5 U.S.C. § 8905 : US Code - Section 8905: Election of coverage

Search 5 U.S.C. § 8905 : US Code - Section 8905: Election of coverage

(a) An employee may enroll in an approved health benefits plan
described by section 8903 or 8903a of this title either as an
individual or for self and family.
(b) An annuitant who at the time he becomes an annuitant was
enrolled in a health benefits plan under this chapter - 
(1) as an employee for a period of not less than - 
(A) the 5 years of service immediately before retirement;
(B) the full period or periods of service between the last
day of the first period, as prescribed by regulations of the
Office of Personnel Management, in which he is eligible to
enroll in the plan and the date on which he becomes an
annuitant; or
(C) the full period or periods of service beginning with the
enrollment which became effective before January 1, 1965, and
ending with the date on which he becomes an annuitant;
whichever is shortest; or
(2) as a member of the family of an employee or annuitant;
may continue his enrollment under the conditions of eligibility
prescribed by regulations of the Office. The Office may, in its
sole discretion, waive the requirements of this subsection in the
case of an individual who fails to satisfy such requirements if the
Office determines that, due to exceptional circumstances, it would
be against equity and good conscience not to allow such individual
to be enrolled as an annuitant in a health benefits plan under this
chapter (!1)
(c)(1) A former spouse may - 
(A) within 60 days after the dissolution of the marriage, or
(B) in the case of a former spouse of a former employee whose
marriage was dissolved after the employee's retirement, within 60
days after the dissolution of the marriage or, if later, within
60 days after an election is made under section 8339(j)(3) or
8417(b) of this title for such former spouse by the retired
employee,
enroll in an approved health benefits plan described by section
8903 or 8903a of this title as an individual or for self and family
as provided in paragraph (2) of this subsection, subject to
agreement to pay the full subscription charge of the enrollment,
including the amounts determined by the Office to be necessary for
administration and reserves pursuant to section 8909(b) of this
title. The former spouse shall submit an enrollment application and
make premium payments to the agency which, at the time of divorce
or annulment, employed the employee to whom the former spouse was
married or, in the case of a former spouse who is receiving annuity
payments under section 8341(h), 8345(j), 8445, or 8467 of this
title, to the Office of Personnel Management.
(2) Coverage for self and family under this subsection shall be
limited to - 
(A) the former spouse; and
(B) unmarried dependent natural or adopted children of the
former spouse and the employee who are - 
(i) under 22 years of age; or
(ii) incapable of self-support because of mental or physical
disability which existed before age 22.
(d) An individual whom the Secretary of Defense determines is an
eligible beneficiary under subsection (b) of section 1108 of title
10 may enroll, as part of the demonstration project under such
section, in a health benefits plan under this chapter in accordance
with the agreement under subsection (a) of such section between the
Secretary and the Office and applicable regulations under this
chapter.
(e) If an employee, annuitant, or other individual eligible to
enroll in a health benefits plan under this chapter has a spouse
who is also eligible to enroll, either spouse, but not both, may
enroll for self and family, or each spouse may enroll as an
individual. However, an individual may not be enrolled both as an
employee, annuitant, or other individual eligible to enroll and as
a member of the family.
(f) An employee, annuitant, former spouse, or person having
continued coverage under section 8905a of this title enrolled in a
health benefits plan under this chapter may change his coverage or
that of himself and members of his family by an application filed
within 60 days after a change in family status or at other times
and under conditions prescribed by regulations of the Office.
(g)(1) Under regulations prescribed by the Office, the Office
shall, before the start of any contract term in which - 
(A) an adjustment is made in any of the rates charged or
benefits provided under a health benefits plan described by
section 8903 or 8903a of this title,
(B) a newly approved health benefits plan is offered, or
(C) an existing plan is terminated,
provide a period of not less than 3 weeks during which any
employee, annuitant, former spouse, or person having continued
coverage under section 8905a of this title enrolled in a health
benefits plan described by such section shall be permitted to
transfer that individual's enrollment to another such plan or to
cancel such enrollment.
(2) In addition to any opportunity afforded under paragraph (1)
of this subsection, an employee, annuitant, former spouse, or
person having continued coverage under section 8905a of this title
enrolled in a health benefits plan under this chapter shall be
permitted to transfer that individual's enrollment to another such
plan, or to cancel such enrollment, at such other times and subject
to such conditions as the Office may prescribe in regulations.
(3)(A) In addition to any informational requirements otherwise
applicable under this chapter, the regulations shall include
provisions to ensure that each employee eligible to enroll in a
health benefits plan under this chapter (whether actually enrolled
or not) is notified in writing as to the rights afforded under
section 8905a of this title.
(B) Notification under this paragraph shall be provided by
employing agencies at an appropriate point in time before each
period under paragraph (1) so that employees may be aware of their
rights under section 8905a of this title when making enrollment
decisions during such period.
(h)(1) An unenrolled employee who is required by a court or
administrative order to provide health insurance coverage for a
child who meets the requirements of section 8901(5) may enroll for
self and family coverage in a health benefits plan under this
chapter. If such employee fails to enroll for self and family
coverage in a health benefits plan that provides full benefits and
services in the location in which the child resides, and the
employee does not provide documentation showing that such coverage
has been provided through other health insurance, the employing
agency shall enroll the employee in a self and family enrollment in
the option which provides the lower level of coverage under the
Service Benefit Plan.
(2) An employee who is enrolled as an individual in a health
benefits plan under this chapter and who is required by a court or
administrative order to provide health insurance coverage for a
child who meets the requirements of section 8901(5) may change to a
self and family enrollment in the same or another health benefits
plan under this chapter. If such employee fails to change to a self
and family enrollment and the employee does not provide
documentation showing that such coverage has been provided through
other health insurance, the employing agency shall change the
enrollment of the employee to a self and family enrollment in the
plan in which the employee is enrolled if that plan provides full
benefits and services in the location where the child resides. If
the plan in which the employee is enrolled does not provide full
benefits and services in the location in which the child resides,
or, if the employee fails to change to a self and family enrollment
in a plan that provides full benefits and services in the location
where the child resides, the employing agency shall change the
coverage of the employee to a self and family enrollment in the
option which provides the lower level of coverage under the Service
Benefits Plan.
(3) The employee may not discontinue the self and family
enrollment in a plan that provides full benefits and services in
the location in which the child resides for so long as the court or
administrative order remains in effect and the child continues to
meet the requirements of section 8901(5), unless the employee
provides documentation showing that such coverage has been provided
through other health insurance.