- If the discontinuation is at the end of the contract year, the former spouse must change the enrollment during the Open Season, unless OPM sets a different time frame.
- If the discontinuation is at a time other than the end of the contract year, OPM will set the time and effective date for changing the enrollment.
- If the whole plan is discontinued and the former spouse doesn’t change within the set time frame, he/she will be enrolled in the lowest-cost nationwide plan option as determined by OPM.
- If one or more options of a plan are discontinued and the former spouse doesn’t change within the set time frame, he/she is considered to be enrolled in the lowest-cost remaining plan option that is not a high-deductible health plan (HDHP).
Move from an HMO's Service Area
If a former spouse is enrolled in an HMO and moves or becomes employed outside the plan's service area (or, if already outside this area, moves or becomes employed further away), he/she may change the enrollment. If a covered family member moves outside the HMO's service area (or if already outside this area, moves further away), the former spouse may also change the enrollment. The enrollment change is effective on the first day of the pay period beginning after the employing office receives the Health Benefits Election Form (SF 2809) or other enrollment request.
On Becoming Eligible for Medicare
The former spouse may change enrollment from one plan or option to another at any time beginning 30 days before becoming eligible for Medicare coverage. An enrollment change based on becoming eligible for Medicare may be made only once.
Annuity Insufficient to Pay Withholdings
If the former spouse is receiving an annuity and it is insufficient to pay the premiums for his/her health plan, the retirement system will provide him/her with information on lower cost plans and will give him/her the opportunity to either:
- pay premiums directly to the retirement system; or
- enroll in a plan with a premium less than the annuity.
If the former spouse elects a lower-cost plan, the change is effective immediately upon loss of coverage in the prior plan.
If the former spouse is enrolled in the high option of a two-option plan, and doesn’t make one of the elections noted above, the enrollment will be changed to the standard option of the same plan (unless the annuity won't cover the cost of the standard option). If the former spouse is enrolled in a one-option plan, and doesn’t make one of the elections, coverage will be terminated.
Former Spouses with Other FEHB Coverage
If a former spouse is eligible for FEHB coverage, he/she may defer enrolling as a former spouse if he/she is already enrolled in FEHB.
When he/she loses regular coverage under FEHB, he/she may enroll as a former spouse from 31 days before to 60 days after the covering enrollment terminates, as long as he/she meets all the eligibility requirements. The former spouse may enroll in any available plan.
Losing Coverage as an Employee and Enrolling as a Former Spouse
When a former spouse’s enrollment as an employee terminates, his/her current employing office must terminate the enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810) and note the time limits for enrolling as a former spouse with other FEHB coverage. The former spouse then must notify the employing office responsible for his/her Spouse Equity enrollment of his/her intent to enroll as a former spouse. That employing office will verify that he/she is still eligible under Spouse Equity provisions, and if so, enroll him/her based on his/her submission of a Health Benefits Election Form (SF 2809). The employing office will also give the former spouse a certification to sign and date.
The employing office responsible for the Spouse Equity enrollment will note on the SF 2809 that he/she was previously covered as an employee and is enrolling as a former spouse under the same Social Security number. Once Spouse Equity coverage begins, the former spouse must pay both the employee and Government shares of the premium.
If the employing office determines that the former spouse is no longer eligible to enroll under Spouse Equity, it will deny his/her enrollment, explain the right to request reconsideration, and place a copy of the request for enrollment and its denial in the former spouse’s health benefits file.
Losing Coverage as a Family Member and Becoming Eligible as a Former Spouse
If a former spouse is covered as a family member under a non-spouse’s FEHB enrollment when the former spouse is determined eligible for health benefits under Spouse Equity provisions, the employing office responsible for the Spouse Equity enrollment must note in the health benefits file that he/she is deferring the Spouse Equity enrollment until he/she loses coverage as a family member. When the former spouse loses the family member coverage and requests enrollment, that employing office will process the Spouse Equity enrollment.
Cancellation of a Former Spouse Enrollment
A former spouse may cancel Spouse Equity enrollment at any time. With one exception noted below, the cancellation is effective on the last day of the pay period in which the employing office receives the Health Benefits Election Form (SF 2809) cancelling the enrollment. The former spouse and his/her covered family members are not entitled to the 31-day extension of coverage and may not convert to a non-group contract when the enrollment is canceled. The former spouse may not reenroll, unless he/she suspended Spouse Equity enrollment to enroll in a Medicare managed care plan or Medicaid (or a similar State-sponsored program of medical assistance for the needy).
