PART 894—FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Authority: 5 U.S.C. 8962; 5 U.S.C. 8992; Subpart C also issued under section 1 of Pub. L. 110-279, 122 Stat. 2604 (2 U.S.C. 2051); and Sec. 894.601(b) also issued under Pub. L. 116-92, 133 Stat. 1198 (5 U.S.C. 8956 note). Source: 73 FR 50184, Aug. 26, 2008, unless otherwise noted. Subpart A—Administration and General Provisions § 894.101 Definitions. This part is written as if the reader were an applicant or enrollee enrollee Acquiring an eligible child (1) Birth of a child; (2) Adoption of a child; (3) Acquisition of a foster child as described in § 890.101(a)(8) of this chapter; (4) Acquisition of a stepchild who lives with the enrollee (5) Establishment of a recognized natural child; (6) Residence change of the enrollee's enrollee (7) An otherwise eligible child becoming unmarried due to divorce or annulment of marriage, or death. Administrator Annuitant employee employee employees. employee employee employees Carrier Child (1) Except as discussed in paragraph (4) of this definition, a child is one of the following: (i) A child born within marriage; (ii) An adopted child; (iii) A stepchild or foster child who lives with the enrollee (iv) A recognized natural child. (2) This definition does not include a grandchild (unless the grandchild meets all the requirements of a foster child as stated in § 890.101(a)(8) of this chapter). (3) The child must be unmarried and under age 22. A child age 22 or over is eligible if the child is incapable of self-support because of a physical or mental disability that existed before the child reached age 22. (4) With respect to a TEl, child TEI child. Compensation Compensationer Covered position employee Days Dependent enrollee Employee employee employee Enrollee enrollee family members enrollee enrollee employee annuitant. enrollee employee annuitant TEI, enrollee sponsor TEI sponsor TEI, sponsor TEI certifying family member. TEI former spouse enrollee Enrollment reconsideration Administrator's Family member TEI, family member TEI family member. OPM OWCP Premium conversion employee premium conversion QLE Recognized natural child enrollee enrollee Regular parent-child relationship enrollee Sponsor Stepchild TEI TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) TRICARE-eligible individual for FEDVIP vision benefits (TEI-V). TEI certifying family member sponsor enrollee TEI family member enrollee TEI child TEI sponsor. TEI family member TEI former spouse TEI TRICARE-eligible individual (TEI) TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) TRICARE-eligible individual for FEDVIP vision benefits (TEI-V), TRICARE-eligible individual for FEDVIP dental benefits TEI-D TRICARE-eligible individual for FEDVIP vision benefits TEI-V Type of enrollment (1) Self only; (2) Self plus one; or (3) Self and family. [73 FR 50184, Aug. 26, 2008, as amended at 78 FR 64879, Oct. 30, 2013; 81 FR 86906, Dec. 2, 2016; 83 FR 32193, July 12, 2018; 83 FR 58177, Nov. 19, 2018; 84 FR 1599, Feb. 5, 2019; 84 FR 26544, June 7, 2019; 88 FR 47745, 47749, July 25, 2023] § 894.102 If I have a pre-existing dental or vision condition, may I join FEDVIP? Yes. Pre-existing conditions do not exclude you from coverage under FEDVIP. The Administrator § 894.103 How do I enroll? You may enroll through an Administrator OWCP § 894.104 Who makes enrollment decisions and reconsiderations? The Administrator Administrator Administrator's § 894.105 Who may correct an error in my enrollment? (a) The Administrator (b) OPM may order correction of an administrative error or other noncompliance with FEDVIP rules in this part if it receives evidence that it would be against equity (fairness) and good conscience not to order the correction. Corrections are made at the discretion of OPM and are not subject to review. (c) If the correction gives you or a family member [73 FR 50184, Aug. 26, 2008, as amended at 88 FR 47746, July 25, 2023] § 894.106 Special provisions for TRICARE-eligible individuals (TEI). Generally, applicable provisions of this part are effective for TEIs. employees, annuitants family members TEIs. See TEIs TEIs, [83 FR 58178, Nov. 19, 2018] Subpart B—Coverage and Types of Enrollment § 894.201 What types of enrollments are available under FEDVIP? FEDVIP has three types of enrollment: (a) Self only, which covers only the enrollee; (b) Self plus one, which covers the enrollee family member; (c) Self and family, which covers the enrollee family members. [88 FR 47746, July 25, 2023] § 894.202 I am an enrollee; if I enroll for self plus one, may I decide which family member to cover? Yes, if you enroll for self plus one, you must state at the time you enroll which eligible family member [73 FR 50184, Aug. 26, 2008, as amended at 88 FR 47746, July 25, 2023] § 894.203 May I be enrolled in more than one dental or vision plan at a time? You may be enrolled or be covered in a FEDVIP dental plan and a separate FEDVIP vision plan at the same time. But no one may enroll or be covered as a family