The proposed regulation provides that              (including potential economic,
                                                     be required for coverage under an FEHB                  if OPM, the employing office, or the                  environmental, public, health, and
                                                     Program self plus one or self and family                carrier, as applicable, finds the                     safety effects, distributive impacts, and
                                                     enrollment and (2) to establish the                     documentation to establish eligibility,               equity). A regulatory impact analysis
                                                     circumstances under which individuals                   the individual will continue to be                    must be prepared for major rules with
                                                     covered under an existing self plus one                 covered as a family member under the                  economically significant effects of $100
                                                     or self and family FEHB enrollment will                 enrollment without a gap in coverage, as              million or more in any 1 year. This rule
                                                     be removed from such enrollment and                     appropriate. The proposed regulation                  is not considered a major rule because
                                                     the processes for removal, where the                    provides that appropriate                             it provides a process for removal of
                                                     enrollee does not provide adequate                      documentation of an enrollment                        erroneously enrolled ineligible and
                                                     documentation of eligibility. Currently,                includes, but is not limited to, copies of            eligible family members from self and
                                                     under § 890.302 of title 5, all eligible                birth certificates, marriage certificates             family enrollments, which we do not
                                                     family members are covered under a self                 and, if applicable, other proof such as               estimate to have widespread
mstockstill on DSK3G9T082PROD with PROPOSALS3




                                                     and family enrollment. A family                         that the individual lives with and is                 applicability under the FEHB Program.
                                                     member’s coverage terminates, subject                   supported by the enrollee. OPM plans to
                                                     to a temporary extension of coverage, on                provide more specific information on                  Regulatory Flexibility Act
                                                     the day he or she ceases to be an eligible              what constitutes adequate                                I certify that this regulation will not
                                                     family member, as provided by                           documentation in forthcoming sub-                     have a significant economic impact on
                                                     § 890.304. For example, if an enrollee’s                regulatory guidance. OPM solicits                     a substantial number of small entities
                                                     child reaches age 26, coverage                          comments on what may constitute                       because the regulation only affects
                                                     terminates. Currently, the regulations do               appropriate documentation of family                   health insurance benefits of Federal
                                                     not address the removal of an                           member eligibility.                                   employees and annuitants.


                                                VerDate Sep<11>2014   17:16 Nov 30, 2016   Jkt 241001   PO 00000   Frm 00002   Fmt 4701   Sfmt 4702   E:\FR\FM\01DEP3.SGM   01DEP3


                                                                          Federal Register / Vol. 81, No. 231 / Thursday, December 1, 2016 / Proposed Rules                                           86903