If the former spouse suspends his/her enrollment to enroll in a Medicare managed care plan, the suspension is effective on the day before coverage under the Medicare managed care plan takes effect. The former spouse must submit documentation of his/her new enrollment to the employing office from 31 days before to 31 days after the enrollment takes effect.
Premium Payments
The former spouse must pay the employee and Government shares of the premium for every pay period he/she is enrolled. There is no Government contribution. The employing office must establish a premium payment schedule and is responsible for collecting the premiums.
Employing Office Submission of Premiums
The employing office submits premium payments collected from former spouses along with regular health benefits payments to OPM.
When the Former Spouse Does Not Pay the Premium
If the employing office doesn't receive a premium payment by the due date, it must notify the former spouse in writing that he/she must pay within 15 days (45 days if he/she lives overseas) after he/she receives the notice in order for the coverage to continue. The notice must state that if he/she doesn't make payment within this time frame, he/she is considered to have voluntarily canceled the enrollment.
If the former spouse doesn't make further payments, the employing office terminates the enrollment 60 days (90 days if he/she lives overseas) after the date of the notice.
The employing office's notice will ask if the former spouse has obtained other coverage as described below. It will explain in the notice that he/she may resume coverage under spouse equity provisions when this other coverage ends only if the former spouse informs the employing office of the other coverage now. It will place a copy of the notice and the former spouse’s response in his/her health benefits file.
The former spouse must inform the employing office if he/she obtains FEHB coverage as an employee or as a family member under another person's FEHB enrollment, or has coverage under a Medicare managed care plan or Medicaid (or a similar State-sponsored program of medical assistance for the needy). This notice will preserve the former spouse’s right to continue the Spouse Equity enrollment if he/she loses the other coverage.
Cancellation for Nonpayment of Premiums
If the coverage is canceled because the former spouse didn't pay premiums:
- he/she is not entitled to the 31-day extension of coverage;
- he/she cannot convert to a non-group contract;
- he/she cannot enroll under temporary continuation of coverage; and
- he/she may not reenroll based on the same former spouse entitlement unless nonpayment was for reasons beyond his/her control.
If the former spouse was unable to make timely payment for reasons beyond his/her control, he/she may write to the employing office to ask that coverage be reinstated. This request must be filed within 30 calendar days from the termination date and must provide proof that nonpayment was beyond his/her control. The employing office determines if he/she is eligible for reinstatement of coverage. If the employing office decides to allow reinstatement, it will be restored retroactively to the termination date upon receipt of the back premiums. If the employing office denies the reinstatement request, the former spouse may request that the employing office reconsider its initial decision.
Actions to Complete Cancellation for Nonpayment
If the former spouse does not make payment within the required time frame, the employing office must cancel the enrollment on the Health Benefits Election Form (SF 2809). In part G, which would normally show the former spouse's signature, enter "Canceled due to nonpayment of premium." Enter "N/A" in item 2 of part H and enter the effective date of the cancellation in item 3. The effective date of the cancellation is 60 days (90 days for enrollees residing overseas) after the date of the notice advising that continuation of coverage depends on premium payment within 15 days (45 days for enrollees residing overseas). If the former spouse never made a payment, enter the enrollment effective date and state in the Remarks section: "This cancellation voids the prior SF 2809 enrolling this individual in your plan on the date in item 3."
Termination of a Former Spouse Enrollment
A Spouse Equity enrollment terminates, subject to the 31-day extension of coverage, at midnight of the last day of the pay period in which:
- a qualifying court order ceases to provide entitlement to a portion of a retirement annuity or a former spouse survivor annuity under a retirement system for Government employees;
- the former spouse remarries before age 55;
- the former spouse dies;
- the employee on whose service the benefits are based dies and no survivor annuity is payable;
- the separated employee on whose service the benefits are based dies before meeting the requirements for a deferred annuity;
- the employee on whose service the benefits are based leaves Federal service before establishing title to an immediate annuity or a deferred annuity; or
- the retirement system pays a refund of retirement contributions to the separated employee on whose service the benefits are based.
The enrollments of certain former spouses of CIA and Foreign Service employees can only be terminated if the former spouse dies or remarries before reaching age 55.
The employing office must give the former spouse a copy of the Notice of Change in Health Benefits Enrollment (SF 2810) terminating his/her enrollment as soon as possible. This will allow the former spouse to convert to individual coverage within the 31-day time limit. The employing office must also advise him/her that when the enrollment terminates, he/she cannot later reenroll under the Spouse Equity Act. If the former spouse was enrolled in an employee organization plan and the enrollment terminates because the membership in the sponsoring employee organization terminates, the employing office will allow the former spouse to change to another plan.