member in a FEDVIP dental or vision plan if he or she is covered under another person's FEDVIP dental or vision self plus one or self and family enrollment, except as provided under § 890.302(a)(2) of this chapter, with respect to dual enrollments. If two parents of a TEI child are entitled to be a sponsor, they must choose one parent to be the child's sponsor. Dual enrollments of TEIs are permitted as provided under § 890.302(a)(2) of this chapter as applicable to TEI family members. [88 FR 47746, July 25, 2023] Subpart C—Eligibility § 894.301 Am I eligible to enroll in FEDVIP as an employee? You are eligible if— (a) You meet the definition of employee (b) You are an employee of the United States Postal Service or the District of Columbia courts; (c)(1) You were employed by the Architect of the Capitol as a Senate Restaurants employee (2) You accepted employment by the business concern and elected to continue your Federal retirement benefits and your FEDVIP coverage. You continue to be eligible for FEDVIP coverage as long as you remain employed by the business concern or its successor; or (d) You are an employee employee employees [75 FR 20514, Apr. 20, 2010, as amended at 88 FR 47746, 47749, July 25, 2023] § 894.302 What is an excluded position? Excluded positions are described in 5 U.S.C. 8901(1)(i), (ii), (iii), and (iv) and § 890.102(c) of this chapter, except that employees of the United States Postal Service, District of Columbia courts, and employees identified in § 890.102(c)(9)(i) and (ii) of this chapter are not excluded positions. You are in an excluded position if you are: (a) An employee (b) An employee Exception: employee (c) An employee (d) An individual first employed by the Government of the District of Columbia on or after October 1, 1987, except employees employees (e) Serving under an appointment limited to 1 year or less. Exceptions: (1) You are an acting postmaster; (2) You are a Presidential appointee appointed to fill an unexpired term; (3) You are an employee (4) You have completed 1 year of current continuous employment, excluding any break in service of 5 days (5) You are an employee (6) You are an employee of the United States Postal Service working on a temporary appointment, and if you meet the conditions of § 890.102(j) of this chapter except the requirement of being a non-Postal employee, you are eligible to enroll in a FEDVIP plan upon notification by your employing office. (f) Expected to work fewer than six months in each year. Exceptions: (1) You receive an appointment of at least one year's duration as an Intern under § 213.3402(a) of this chapter. To qualify, you must be expected to be in a pay status for at least one-third of the total period of time from the date of the first appointment to the completion of the work-study program. (2) You are an employee (3) You are an employee of the United States Postal Service working on a seasonal schedule of less than 6 months in a year, and if you meet the conditions in § 890.102(j) of this chapter except the requirement of being a non-Postal employee, you are eligible to enroll in a FEDVIP plan upon notification by your employing office. (g)(1) An intermittent employee employee Exception: employe (2) An intermittent employee of the United States Postal Service (a non-full-time employee without a prearranged regular tour of duty). Exception: (h) A beneficiary or patient employee (i) Paid on a contract or fee basis. Exception: (j) Paid on a piecework basis. Exception: (k) The following positions are not excluded positions: (1) An employee (2) An employee (l) For purposes of this subpart and as defined in § 890.102(j)(4) of this chapter, qualifying leave without pay hours et seq., (m) Once an employee employee [73 FR 50184, Aug. 26, 2008, as amended at 75 FR 20514, Apr. 20, 2010; 79 FR 532, Jan. 6, 2014; 81 FR 58382, Aug. 25, 2016; 88 FR 47746, 47749, July 25, 2023] § 894.303 What happens to my enrollment if I transfer to an excluded position? (a) If you have FEDVIP coverage and you transfer to a position excluded under § 894.302(a) through (d), your enrollment stops. (b) If you have FEDVIP coverage and you transfer to a position excluded under § 894.302(e) through (j) with no break in service of more than 3 days, your enrollment is not affected. If you have a break in service of more than 3 days, your enrollment stops. (c) If you did not elect to enroll in FEDVIP and then transfer to an excluded position, you lose all rights to enroll at that time. § 894.304 Am I eligible to enroll if I'm retired or receiving workers' compensation? If you are retired, receiving workers' compensation annuitant annuitant § 894.305 Am I eligible to enroll if I am a former spouse receiving an apportionment of annuity? No. Former spouses receiving an apportionment of annuity are not eligible to enroll in FEDVIP. However, a TEI former spouse [83 FR 58178, Nov. 19, 2018] § 894.306 Are foster children eligible as family members? Generally, foster children are eligible for coverage as family members