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EmpowHR: Section 6 - Payroll Documents

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Health Benefits

Health Benefits processing uses specific enrollment codes that are assigned by OPM. These codes consist of three numbers: The first two identify the plan, and the third identifies the option and type of enrollment (e.g., in Enrollment Code 105, 10 indicates the Service Benefit Plan and 5 indicates high option for self and family). After a FEHB document has been successfully processed, the database is updated with the appropriate FEHB coverage code and the carrier copies are sent to the carrier. The carrier then issues the identification cards. FEHB deductions begin during the pay period in which the health benefits enrollment is processed and applied to the database.

The enrollment code is the only type of correction that can be made in the system. To correct enrollment code, enter a health benefits registration form. Select Change In Enroll (SF-2809) at the Transaction drop-down menu and Correction at the Event Code drop-down menu. All other corrections must be sent to NFC (e.g., Correcting effective dates displayed on IRIS Program 115, Health Benefits, can be made using a Master File Change Document (Type 030). See NFC Bulletin Title I, 09-14, Federal Employees Health Benefits Changes, dated July 23, 2009). The correction should be indicated in the Remarks block of the Form SF 2809, Health Benefits Election Form. To adjust for the erroneous deductions, enter the information in the Document Tracking System External (DOTSE).

This section of the procedure will show how to enter and verify an employee’s Form SF 2809.

Note: Before FEHB enrollment data can be entered; FEHB Coverage must be established (i.e., FEHB Coverage Code 4, Eligible-Pending) in the Benefits Data of the EmpowHR PAR Processing module.

Before beginning, the following information is needed (refer to the SF 2809):

Proration of Health Benefits

A proration of benefits exists when a new employee enters on duty in the middle of a biweekly pay cycle from another Federal Department having a different biweekly pay cycle. Health Benefits is automatically adjusted on a prorated bases based on the effective date. The cost for a part-time career employee is also prorated depending on the Agency regulations. If the employee has dual appointments, both Agencies contribute to the cost of FEHB.

Temporary Employment Relating to Health Benefits

Certain temporary employees are eligible to participate in FEHB. PPS produces a Report AEC037U4, Temporary Employees FEHB Coverage Eligibility, to identify eligible temporary employees.

When a personnel action is processed for LWOP in excess of 30 days, the timekeeper should not submit a T&A. A bill will be generated for health benefits premiums.

When an employee in nonpay status chooses not to pay their share of the health benefits premium before returning to work, the payroll office sends a letter to the employee indicating the amount owed.

When an employee separates from an Agency owing FEHB premiums, the amount due will be withheld from the employee’s final salary. If the amount is insufficient, it will be considered an indebtedness due the United States. Recovery of the funds are made from any lump sum payment due the employee, retirement deductions, annuities, or other monies owed to the employee by the Federal Government.

Former Spouse Health Benefits Enrollment

The former spouse must have been covered as a family member under the employee’s FEHB enrollment within an 18-month period prior to the divorce/annulment in order to be eligible for either of the two available programs.

There are two programs under which qualifying spouses may continue their health insurance coverage after a divorce/annulment. They are:

It is the responsibility of the employee to inform the Agency of the divorce/annulment. The employee of the former spouse has 60 days from the divorce/annulment date to notify the employing office of the change in family status. OPM approves eligibility for Spouse Equity; Agency personnel offices approve eligibility for TCC. Former spouses may apply for TCC while waiting for OPM to approve Spouse Equity. An SF 2809 must be submitted to the employing office.

After OPM and/or the Agency determines eligibility and submits documentation, DPRS handles billing and collection of premiums and notifies the carrier.

Direct Premium Remittance System (DPRS)

DPRS is a centralized automated system for collecting premiums from eligible non-Federal enrollees who elect to participate in FEHB (e.g., former spouses). Refer to the Direct Premium Remittance System (DPRS), procedure located on the Insurance Services Clients page, under Publication Instructions, for completing the SF 2809.

Children's Equity Act

The Federal Employees Children’s Equity Act requires FEHB-eligible employees who do not comply with a court or administrative order to provide health benefits coverage for their children. An employee who is subject to such an order must enroll in self and family coverage in a plan that provides full benefits to his/her child(ren) in the area where they live or provide documentation that he/she has other health coverage for the children.

Public Law 106-394

P.L. 106-394, the Federal Health Benefits Children Equity Act of 2000, enacted October 30, 2000, required mandatory self and family coverage for FEHB-eligible employees who do not comply with a court or administrative order to provide health benefits for their child(ren).

Agency Personnel Office Responsibilities

When a court or administrative order is received for an individual, the Agency personnel office must review the employee’s records to determine whether he/she is eligible for FEHB and, if so, whether he/she is enrolled in a self family plan that provides full benefits in the location where the child(ren) live. Listed below are the specific actions that must be taken by the Agency personnel office to ensure compliance with the court or administrative order.