Belated Extension of Coverage
When the former spouse belatedly learns that his/her enrollment under Spouse Equity has terminated because:
- the employee on whose service the benefits were based separates from service with no future entitlement to annuity; or
- the separated employee on whose service the benefits were based dies before becoming eligible for a deferred annuity;
the former spouse is allowed an extension of coverage of 31 days after the employing office's notice that coverage has terminated, during which he/she may convert to individual coverage.
The former spouse must pay the full premium during the extended period, except for the 31-day period following the notice.
Eligibility to Enroll under Temporary Continuation of Coverage
The former spouse is eligible to enroll under temporary continuation of coverage (TCC) when the Spouse Equity enrollment terminates during the first 36 months after the divorce or annulment because:
- there is no longer a qualifying court order; or
- the former spouse remarries before reaching age 55.
Termination of Eligible Child's Coverage
An eligible child's coverage under Spouse Equity enrollment terminates, subject to the 31-day extension of coverage and conversion rights, at midnight of:
- the day on which he/she is no longer an eligible family member: or
- the day the former spouse’s enrollment terminates.
The child is not eligible for TCC beyond the original 36-month period from the date of the divorce. If the former spouse cancels Spouse Equity enrollment, the child's enrollment also ends on the same date with no extension of coverage or conversion rights.
Reenrollment
If a former spouse is enrolled under the Spouse Equity provisions and become covered under another FEHB enrollment (either as an employee or a family member), he/she may suspend the spouse equity enrollment while covered under the other enrollment. The former spouse may reenroll when the other FEHB coverage ends.
Eligibility as a Federal Employee after Enrollment as a Former Spouse
If a person is enrolled as a former spouse and then become eligible to enroll as a Federal employee, he/she must notify the employing office responsible for the Spouse Equity enrollment that he/she is enrolling as a Federal employee. This employing office will terminate the Spouse Equity enrollment on the Notice of Change in Health Benefits Enrollment (SF 2810), and note in the Remarks section that he/she remains entitled to enrollment as a former spouse. It will file the Official Personnel Folder (OPF) copy of the SF 2810 in the former spouse health benefits file and note that the spouse equity enrollment is being suspended while the former spouse is covered as a Federal employee.
The current employing office will enroll the former spouse as an employee on the Health Benefits Election Form (SF 2809). It must note in the Remarks section that he/she was previously covered as a former spouse and is now enrolling as an employee under the same Social Security number. When the health benefits coverage as an employee terminates, the former spouse and the employing offices involved should follow the procedures in "Losing Coverage as an Employee and Enrolling as a Former Spouse."
Eligibility as a Covered Family Member after Enrollment as a Former Spouse
If a former spouse is enrolled under the Spouse Equity provisions and becomes covered as a family member under another person's FEHB enrollment, the employing office responsible for the Spouse Equity enrollment will terminate it on the Notice of Change in Health Benefits Enrollment (SF 2810). It will note in the Remarks section that the enrollment is being terminated because the former spouse is now covered as a family member under another FEHB enrollment, and give the enrollee's name, Social Security number, and the effective date of coverage. The Spouse Equity enrollment is suspended until the former spouse loses coverage as a family member. When he/she loses family member coverage and request reinstatement, the employing office that was previously responsible for the Spouse Equity enrollment will again be responsible for the enrollment.
When Coverage under Medicare Managed Care Plan or Medicaid Ends
If a former spouse postponed enrolling or suspended his/her Spouse Equity enrollment to enroll in a Medicare managed care plan or Medicaid (or a similar State-sponsored program of medical assistance for the needy), he/she may later reenroll under the Spouse Equity provisions if enrollment in the Medicare managed care plan or Medicaid ends and he/she still qualifies for a Spouse Equity enrollment. The former spouse must have informed the employing office of the Medicare managed care plan or Medicaid enrollment when he/she postponed or suspended his/her spouse equity enrollment.
If the Medicare managed care plan or Medicaid enrollment ends involuntarily, the former spouse can immediately reenroll under the Spouse Equity provisions in any available plan at any time from 31 days before to 60 days after coverage in the Medicare managed care plan or Medicaid ends. The reenrollment is effective on the date following the involuntary loss of coverage as shown in documentation from the Medicare managed care plan or Medicaid.
If the former spouse voluntarily disenrolls from the Medicare managed care plan or Medicaid, he/she may reenroll under the Spouse Equity provisions during the following Open Season.
Health Benefits File
The employing office must establish and maintain a health benefits file for the former spouse, even when he/she was denied eligibility for coverage. The file must be set up in the former spouse's name and must be separate from the employee's OPF. The front cover of the file will show the name and date of birth of the employee on whose service the Spouse Equity benefits are based.