TEI family member, sponsor. sponsor TEI family members. [84 FR 26544, June 7, 2019] § 894.307 Are disabled children age 22 or over eligible as family members? (a) Except as provided at paragraph (b) of this section, a child family member child child (b) A TEI child TEI family member TEI child TEI child TEI family member TEI child [83 FR 58178, Nov. 19, 2018] § 894.308 How do I establish the dependency of my recognized natural child? (a) Dependency is established for a recognized natural child who lives with the enrollee enrollee (b) The following are examples of proof of regular and substantial support. More than one of the following proofs may be required to show support of a recognized natural child who does not live with the enrollee (1) Evidence of eligibility as a dependent child for benefits under other State or Federal programs; (2) Proof of inclusion of the child as a dependent on the enrollee's (3) Canceled checks, money orders, or receipts for periodic payments from the enrollee (4) Evidence of goods or services which show regular and substantial contributions of considerable value; (5) Any other evidence which OPM shall find to be sufficient proof of support or of paternity or maternity. [78 FR 64879, Oct. 30, 2013, as amended at 88 FR 47749, July 25, 2023] § 894.309 I am a TEI-D or TEI-V. Am I eligible to enroll in FEDVIP, and cover my TEI family members? (a) FEDVIP dental plan. sponsor TEI-D TEI-D family members (2) A sponsor TEI-D enrollee TEI family members. (3) A TEI certifying family member TEI-D TEI-D family members (i) The sponsor TEI-D; (ii) The sponsor (iii) The sponsor TEI-D enrollee TEI family members sponsor: (A) Receives dental services from the Department of Veterans Affairs (VA); (B) Has employer-sponsored dental coverage without a family coverage option; or (C) Has a medical or dental condition that prevents him or her from obtaining dental benefits. (b) FEDVIP vision plan. sponsor TEI-V TEI-V family members. (2) A TEI certifying family member TEI-V TEI-V family members (i) The sponsor TEI-V; (ii) The sponsor (3) A TEI former spouse type of enrollment family members, TEI family members. [83 FR 58178, Nov. 19, 2018] Subpart D—Cost of Coverage § 894.401 How do I pay premiums? (a) Employees (b) Annuitants annuitants (c) Compensationers compensation (d) In limited circumstances, individuals may make direct premium payments. See § 894.405. (e) A sponsor, TEI certifying family member, TEI former spouse, or TEI (1) A sponsor TEI certifying family member (2) A sponsor TEI certifying family member TEI former spouse TEI (i) Automatic bank withdrawal; or (ii) Direct premium payments. [73 FR 50184, Aug. 26, 2008, as amended at 83 FR 58179, Nov. 19, 2018; 88 FR 47747, July 25, 2023] § 894.402 Do the premiums I pay reflect the cost of providing benefits? The premiums you pay shall reasonably and equitably reflect the cost of the benefits provided. § 894.403 Are FEDVIP premiums paid on a pre-tax basis? (a) Your FEDVIP premiums are paid on a pre-tax basis (called premium conversion) if you are an active employee employee (b) Your FEDVIP premiums are not (1) You are an employee employee (2) You are an annuitant annuitant compensationer (3) Your enrollment change was made effective retroactively which resulted in additional premium withholdings, unless it is as a result of birth or adoption of a child (4) You have been approved to pay premiums directly to the Administrator (5) You are a TEI (6) You are an employee of the United States Postal Service not eligible to enroll in the FEHB Program under part 890 of this chapter. [73 FR 50184, Aug. 26, 2008, as amended at 78 FR 64879, Oct. 30, 2013; 83 FR 32193, July 12, 2018; 83 FR 58179, Nov. 19, 2018; 88 FR 47747, July 25, 2023] § 894.404 May I opt out of premium conversion? No, all enrolled employees [73 FR 50184, Aug. 26, 2008, as amended at 88 FR 47749, July 25, 2023] § 894.405 What happens if I go into nonpay status or if my pay/annuity is insufficient to cover the allotments? (a) If your pay, annuity compensation Administrator Administrator (b) If you do not make the premium payments, your FEDVIP coverage will stop. You will not be able to reenroll until the next open season after: (1) You are in pay status; or (2) Your pay is sufficient to make the premium allotments. (c) If you are a FEDVIP enrollee [73 FR 50184, Aug. 26, 2008, as amended at 86 FR 17274, Apr. 2, 2021; 88 FR 47749, July 25, 2023] § 894.406 What happens if my uniformed services pay or uniformed services retirement pay is insufficient to cover my FEDVIP premiums, or I go into a nonpay status? (a) You must contact the Administrator Administrator. (b) If you do not make the premium payments, your FEDVIP coverage will stop. You will not be able to reenroll until the next open season after: (1) You are in pay status; or (2) Your uniformed services pay or uniformed services retirement pay (retired, retainer, or equivalent) is sufficient to make the premium payment. (c) If you are a FEDVIP enrollee [83 FR 58179, Nov. 19, 