                                                     Regulatory Review                                       and family includes all family members                birth certificates, marriage certificates,
                                                       This rule has been reviewed by the                    who are eligible to be covered by the                 and, if applicable, other proof including
                                                     Office of Management and Budget in                      enrollment. Proof of family member                    that the individual lives with the
                                                     accordance with Executive Orders                        eligibility may be required, and must be              enrollee and the enrollee is the
                                                     13563 and 12866.                                        provided upon request, to the carrier,                individual’s primary source of financial
                                                                                                             the employing office or OPM. Except as                support.
                                                     Federalism                                              provided in paragraph (a)(2) of this                     (3) The effective date of a removal
                                                       We have examined this rule in                         section, no employee, former employee,                shall be prospective unless the record
                                                     accordance with Executive Order 13132,                  annuitant, child or former spouse may                 shows that the enrollee or the
                                                     Federalism, and have determined that                    enroll or be covered as a family member               individual has committed fraud or made
                                                     this rule will not have any negative                    if he or she is already covered under                 an intentional misrepresentation of
                                                     impact on the rights, roles, and                        another person’s self plus one or self                material fact as prohibited by the terms
                                                     responsibilities of State, local, or Tribal             and family enrollment in the FEHB                     of the plan.
                                                                                                             Program.                                                 (4) A request for reconsideration of
                                                     governments.
                                                                                                                                                                   the carrier’s initial decision must be
                                                                                                             *     *     *      *     *
                                                     Paperwork Reduction Act                                 ■ 3. Amend § 890.308 by revising the
                                                                                                                                                                   filed with the enrollee’s employing
                                                        The Paperwork Reduction Act of 1995                  section heading, adding headings to                   office within 60 calendar days after the
                                                     (44 U.S.C. chapter 35; see 5 CFR part                   paragraphs (a), (b), (c), (d) and adding              date of the initial decision. The
                                                     1320) requires that the U.S. Office of                  paragraphs (e), (f), and (g) to read as               employing office must notify the carrier
                                                     Management and Budget (OMB)                                                                                   when a request for reconsideration of
                                                                                                             follows:
                                                     approve all collections of information                                                                        the decision to remove the individual
                                                     by a Federal agency from the public                     § 890.308 Disenrollment and removal from              from the enrollment is made. The time
                                                     before they can be implemented.                         enrollment.                                           limit for filing may be extended when
                                                     Respondents are not required to respond                    (a) Carrier Disenrollment: Enrollment              the enrollee shows that he or she was
                                                     to any collection of information unless                 Reconciliation. * * *                                 not notified of the time limit and was
                                                     it displays a current valid OMB control                 *      *     *     *    *                             not otherwise aware of it, or that he or
                                                                                                                (b) Carrier Disenrollment: Death of                she was prevented by circumstances
                                                     number. OPM is not proposing any
                                                                                                             Enrollee. * * *                                       beyond his or her control from making
                                                     additional collections in this rule.
                                                                                                                                                                   the request within the time limit. The
                                                                                                             *      *     *     *    *
                                                     List of Subjects on 5 CFR Part 890                                                                            request for reconsideration must be
                                                                                                                (c) Carrier Disenrollment: Child
                                                       Administrative practice and                                                                                 made in writing and must include the
                                                                                                             Survivor Annuitant. * * *
                                                     procedure, Government employees,                                                                              enrollee’s name, address, Social
                                                                                                             *      *     *     *    *                             Security Number or other personal
                                                     Health insurance.                                          (d) Carrier Disenrollment: Separation              identification number, the family
                                                     U.S. Office of Personnel Management.                    from Federal Employment. * * *                        member’s name, the name of carrier,
                                                     Beth F. Cobert,                                         *      *     *     *    *                             reason(s) for the request, and, if
                                                     Acting Director.                                           (e) Carrier Removal from Enrollment:               applicable, retirement claim number.
                                                                                                             Family Members (1) A carrier may                         (5) The employing office must issue a
                                                       For the reasons set forth in the
                                                                                                             request verification from the enrollee at             written notice of its final decision to the
                                                     preamble, OPM proposes to amend part
                                                                                                             any time of eligibility of an individual              enrollee, and notify the carrier of the
                                                     890 of Title 5 of the Code of Federal
                                                                                                             who is covered as a family member of                  decision, within 30 days of receipt of
                                                     Regulations as follows:
                                                                                                             the enrollee in accordance with                       the request for reconsideration. The
                                                     PART 890—FEDERAL EMPLOYEES                              § 890.302. To verify eligibility, the                 notice must fully set forth the findings
                                                     HEALTH BENEFITS PROGRAM                                 carrier shall send the enrollee a request             and conclusions on which the decision
                                                                                                             for appropriate documentation of the                  was based.
                                                     ■ 1. The authority citation for part 890                individual’s relationship to the enrollee                (6) If an enrollee or individual
                                                     continues to read as follows:                           with a copy to the enrollee’s employing               provides acceptable proof of eligibility
                                                        Authority: 5 U.S.C. 8913; Sec. 890.301 also          office. The request shall contain a                   of an individual subsequent to removal,
                                                     issued under sec. 311 of Public Law 111–03,             written notice that the individual will               coverage under the enrollment shall be
                                                     123 Stat. 64; Sec. 890.111 also issued under            no longer be covered 60 calendar days                 reinstated retroactively so that there is
                                                     section 1622(b) of Public Law 104–106, 110              after the date of the notice unless the               no gap in coverage, as appropriate.
                                                     Stat. 521; Sec. 890.112 also issued under               enrollee or the employing office                         (f) Employing Office and OPM. (1) An
                                                     section 1 of Public Law 110–279, 122 Stat.              provides appropriate documentation as                 enrollee’s employing office or OPM may
                                                     2604; 5 U.S.C. 8913; Sec. 890.803 also issued           requested. If the carrier does not receive            request verification of eligibility from
                                                     under 50 U.S.C. 403p, 22 U.S.C. 4069c and               the requested documentation within the                the enrollee of an individual who is
                                                     4069c–1; subpart L also issued under sec.                                                                     covered as a family member of the
                                                     599C of 101, 104 Stat. 2064, as amended; Sec.
                                                                                                             specified time frame or if based on the
                                                     890.102 also issued under sections 11202(f),            documentation provided the individual                 enrollee in accordance with § 890.302 at
                                                     11232(e), 11246(b) and (c) of Public Law                is found not to be eligible, written                  any time. To verify eligibility, the
                                                     105–33, 111 Stat. 251; and section 721 of               notice of removal must be sent to the                 employing office or OPM shall send a
                                                     Public Law 105–261, 112 Stat. 2061; Public              enrollee, with a copy to the employing                request for appropriate documentation
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                                                     Law 111–148, as amended by Public Law                   office, including an explanation of the               of the individual’s status to the enrollee.
                                                     111–152.                                                process for seeking reconsideration. The              The request shall contain a written
                                                     ■ 2. In § 890.302 revise paragraph (a)(1)               time limit may be extended when the                   notice that the individual will no longer
                                                     to read as follows:                                     enrollee shows that he or she is                      be covered 60 calendar days after the
                                                                                                             prevented by circumstances beyond his                 date of the notice unless the enrollee
                                                     § 890.302   Coverage of family members.                 or her control from providing timely                  provides appropriate documentation as
                                                       (a)(1) An enrollment for self plus one                documentation.                                        requested. If the employing office or
                                                     includes the enrollee and one eligible                     (2) Appropriate documentation                      OPM does not receive the requested
                                                     family member. An enrollment for self                   includes, but is not limited to, copies of            documentation within the specified


