5 U.S.C. § 8905a : US Code - Section 8905A: Continued coverage

Search 5 U.S.C. § 8905a : US Code - Section 8905A: Continued coverage

(a) Any individual described in subsection (b) may elect to
continue coverage under this chapter in accordance with the
provisions of this section.
(b) This section applies with respect to - 
(1) any employee who - 
(A) 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
(B) 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);
(2) any individual who - 
(A) ceases to meet the requirements for being considered an
unmarried dependent child under this chapter;
(B) 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
(C) 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
(3) any employee who - 
(A) is enrolled in a health benefits plan under this chapter;
(B) is a member of a reserve component of the armed forces;
(C) is called or ordered to active duty in support of a
contingency operation (as defined in section 101(a)(13) of
title 10);
(D) is placed on leave without pay or separated from service
to perform active duty; and
(E) serves on active duty for a period of more than 30
consecutive days.
(c)(1) The Office shall prescribe regulations and provide for the
inclusion of appropriate terms in contracts with carriers to
provide that - 
(A) 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
(B) 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 - 
(i) 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) - 
(I) to the employee's employing agency; or
(II) in the case of an annuitant, to the Office; and
(ii) 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.
(2) 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 - 
(A) 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 - 
(i) the effective date of the separation; or
(ii) the date the separated individual receives the notice
required under paragraph (1)(A); or
(B) 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 - 
(i) the date as of which such individual first ceases to meet
the requirements for being considered an unmarried dependent
child; or
(ii) 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.
(d)(1)(A) Except as provided in paragraphs (4) and (5), 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 - 
(i) 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
(ii) 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).
(B) Payments under this section to the Fund shall - 
(i) 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
(ii) 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 - 
(I) 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
(II) 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.
(2) 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.
(3)(A) 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 and family.
(B) 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.
(C) Nothing in this paragraph shall be considered to limit an
individual making an election under subsection (c)(2)(A) to
coverage for self alone.
(4)(A) 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 - 
(i) the individual shall be liable for not more than the
employee contributions referred to in paragraph (1)(A)(i); and
(ii) the agency which last employed the individual shall pay
the remaining portion of the amount required under paragraph
(1)(A).
(B) 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 - 
(i) October 1, 2010; or
(ii) February 1, 2011, if specific notice of such separation
was given to such individual before October 1, 2010.
(C) 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.
(5)(A) 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 4421 of the Atomic Energy Defense
Act - 
(i) the individual shall be liable for not more than the
employee contributions referred to in paragraph (1)(A)(i); and
(ii) the agency which last employed the individual shall pay
the remaining portion of the amount required under paragraph
(1)(A).
(B) 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.
(e)(1) Continued coverage under this section may not extend
beyond - 
(A) 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;
(B) 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
(C) 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.
(2) In the case of an individual who - 
(A) ceases to meet the requirements for being considered an
unmarried dependent child;
(B) 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
(C) 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).
(f)(1) 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 - 
(A) to any individual who - 
(i) 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
(ii) would not, but for this subsection, be eligible to be so
considered; and
(B) to any individual whose coverage as a family member would
otherwise terminate as a result of a legal separation.
(2) The terms and conditions for coverage under the regulations
shall include - 
(A) consistent with subsection (c), any necessary notification
provisions, and provisions under which an election period of at
least 60 days' duration is afforded;
(B) 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;
(C) 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
(D) 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.
(3) In the case of an individual - 
(A) 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 for self and family based
on such person's separation from service; and
(B) 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).