2018, as amended at 86 FR 17274, Apr. 2, 2021; 88 FR 47749, July 25, 2023] Subpart E—Enrollment and Changing Enrollment § 894.501 When may I enroll? You may enroll: (a) During the annual open season; (b) Within 60 days (1) A new employee (2) A previously ineligible employee (3) A new survivor annuitant, (4) An employee employee employee (5) An employee employee (6) A TEI certifying family member, sponsor TEI sponsor (7) A TEI former spouse; (c) Within 60 days of when you return to service following a break in service of at least 30 days; (d) From 31 days before you or an eligible family member loses other dental or vision coverage to 60 days after a QLE that allows you to enroll; (e) For a sponsor TEI, TEI; (f) From 31 days before you get married to 60 days after;
) (g) Within 60 days after returning to Federal employment or employment with the United States Postal Service after being on leave without pay if you did not have Federal dental or vision coverage prior to going on leave without pay, or your coverage was terminated or canceled during your period of leave without pay; (h) Within 60 days of your annuity compensation (i) For a TEI, [73 FR 50184, Aug. 26, 2008, as amended at 75 FR 20514, Apr. 20, 2010; 79 FR 41405, July 16, 2014; 83 FR 58179, Nov. 19, 2018; 88 FR 47747, July 25, 2023] § 894.502 What are the Qualifying Life Events (QLEs) that allow me to enroll or become covered in FEDVIP outside of open season? You may enroll or become covered outside of open season if you are otherwise eligible to enroll and: (a) You or a family member or TEI family member (b) Your annuity (c) You return to pay status as an employee (d) You are an employee (e) You return to Federal employment or employment of the United States Postal Service after being on leave without pay if you did not have Federal dental or vision coverage prior to going on leave without pay, or your coverage was terminated or canceled during your period of leave without pay; (f) You are a TEI (g) You are not a TEI TEI TEI family member; TEI TEI sponsor a TEI certifying family member. TEI former spouse TEI TEI sponsor. [73 FR 50184, Aug. 26, 2008, as amended at 79 FR 41405, July 16, 2014; 83 FR 58179, Nov. 19, 2018; 88 FR 47748, July 25, 2023] § 894.503 Are belated enrollments or changes allowed? (a) The time limit for enrolling or changing your enrollment may be extended up to 3 months after the date you became newly eligible or had a QLE Administrator (b) If the Administrator days Administrator § 894.504 When is my enrollment effective? (a) Open season enrollments are effective on the date set by OPM. (b) If you enroll when you first become eligible your enrollment is effective the 1st day Administrator (c) If you are a TEI (d) Outside of open season, if you are an active duty service member who becomes a uniformed services retiree ( TEI (e) A QLE day QLE. (f)(1) A belated open season enrollment or change is effective retroactive to the date it would have been effective if you had made a timely enrollment or request for a change. (2) Any belated enrollment or change outside of open season that goes beyond the allowable 60-day enrollment timeframe is effective retroactive to the 1st day QLE. (3) You must pay any retroactive premiums due to a belated enrollment or request for a change. [73 FR 50184, Aug. 26, 2008, as amended at 83 FR 58179, Nov. 19, 2018; 88 FR 47748, July 25, 2023] § 894.505 Are retroactive premiums paid with pre-tax dollars (premium conversion)? Retroactive premiums are not paid under premium conversion, except when you are changing your enrollment retroactively as a result of birth or adoption of a child. Administrator § 894.506 How often will there be open seasons? There will be an annual open season for FEDVIP at the same time as the annual Federal Benefits Open Season. § 894.507 After I'm enrolled, may I change from one dental or vision plan or plan option to another? (a) You may change from one dental plan to another, and/or from one vision plan to another, or you may change from one plan option to another option in that same plan: (1) During the annual open season; (2) When you get married (except for TEIs TEI former spouses, TEI children); (3) For employees (b)(1) If you are enrolled in a dental or vision plan with a geographically restricted service area, and you or a covered eligible family member TEI family member (2) You may make this change at any time before or after the move, once you or a covered eligible family member TEI family member (3) The enrollment change is effective the first day of the pay period following the pay period in which you make the change. (4) You may not change your type of enrollment QLE type of enrollment. [83 FR 58179, Nov. 19, 2018, as amended at 88 FR 47748, July 25, 2023] § 894.508 When may I increase my type of enrollment? (a) You may increase your type of enrollment: (1) during the annual open season; or (2) If you have a QLE type of enrollment. (b) Increasing your type of enrollment (1) Self only to self plus one; (2) Self