USPS: ELM Revision – Federal Employees Health Benefits Program (fehb)
Effective October 16, 2014, the Postal Service™ is revising the Employee and Labor Relations Manual (ELM), subchapter 520, Health Benefits Program, to update policy and procedures in accordance with Office of Personnel Management regulations and the Patient Protection and Affordable Care Act as follows:
521.1 — Revised to update Reference Note.
521.2 — Revised to update Reference Note and to reflect changes in noncareer employees’ titles.
521.4 — Revised to update Reference Note and to reflect changes to Federal Employees Health Benefits (FEHB) policy in accordance with the Affordable Care Act, covering Children until Age 26. Includes policy change concerning eligible same-sex spouses and qualified step-children of same-sex domestic partners who live in states that do not allow same-sex marriage. Updates FEHB Certification for Foster Child to include coverage for Federal Employees’ Group Life Insurance Program, and Federal Employees’ Dental and Vision Insurance Program. Changes references to “employing office” to Human Resources Shared Service Center or HRSSC.
521.6 — Revised to update Reference Note and to align ELM guidance with OPM’s requirements that allow former spouses to enroll in FEHB, and to correct the address to which former spouses should mail their requests for determination. In addition, changes references to “employing office” to Human Resources Shared Service Center or HRSSC.
521.7 — Revised to update Reference Note and to change the age of eligible dependent children from 22 to 26 years of age and “employing office” references to Human Resources Shared Service Center or HRSSC.
522 — Revised to update Reference Note and plan descriptions and to add description of High Deductible and Consumer-Driven Health Plans.
523 — Title was revised from Registration to Election Procedures to reflect OPM’s FEHB Handbook language.
523.2, 523.33 and 523.342 — Updated in accordance with current processes. References to “employing office” were changed to Human Resources Shared Service Center or HRSSC.
523.6 — Revised to replace “employing office” or “personnel office” with Human Resources Shared Service Center or HRSSC, and to change the age for which a child’s disability must be documented from age 22 to age 26.
524 — Revised to:
- Update Dual Enrollment policy in accordance with regulation changes in dependent eligibility.
- Change employing office to Human Resources Shared Service Center and HRSSC.
- Include a direct link under the Table of Permissible Changes in FEHB Enrollment and Pre-Tax/After-Tax Premium Payment on OPM’s website.
- Align with OPM’s FEHB Handbook policy concerning change in marital status.
- Update policy concerning Change in Family Status, and changing reference to dependents from age 22 to age 26.
- Delete ELM 524.537, Employee Reaches Age 19, as it is no longer applicable and has been deleted from OPM’s FEHB Handbook.
- Clarify implications of pre-tax payment of FEHB premiums.
- Update APWU and NALC noncareer employees’ titles.
- Provide a direct link to FEHB Handbook for employees who need guidance concerning Spouse Equity and TCC enrollment for former spouses.
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Here are a few excerpts of the changes:
521.2 Eligible Employees
[Revise the text of 521.2 Reference Note and 521.2a and g to read as follows:]
a. Officers in charge, except “off-the-street” officers in charge, as noted in 521.3a.
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g. Noncareer employees (such as, Substitute Rural Carriers, Rural Carrier Associates, Postmaster Leave Replacements, Postal Support Employees, City Carrier Assistants, and Mail Handler Assistants) who meet the following criteria:
(1) Have completed 1 year of continuous employment, disregarding breaks in service of 5 days or less.
(2) Have a predetermined tour of duty.
(3) Have sufficient earnings to cover mandatory withholdings and premium deductions.
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521.4 Family Member Eligibility
[Revise the text of 521.4 Reference Note to read as follows:]
521.412 Family Members Eligible
[Revise the text of 521.412 to read as follows:]
The employee’s spouse, including a spouse in a valid common-law marriage, and children under age 26, including legally adopted children, recognized natural (born out of wedlock) children and stepchildren, are eligible for coverage. A child is eligible for coverage under an employee’s Self and Family enrollment, if a state-issued birth certificate lists the employee as a parent of that child.
A child over age 26 who is incapable of self-support because of mental or physical incapacity that existed before the child’s 26th birthday is eligible if the incapacity is established as explained in 526.
Foster Children are included if they meet the requirements listed below:
a. The child must be under age 26 (if the child is age 26 or over, he/she must be incapable of self-support);
b. The child must currently live with the employee;
c. The parent-child relationship must be with the employee, not the child’s biological parent;
d. The employee must currently be the primary source of financial support for the child; and
e. The employee must expect to raise the child to adulthood.
