Enrollment headaches

The Office of Personnel Management recently issued well- intentioned instructions that are bound to create an administrative nightmare for federal agencies.

OPM says it considers a court or administrative order requiring employees to provide health benefits for their children to be a change in family status that allows an enrollment change in the government's health program. But there was nothing in the Federal Employees Health Benefits (FEHB) law that actually required an employee to make the change.

Now there is. A law that took effect last Oct. 30 requires mandatory self and family coverage for FEHB-eligible employees who are under court order to provide such health benefits to their children. If the employee does not enroll in a health plan or provide documentation of other coverage for the children, OPM says the agency must enroll the employee for self and family coverage in the standard option of the Blue Cross and Blue Shield Service Benefit Plan. I bet the other FEHB carriers will be thrilled with this provision!

How this law is supposed to work is peculiar. It appears it will only work if a representative of a child who will benefit from this law is aware of this provision and submits the necessary documentation to an employee's agency. But if the representative is unaware of this provision, the child is out of luck.

If a federal employee gains custody of a child as a result of a court order, then the employee will probably enroll that child in the FEHB plan. But if a non-fed obtains custody—presumably as a result of a divorce or separation settlement—that person would have to know about the provisions of this law and submit the necessary documentation to the other parent's agency.

OPM has told agency officials that if they receive a court order, they're supposed to determine whether the employee has enrolled the child in an FEHB plan. If so, the official should notify whoever sent in the court order. The official must also send a copy of the enrollment form to the carrier, along with a copy of the court order.

I don't understand this. If the employee has enrolled his or her child, why send anything to the carrier? The carrier already has the necessary information.

If the employee is eligible for FEHB but doesn't have coverage for his or her child, the agency official must notify the employee that it has received a court order requiring it. If the employee doesn't enroll in an appropriate plan or provide documentation of other coverage for the child, the agency must enroll the child. The health plan must get the name and birth date of the child from the court order or from the custodial parent. How the plan is supposed to do this isn't specified.

This is sloppy work by both OPM and Congress. The law and regulations are too ambiguous and, while well-intentioned, will create many problems.

Zall is a retired federal employee who since 1987 has written the Bureaucratus column for Federal Computer Week. He can be reached at [email protected].


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