only to self and family; or (3) Self plus one to self and family. (c) You may increase your type of enrollment days QLE days QLE. (d) Your new type of enrollment day (e) You may not change from one dental or vision plan to another, except as stated in § 894.507. [73 FR 50184, Aug. 26, 2008, as amended at 79 FR 41406, July 16, 2014] § 894.509 What are the QLEs that are consistent with increasing my type of enrollment? (a) Marriage; except for a TEI TEI former spouse; TEI child(ren); (b) Acquiring an eligible child TEI child; (c) Loss of other dental or vision coverage by an eligible family member TEI family member. [83 FR 58179, Nov. 19, 2018] § 894.510 When may I decrease my type of enrollment? (a) You may decrease your type of enrollment: (1) During the annual open season; (2) If you have a QLE type of enrollment (3) You are an enrollee, family member TEI family member enrollee family member TEI family member is eligible for (b) Decreasing your type of enrollment (1) Self and family to self plus one; (2) Self and family to self only; or (3) Self plus one to self only. (c)(1) Except as provided in paragraph (c)(2) of this section, you may decrease your type of enrollment (2) You may make any of the following enrollment changes at any time beginning 31 days before a QLE listed in § 894.511(a): (i) A decrease in your self plus one enrollment; (ii) A decrease in your self and family enrollment to a self plus one enrollment, when you have only one remaining eligible family member TEI family member; (iii) A decrease in your self and family enrollment to a self only enrollment, when you have no remaining eligible family members TEI family members. (d)(1) Except as provided in paragraph (d)(2) of this section, your change in enrollment is effective the first day of the first pay period following the one in which you make the change. (2) If you are making an enrollment change described in paragraph (c)(2) of this section, your change in enrollment is effective on the first day of the first pay period following the QLE on which the enrollment change is based. (e) You may not change from one dental or vision plan or option to another, except as stated in § 894.507(b). [73 FR 50184, Aug. 26, 2008, as amended at 75 FR 20514, Apr. 20, 2010; 83 FR 58180, Nov. 19, 2018; 88 FR 47748-47749, July 25, 2023] § 894.511 What are the QLEs that are consistent with decreasing my type of enrollment? (a) Loss of an eligible family member TEI family member (1) Divorce; (2) Death; or (3) Loss of eligibility of a previously enrolled child TEI child. (b) You are an enrollee [83 FR 58180, Nov. 19, 2018, as amended at 88 FR 47748, July 25, 2023] § 894.512 What happens if I leave Federal Government and then return? (a) Your FEDVIP coverage terminates at the end of the pay period in which you separate from government service. Exception: compensation (b)(1) If you return to Federal service after a break in service of fewer than 30 days QLE (2) If you return to Federal service after a break in service of fewer than 30 days type of enrollment Exceptions: (i) If you were enrolled in a dental or vision plan with a restricted geographic service area, and you have since moved out of the plan's service area, you may change to a different dental or vision plan that serves that area. (ii) If you have since gained or lost an eligible family member type of enrollment family members. (3) If you return to Federal service as a new hire after a break in service of 30 days type of enrollment. § 894.513 Do I have to elect FEDVIP coverage each year in order to remain covered? No. If you do not change or cancel your enrollment, and if your enrollment does not terminate pursuant to this part, then your current enrollment will continue into the next year. Before open season, you should review the plan brochure for any changes in benefits and premiums for the next year. [83 FR 58180, Nov. 19, 2018] Subpart F—Termination or Cancellation of Coverage § 894.601 When does my FEDVIP coverage stop? (a) If you no longer meet the definition of an eligible employee annuitant, TEI, (b) If you go into a period of nonpay or insufficient pay (or insufficient uniformed services pay or uniformed services retirement pay) and you do not make direct premium payments, your FEDVIP coverage stops at the end of the pay period for which your agency, retirement system, OWCP, Exception: enrollee (c) If you are making direct premium payments or payments by automatic bank withdrawal, and you stop making the payments, your FEDVIP coverage stops at the end of the pay period for which you last made a payment. (d) If you cancel your enrollment during an open season, your FEDVIP coverage stops at midnight of the day (e) If you are enrolled with a combination dental and vision carrier carrier's carrier carrier day (f) If your FEDVIP carrier discontinues participation in the program at the end of the contract year, then you must change to another carrier day carrier. (g) If your status as a uniformed services retiree discontinues and you