Disclosure of the contents of the health benefits file must be consistent with OPM regulations concerning access to the OPM/CENTRAL-1, Civil Service Retirement and Insurance Records, system of records under the Privacy Act of 1974 [5 CFR, part 297]. The System Manager for this system of records is: Associate Director of Retirement and Insurance, Office of Personnel Management, 1900 E Street, NW., Washington, DC 20415.
File Contents
The employing office must keep the following documents in the former spouse's health benefits file:
- documentation that the former spouse applied in writing or in person (this may be a brief statement signed by the former spouse, with the receipt date noted by the employing office) within the 60-day time limit;
- a copy (provided by the former spouse) of the court order used by the retirement system to determine eligibility;
- a copy of the retirement system's written notification verifying that the court order is acceptable;
- the employing office's letter approving or denying eligibility for health benefits coverage along with the documents it used to make its decision;
- the OPF copies of the Health Benefits Election Form (SF 2809) or other enrollment request for enrollment documenting the former spouse's enrollment, enrollment changes, or cancellation;
- the former spouse's certification that he/she will notify the employing office within 31 days of an event that terminates eligibility;
- the notice of premium amount and payment schedule;
- the OPF copy of the Notice of Change in Health Benefits Enrollment (SF 2810) terminating the enrollment;
- the employing office's copy of the letter transferring the enrollment to the retirement system; and
- any other correspondence regarding eligibility or enrollment, such as a letter requesting payment of overdue premium prior to terminating coverage; documentation of a child's disability existing before age 26; a court order terminating entitlement to a portion of a retirement annuity or a former spouse survivor annuity; a letter from the former spouse canceling enrollment; or a retirement system notice that a refund has been paid to the former employee or that he/she has died and no survivor annuity is payable.
File Disposition
The employing office must keep the former spouse's health benefits file for as long as the office maintains his/her Spouse Equity enrollment. If he/she becomes a Federal employee eligible for an employee enrollment, his/her current employing office maintains the enrollment as an employee, and the employing office maintaining the Spouse Equity enrollment will continue to maintain the inactive enrollment.
If the former spouse did not qualify for coverage under the Spouse Equity provisions, the employing office must keep the file containing the records for at least one year from the date of notice stating that he/she did not qualify. The office may then either destroy the file contents or return it to the former spouse.
Transfer to Retirement System
The employing office will transfer the former spouse's health benefits file to the appropriate retirement system when:
- the former spouse cancels the enrollment;
- the employing office terminates his/her enrollment; or
- he/she begins receiving an annuity payment (a portion of the employee's retirement annuity or a former spouse survivor annuity). At that time the retirement system begins to withhold premiums from the annuity check and becomes the former spouse's employing office.
The employing office will send the former spouse's health benefits file to the applicable retirement system address shown below:
| Retirement System | Address |
|---|---|
| Civil Service Retirement System | Office of Personnel Management, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017. |
| Federal Employees Retirement System | Federal Employees Retirement System, P.O. Box 200, Boyers, PA 16017 |
| Foreign Service Retirement and Disability System | Department of State, Retirement Division, Room 1251, Washington, DC 20520 |
| CIA Retirement and Disability System | Central Intelligence Agency, P.O. Box 1925, Washington, DC 20505 |
Notice to Retirement System of Former Spouse Enrollment
When the employee on whose service Spouse Equity benefits are based separates, transfers, or retires, the employing office must document on his/her Individual Retirement Record (SF 2806 or 3100) that a Spouse Equity enrollment exists. Include on the employee's Individual Retirement Record the former spouse's name, date of birth, Social Security number, and the name and address of the office maintaining the health benefits file.
If the Individual Retirement Record has already been forwarded to the retirement system, use a retirement record supplement (such as the SF 2806-1 or SF 3101) to notify the retirement system of the Spouse Equity enrollment, cancellation, or termination of enrollment.
Retirement System Notice to Employing Office
If the employee's retirement record shows that a former spouse is eligible for health benefits coverage under Spouse Equity, the retirement system will notify the employing office when a lump-sum benefit or annuity becomes payable.
If a refund is being paid to the former employee, and/or when no survivor annuity is payable to the former spouse, the employing office will terminate the former spouse's enrollment and forward the health benefits file to the retirement system. The file must note the former employee's name and date of birth.
If any annuity benefit is payable to the former spouse, the employing office will forward the health benefits file to the retirement system. Note the date through which premiums have been paid so the retirement system can know the effective date of the transfer of enrollment and when to begin withholding premiums.