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                                                     86904                Federal Register / Vol. 81, No. 231 / Thursday, December 1, 2016 / Proposed Rules

                                                     time frame, or if based on the                          or OPM’s decision to remove the                          (5) The employing office or OPM must
                                                     documentation provided the individual                   individual from the enrollment within                 issue a written notice of its final
                                                     is found not to be eligible, the                        60 days of the initial decision. The                  decision to the enrollee, and notify the
                                                     employing office or OPM shall direct                    enrollee may request reconsideration of               carrier of the decision, within 30 days
                                                     the carrier to remove the individual                    an employing office decision to the                   of receipt of the request for
                                                     from the enrollment and the employing                   employing office or an OPM decision to                reconsideration. The notice must fully
                                                     office or OPM shall provide written                     OPM. The employing office or OPM                      set forth the findings and conclusions
                                                     notice to the enrollee including an                     must notify the carrier when a request                on which the decision was based.
                                                     explanation of the process for seeking                  for reconsideration of the decision to                   (6) If an enrollee or family member
                                                     reconsideration. The time limit may be                  remove the individual from the                        provides acceptable proof of eligibility
                                                     extended when the enrollee shows that                   enrollment is made. The time limit for                of an individual subsequent to removal,
                                                     he or she is prevented by circumstances                 filing may be extended when the                       coverage under the enrollment shall be
                                                     beyond his or her control from                          enrollee shows that he or she was not                 reinstated retroactively so that there is
                                                     providing timely documentation.                         notified of the time limit and was not                no gap in coverage, as appropriate.
                                                        (2) Appropriate documentation                        otherwise aware of it, or that he or she
                                                     includes, but is not limited to, copies of              was prevented by circumstances beyond                    (g) If an individual is removed from
                                                     birth certificates, marriage certificates,              his or her control from making the                    an enrollment pursuant to paragraph (e)
                                                     and, if applicable, other proof including               request within the time limit. The                    or (f) of this section, the individual may
                                                     that the individual lives with the                      request for reconsideration must be                   be eligible for a 31-day temporary
                                                     enrollee and that the enrollee is the                   made in writing and must include the                  extension of coverage, conversion and/
                                                     individual’s primary source of financial                enrollee’s name, address, Social                      or temporary continuation of coverage
                                                     support.                                                Security Number or other personal                     in accordance with § 890.401 and
                                                        (3) The effective date of the removal                identification number, the family                     subparts H and K of this part. Any
                                                     shall be prospective unless the record                  member’s name, the name of carrier,                   entitlement to coverage under § 890.401
                                                     shows that the enrollee or the                          reason(s) for the request, and, if                    and subparts H and K shall not extend
                                                     individual has committed fraud or made                  applicable, retirement claim number.                  beyond the date that entitlement would
                                                     an intentional misrepresentation of                     The employing office or OPM must                      have ended if the individual had been
                                                     material fact as prohibited by the terms                notify the carrier when a request for                 removed on the date of loss of
                                                     of the plan.                                            reconsideration of the decision to                    eligibility.
                                                        (4) The enrollee may request                         remove the individual from the                        [FR Doc. 2016–28788 Filed 11–30–16; 8:45 am]
                                                     reconsideration of an employing office                  enrollment is made.                                   BILLING CODE 6325–63–P
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Document Created: 2018-02-14 09:00:43
Document Modified: 2018-02-14 09:00:43
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionProposed Rules
ActionProposed rule.
DatesComments are due on or before January 30, 2017.
ContactPadma Shah at (202) 606-0004.
FR Citation81 FR 86902 
RIN Number3206-AN09
CFR AssociatedAdministrative Practice and Procedure; Government Employees and Health Insurance

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