become a uniformed services member on active duty, your FEDVIP dental and/or vision plan enrollment terminates and your coverage stops at the end of the last pay period for which the premium payment was made from your uniformed services retirement pay. You will still be the sponsor enrollee, TEI certifying family member TEI family members. sponsor, family members See (h) If your status as a uniformed services member on active duty discontinues and you become a uniformed services retiree, the FEDVIP vision plan enrollment of your TEI family members TEI family members sponsor enrollee, TEI family members. sponsor, family members See (i) If you are an enrollee sponsor [73 FR 50184, Aug. 26, 2008, as amended at 83 FR 58180, Nov. 19, 2018; 86 FR 17274, Apr. 2, 2021; 88 FR 47748-47749, July 25, 2023] § 894.602 May I cancel my enrollment at any time? Generally, an enrollee Exceptions: (a) You are an enrollee (b) You are an enrollee (c) You are an enrollee sponsor sponsor, family members sponsor enrollee, TEI-D TEI family member TEI certifying family member TEI family members. (d) Cancellations under this section will become effective at the end of the pay period that you submit your request. [88 FR 47748, July 25, 2023] § 894.603 Is there a temporary extension of coverage and conversion right when my coverage stops or when a covered family member loses eligibility? No. There is no temporary extension of coverage, or Temporary Continuation of Coverage (TCC), or right to convert to an individual dental or vision policy when your FEDVIP coverage stops or when a family member TEI family member [83 FR 58180, Nov. 19, 2018] Subpart G—Annuitants and Compensationers § 894.701 May I keep my dental and/or vision coverage when I retire or start receiving workers' compensation? (a) Your FEDVIP coverage continues if you retire on an immediate annuity or on a disability annuity, or start receiving compensation (b) If you retire on a Minimum Retirement Age +10 annuity that you elect to postpone in accordance with 5 U.S.C. 8412(g), your FEDVIP coverage will stop when you separate from service. However, you may enroll again within 60 days (c) If you retire on a deferred annuity in accordance with 5 U.S.C. 8413, your FEDVIP coverage stops and you are not eligible to enroll. § 894.702 May I participate in open season and make changes to my enrollment as an annuitant or compensationer? Yes. Annuitants compensationers employees [88 FR 47749, July 25, 2023] § 894.703 How long does my coverage as an annuitant or compensationer last? Your coverage as an annuitant compensationer compensation compensation. § 894.704 What happens if I retire and then come back to work for the Federal Government or the United States Postal Service? (a) If you have FEDVIP coverage as an annuitant, Administrator (b) If you did not enroll in FEDVIP coverage as an annuitant days (c) If you enroll as an employee Administrator (d) If your reemployment terminates, you must notify the Administrator [73 FR 50184, Aug. 26, 2008, as amended at 88 FR 47749, July 25, 2023] Subpart H—Special Provisions for TRICARE-Eligible Individuals (TEI) Source: 83 FR 58180, Nov. 19, 2018, unless otherwise noted. § 894.801 Am I eligible for FEDVIP based on my eligibility to enroll in a TRICARE dental or health plan? (a) The U.S. Department of Defense (DOD) is responsible for regulating eligibility for obtaining medical and dental care under the TRICARE Program, pursuant to 10 U.S.C. chapter 55. The FEDVIP laws at 5 U.S.C. chapter 89A was amended by the National Defense Authorization Act for Fiscal Year 2017, Public Law 114-328, to allow individuals who were eligible for coverage under the TRICARE Retiree Dental Program (TRDP) in accordance with DOD rules to obtain dental coverage in a FEDVIP dental plan. Public Law 114-328 also added a provision allowing certain individuals who are concurrently enrolled for medical care in specified TRICARE health plans to obtain FEDVIP vision coverage. (b) Categories of individuals who were eligible for TRDP and who are eligible to be covered under a FEDVIP dental plan are set forth in § 894.802. Categories of individuals who may be covered under specified TRICARE health plans and, if so covered, are eligible to be covered under a FEDVIP vision plan, are set forth in § 894.803. Individuals eligible for FEDVIP coverage are referred to as TRICARE eligible individuals (TEI). (c)(1) FEDVIP rules provide an enrollee (i) A dental and/or a vision plan; and (ii) Type of enrollment family members (2) For TRICARE eligible individuals (TEI), (i) If the sponsor TEI sponsor enrollee sponsor TEI family members (ii) If a sponsor TEI TEI family member enrollee TEI family members. (d) If a FEDVIP dental or vision plan has a specific geographic enrollment area, TEI family members enrollee TEI family members § 894.802 Am I a TEI for a FEDVIP dental plan (TEI-D) if I am eligible to enroll or be covered under the TRICARE Retiree Dental Program? A TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) not TEI-D: § 