Post-DOMA Survivor Annuitant Federal Employees Health Benefit Waiver Criteria
SUMMARY:
/1/ See: https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/annuitants-and-compensationers/#current. END FOOTNOTE
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION: Following the
In the ordinary course for a surviving spouse to be enrolled in FEHB after the death of the Federal employee or annuitant, the deceased Federal employee or annuitant must have been enrolled in Self and Family FEHB coverage that covered the surviving spouse at the time of death and the surviving spouse must be entitled to a monthly annuity as the survivor of a deceased Federal employee or annuitant. This means, absent a waiver of the FEHB eligibility requirements codified at 5 U.S.C. 8905(b)(2), individuals who are now receiving a survivor annuity as the surviving same-sex spouse of a deceased employee or annuitant who died on or before
This notice outlines the updates to the OPM FEHB Eligibility Waiver Policy and identifies the criteria OPM will consider when reviewing waiver requests from individuals who are receiving a monthly survivor annuity benefit as the surviving same-sex spouse of a Federal employee or annuitant who died on or before
Waiver Statute and Implementing Regulations
Section 8905(b) of title 5, U.S. Code allows OPM to waive certain FEHB eligibility requirements for an individual if OPM:
"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 /2/ in a health benefits plan under [chapter 89]."
FOOTNOTE 2 For purposes of the Federal Employees Health Benefits program, "annuitant" has been defined to include, inter alia, a member of a family who receives an immediate annuity as the survivor of an employee. 5 U.S.C. 8901(
The implementing regulation, promulgated at 5 CFR 890.108, requires the annuitant to provide OPM with evidence of the following in order to be granted a waiver for FEHB enrollment:
(1) The individual intended to have FEHB coverage as an annuitant (retiree);
(2) The circumstances that prevented the individual from meeting the requirements of 5 U.S.C. 8905(b) were beyond the individual's control; and
(3) The individual acted reasonably to protect his or her right to continue coverage into retirement.
OPM does not want to penalize an individual who is receiving a survivor annuity as a same-sex spouse and who was not covered by a FEHB Self and Family plan before his/her spouse's death because prior to
OPM will accept the following to meet the requirements above:
1. Proof of a legally valid same-sex marriage performed prior to
2. Proof that the deceased annuitant died on or before
3. Proof that the deceased annuitant was enrolled in FEHB at death.
Individuals must submit requests for waiver of the FEHB enrollment eligibility requirements under 5 U.S.C. 8905(b) to OPM in writing. These waiver requests should be mailed to:
In addition, the individual who is seeking a waiver of the FEHB eligibility requirements must have already been adjudicated eligible for a survivor annuity before he or she may seek a waiver under 5 U.S.C. 8905(b).
Enrollment Effective Date
After an individual who is receiving a survivor annuity as a same-sex spouse is granted a waiver pursuant to 5 U.S.C. 8905(b) and the procedures described above, the FEHB enrollment will be effective the first day of the first pay period that begins after the date on which that OPM granted the waiver. The survivor annuitant may not be enrolled in FEHB retroactively, unless there is clear administrative error.
Acting Director.
Notice.
Citation: "80 FR 74817"
Federal Register Page Number: "74817"
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