Note: Effective June 26, 2013, legally married same-sex spouses became eligible family members under a Self and Family enrollment. Coverage is available to any legally married same-sex spouse regardless of the employee’s state of residency. In addition, the children of same-sex marriages will be treated in the same manner as those of opposite-sex marriages and will be eligible family members according to the same eligibility guidelines. This includes coverage for children of same-sex spouses as stepchildren.
In accordance with Office of Personnel Management regulations dated October 30, 2013, qualified stepchildren of same-sex domestic partners are eligible family members effective January 1, 2014. This is only applicable to employees living in states that do not allow same-sex marriage.
521.42 Determining Family Membership Status of Children
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521.422 Stepchildren
[Revise the text of 521.422 to read as follows:]
If not contrary to state law, an employee’s spouse’s legitimate or adopted child, or natural child, is considered to be the employee’s stepchild. However, a stepchild by a previous marriage of the employee’s spouse is not the employee’s stepchild.
An employee’s stepchild remains a stepchild and an eligible family member after the employee’s divorce from, or the death of, the natural parent, provided that the stepchild continues to live with the employee in a regular parent-child relationship. If the stepchild stops living with the employee in a regular parent-child relationship, the child is eligible for coverage under Temporary Continuation of Coverage (TCC) provisions because he/she no longer meets the definition of an eligible child.
If the employee divorces and the former spouse is eligible to enroll under either the Spouse Equity or TCC provisions, only the natural or adopted children of both the employee and the former spouse are covered under the former spouse’s Self and Family enrollment. An employee’s stepchildren are not covered even though they may have been covered previously by the employee’s Self and Family enrollment. However, they may qualify for a TCC enrollment of their own.
521.423 Foster Children
[Revise the text of 521.423 first paragraph and 521.423a to read as follows:]
To be considered a foster child for health benefits purposes, the child must be under age 26, the child must be incapable of self-support, if the child is age 26 or over, the child must live with the employee in a regular parent-child relationship, and the employee must be rearing the child as his or her own. The employee need not be related to the child nor have taken steps to legally adopt the child, but there must be an expectation that the employee will continue to rear the child into adulthood.
a. The employee must currently be the primary source of financial support for the child. However, a foster parent-child relationship between the child and an employee may exist even though the child receives support from other than the employee (e.g., Social Security payments, support payments from a parent, etc.).
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521.424 Child’s Temporary Absence on “Living-With” Requirement
[Revise the text of 521.424 to read as follows:]
Periods of temporary absence while attending school or for other reasons do not affect the family member status of foster children otherwise considered to be living with the employee in a regular parent-child relationship. Also, an employee’s foster child, who lives with the employee at least 6 months a year under a court order directing shared custody may be considered living with the employee in a regular parent-child relationship.
521.425 Effect of Child’s Marriage on Family Member Status
[Revise the text of 521.425 to read as follows:]
An employee’s married child is covered under the employee’s Self and Family enrollment until the child reaches age 26. The child’s spouse and/or children are not covered and dual enrollment is prohibited.
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521.6 Former Spouses.
521.61 Eligibility Determination
521.611 Requirements
[Revise the text of 521.611 to read as follows:]
Former spouses of employees are eligible to enroll for health benefits coverage under the Federal Employees Health Benefits (FEHB) Program if they meet all of the following requirements:
a. Based on a qualifying court order or divorce decree, the OPM has granted the former spouse a portion of the employee’s annuity or a survivor benefit.
b. The former spouse, if under the age of 55, has not remarried.
c. The former spouse was covered as a family member in an FEHB plan at any time during the 18 months before the date of the dissolution of marriage.
d. The application for coverage is filed within 60 days after:
(1) The marriage is dissolved;
(2) The date of OPM’s notice to the former spouse of his/her eligibility to enroll based on a qualifying court order awarding entitlement to a portion of the employee’s future annuity; or
(3) The date of the notice of the former spouse’s eligibility to enroll based on entitlement to a former spouse’s annuity under another retirement system for government employees.
If the application is mailed, the postmark is used in determining the 60-day time limit.
Reference Note:
For more material on the information see:
Office of Personnel Management’s Federal Employees Health Benefits Program Handbook at http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=FEHB-Handbook.
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