894.803 Am I a TEI for a FEDVIP vision plan (TEI-V) based on my concurrent enrollment in a TRICARE health plan? (a) Except as provided in paragraphs (b) and (c) of this section, a TEI-V (1) 10 U.S.C. 1076d (TRICARE Reserve Select (TRS)); (2) 10 U.S.C. 1076e (TRICARE Retired Reserve (TRR)); (3) 10 U.S.C. 1079(a) (uniformed services active duty family members concurrently enrolled in TRICARE Select or TRICARE Prime); (4) 10 U.S.C. 1086(c) (uniformed services retirees and retiree family members or former spouses concurrently enrolled in TRICARE Select or TRICARE Prime); or (5) 10 U.S.C. 1086(d) (TRICARE for Life (TFL)), as set forth in 32 CFR 199.3. The provisions of TFL require Medicare eligible retirees and individual Medicare eligible retiree family members or former spouses to enroll in Medicare Part B (requires payment of applicable premiums), otherwise they are not a TEI-V. (b) An individual covered under any of the following programs is not TEI-V: (1) TRICARE Young Adult provisions of 10 U.S.C. 1110b; (2) Transitional Assistance Management Program (TAMP), 10 U.S.C. 1145(a); (3) Continued Health Care Benefit Program (CHCBP), 10 U.S.C. 1078a; or (4) Foreign Military (including NATO) sponsor/family coverage. (c) An active duty member of the uniformed services under 10 U.S.C. 1074(a) is not TEI-V. § 894.804 Am I a sponsor for a FEDVIP dental or vision plan? (a) Generally, the sponsor is the individual who is eligible for medical or dental benefits under 10 U.S.C. chapter 55 based on his or her direct affiliation with the uniformed services, including military members of the National Guard and Reserves. Relationship to a sponsor conveys TEI status to a TEI family member. If two parents of a TEI child are entitled to be a sponsor, see restriction on dual enrollment at § 894.204. (b) Sponsor (1) Retiree. A member or former member of a uniformed service who is entitled to uniformed services retirement pay. To determine a sponsor's enrollee TEI-D; (2) Retired Reserve member under the age of 60 (“Gray Area Retiree”). To determine sponsor's enrollee TEI-D; (3) Medal of Honor recipient who is not otherwise entitled to dental benefits; or (4) Deceased Member described in paragraph (b)(1) or (2) of this section who died after retiring from active duty and a deceased member who was a Medal of Honor recipient described in paragraph (b)(3) of this section. (c) Sponsor (1) Retiree. A member or former member of a uniformed service who is entitled to uniformed services retirement pay. (2) Retired Reserve member under the age of 60 (“Gray Area Retiree”); (3) Medal of Honor recipient who is enrolled in TRICARE Select or TRICARE Prime and who is not on active duty; (4) Member of the uniformed services (active or Reserve Component) on active duty for more than 30 days. An active duty member of the uniformed services under 10 U.S.C. 1074(a) is not a TEI-V enrollee TEI-V; (5) Ready Reserve member; (6) Deceased member described at paragraphs (c)(1) through (5) of this section; or (7) Deceased Reserve Component member (deceased in the line of duty). [83 FR 58180, Nov. 19, 2018, as amended at 84 FR 1599, Feb. 5, 2019] § 894.805 I am not a TEI-D or TEI-V, but I am a sponsor. Am I eligible to cover my TEI family members? (a) FEDVIP dental plan. sponsor TEI-D enrollee, TEI family members (2) However, a TEI certifying family member TEI family members sponsor TEI-D, (i) Receives VA dental services; (ii) Has employer-sponsored dental coverage without a family coverage option; or (iii) Has a medical or dental condition that prevents him or her from obtaining dental benefits. See (b) FEDVIP vision plan. sponsor TEI-V enrollee TEI family members (2) However, a TEI certifying family member TEI family members. TEI-V TEI family members. See § 894.806 Can a retiree or Retired Reserve member enroll and cover TEI family members in a FEDVIP dental plan? Generally, yes, since a retiree or Retired Reserve member who is a sponsor TEI-D. enrollee TEI family members. TEI certifying family member enrollee (a) Receives VA dental services; (b) Has employer-sponsored dental coverage without a family coverage option; or (c) Has a medical or dental condition that prevents him or her from obtaining dental benefits. See § 894.807 Can an active duty member enroll or be covered under a FEDVIP vision plan? No, a uniformed services member on active duty is not a TEI-V TEI family members See TEI TEI-V § 894.808 I am a TEI family member. Can I enroll myself in FEDVIP? Generally, you are not eligible to enroll yourself as a TEI family member. enrollee type of enrollment TEI family members. sponsor sponsor TEI certifying family member enrollee, TEI family members § 894.809 Who is a TEI certifying family member, and may I be the enrollee if I accept this responsibility? (a) TEI certifying family member sponsor enrollee TEI family member enrollee sponsor's TEI family members type of enrollment. enrollee TEI family members type of enrollment. (b) The following order of precedence governs which TEI family member enrollee: (1) An unremarried surviving spouse of a retiree or Medal of Honor recipient, if any, is the TEI certifying family member TEI child (2) If there is no unremarried surviving spouse of a retiree or Medal of Honor recipient, the surviving TEI child enrollee TEI certifying family member TEI family member(s) (3) The TEI family member spouse TEI certifying family member TEI family member(s). (4) If there is no spouse, the TEI family member enrollee TEI certifying family member TEI family member(s). (c) In the event that the TEI family member TEI certifying family member TEI's (d) Accepting responsibility to self-certify as the enrollee Administrator's § 894.810 If I enroll for self plus one, may I decide which TEI family member to cover? Generally, yes, as specified in § 894.202. However, if you are an enrollee type of enrollment TEI family member, TEI family member TEI family member TEI certifying family member TEI family member TEI family member Administrator § 894.811 I am a TEI family member of a sponsor who is a retiree or Retired Reserve member who is not on active duty. My sponsor is a TEI-D but is not enrolled in a FEDVIP dental plan. Can I enroll in a FEDVIP dental plan even though my sponsor is eligible to enroll but is not enrolled? Generally, if your sponsor TEI-D, TEI family members. TEI family member TEI certifying family member, TEI family members, sponsor TEI-D sponsor (a) The retiree sponsor (b) The retiree sponsor (c) The retiree sponsor § 894.812 I am a widow or widower TEI family member. No. A widow or widower who is a TEI family member TEI certifying family member. sponsor, enrollee, (a) Enroll yourself and the TEI child (b) Enroll all TEI family members TEI child § 894.813 I am a TEI former spouse. Am I eligible to enroll in a FEDVIP vision plan? Yes, you are eligible to enroll in a FEDVIP vision plan only. A TEI former spouse TEI-V, enrollee, type of enrollment TEI child. TEI child sponsor, TEI certifying family member TEI child TEI certifying family member enrollee. TEI child's TEI child enrollee TEI family members sponsor. enrollee TEI child TEI family members of the TEI certifying family member type of enrollment, TEI child TEI family members § 894.814 Is a foster child included in the definition of TEI family member? Generally, a foster child is excluded from coverage as they are not defined to be a TEI family member. sponsor, sponsor, TEI family members. [84 FR 26544 June 7, 2019] § 894.815 I am a sponsor. Am I responsible to notify the Administrator and my TEI family members when my FEDVIP dental or vision eligibility and/or enrollment status changes? Yes, as sponsor, Administrator TEI family members enrollee, sponsor TEI, Administrator TEI family members TEI family members, (a) Example 1. enrollee. (2) You are on active duty (not TEI enrollee TEI certifying family member TEI family members TEI TEI family members TEI certifying family member enrollee, Administrator Administrator TEI certifying family member sponsor i.e. TEI family members (b) Example 2. enrollee. (2) You are a retiree or a retired Reserve member and as a TEI-D enrollee TEI family members. TEI certifying family member TEI family members TEI certifying family member enrollee, Administrator. Administrator TEI certifying family member sponsor i.e. TEI family members (c) Example 3. enrollee (2) You are a retiree or Retired Reserve member (who is not on active duty), and you go on active duty. You lose TEI enrollee. Administrator Administrator TEI certifying family member enrollee TEI family members type of enrollment TEI family members enrollee. § 894.816 If I return from active duty and retire, what happens to my TEI family members' enrollment in their FEDVIP vision plan? As a uniformed services member on active duty, you are the sponsor enrollee. TEI certifying family member enrollee TEI-V TEI-D, enrollee TEI certifying family member sponsor, Administrator TEI family members TEI family members' TEI-V TEI-D sponsor enrollee, TEI family members. See § 894.817 If I am a retiree who is a TEI-V and I return to active duty, what happens to my TEI family members' enrollment in their FEDVIP vision plan? If you and your TEI family members enrollee sponsor. TEI family members TEI certifying family member enrollee TEI family members. TEI family members enrollee. TEI certifying family member TEI family members, See Subpart I—Benefits in Underserved Areas Source: 83 FR 58180, Nov. 19, 2018, unless otherwise noted. § 894.901 Will benefits be available in underserved areas? (a) Dental and vision plans under FEDVIP will include underserved areas in their service areas and provide benefits to enrollees (b) In any area where a FEDVIP dental or vision plan does not meet OPM access standards, including underserved areas, enrollees (c) Contracts under FEDVIP shall include access standards as defined by OPM and payment levels for services to non-network providers in areas that do not meet access standards. [83 FR 58180, Nov. 19, 2018, as amended at 88 FR 47749, July 25, 2023]