If the employee has FEHB self and family coverage, notify the individual that a court or administrative order has been received requiring him/her to provide health benefits for his/her child(ren). If the child(ren) named on the court or administrative order is not identified as a member of the employee’s self and family coverage, submit a copy of the individual’s SF 2809 or SF 2810, along with a copy of the court or administrative order to NFC. NFC will forward the appropriate documentation to the FEHB carrier to identify the additional family member being covered under the self and family enrollment. Inform the appropriate contact of the court or administrative order of the FEHB coverage and that action has been taken to ensure the child(ren) is covered.

If the employee has FEHB self-only coverage, notify the individual that a court or administrative order has been received requiring him/her to provide health benefits for his/her children. The individual has until the end of the pay period following the one in which he/she is given the notice to make a change from self only to self and family coverage. If the individual does not make a change to self and family coverage, the Agency personnel office must enroll them in the Basic Option of the Blue Cross/Blue Shield Service Benefit Plan (Enrollment Code 112, Self and Family). The effective date of coverage is the first day of the pay period following the one in which the SF 2809 is completed or the effective date as stated on the court or administrative order. Submit a copy of the individual’s SF 2809 or SF 2810 along with a copy of the court or administrative order to NFC. NFC will forward all the appropriate documentation to the FEHB carrier identifying the family members being covered under the self and family enrollment. Authorized enrollment changes must be processed retroactively, if necessary, to comply with the effective date of the court or administrative order. Submit Form AD-343 to NFC for processing of the retroactive FEHB personal action indicating:

Inform the appropriate contact for the court or administrative order of the FEHB self and family coverage that action has been taken to ensure the child(ren) is covered.

If the employee is not enrolled in an FEHB health plan that provides full benefits in the location where the child(ren) live, notify the individual that a court of administrative order has been received requiring him/her to provide health benefits for his/her children. The individual has until the end of the pay period following the one in which he/she is given the notice to enroll in a health plan or provide documentation that he/she has other health benefits for the child(ren). If the individual does not enroll in a plan or provide documentation of coverage, enroll the child(ren) in the Basic Option of the Blue Cross/Blue Shield Service Benefit Plan (Enrollment Code 112, Self and Family). Complete an SF 2809 with remarks to identify that the employee is being enrolled for FEHB self and family coverage under P.L. 106-394. The effective date of the coverage is the first day of the pay period following the one in which the SF 2809 along with a copy of the court or administrative order to NFC. NFC will forward the appropriate documentation to the FEHB carrier to identify each family member being covered under the self and family enrollment. Authorized enrollment changes must be processed retroactively, if necessary, to comply with the effective date of the court or administrative order. Inform the appropriate contact for the court or administrative order of the FEHB self and family coverage that action has been taken to ensure the child(ren) is covered.

Health Benefits

Agencies that employ non-Federal employees who are eligible for FEHB coverage, should review P.L. 106-394 to determine the impact on their employees.

Employee in Non-Pay Status

When an employee under a court or administrative order to provide FEHB coverage for his/her child(ren) is in non-pay status, he/she must either make direct premium payments or incur a debt to the Federal Government to be repaid when he/she returns to pay status.

Note: This applies only during the first year in non-pay status. Coverage terminates after 365 days in non-pay status, even for employees subject to a court or administrative order. For additional information, see 5CFR890.502(b).

Termination by Carrier

When an individual under court or administrative order is to provide FEHB coverage for his/her child(ren) has FEHB coverage terminated by a FEHB carrier, it is the responsibility of the employee’s personnel office to ensure that the individual continues to provide self and family FEHB coverage under an alternative plan.

Restricted Enrollment Changes

During open season or when there is an event allowing an enrollment change, employees who are under court or administrative order are restricted as to the type of enrollment changes they may select while enrolled in FEHB. An employee who is under court or administrative order can change to a different fee-for-service plan or a Health Maintenance Organization (HMO) that provides full benefits where the child(ren) live. However, the employee cannot cancel enrollment, change to self only, or change to an HMO that does not provide coverage in the area where the child(ren) are eligible under FEHB. This applies whether the employee enrolled voluntary or involuntarily. If an SF 2809 is received making such an enrollment change, do not process it. If the SF 2809 is processed by mistake, a corrective action must be processed immediately even retroactively, if applicable. Notify the employee that he/she cannot make the change and that the existing self and family will remain in effect.

Exceptions to Restricted Enrollment

The following exceptions are allowed for enrollment changes when an employee is under a court or administrative order.

Dependent Children of Same-Sex Domestic Partners

To be eligible for this coverage, the dependent must be the child(ren) of an unmarried, same-sex domestic partner in a State where marriage between same-sex domestic partners is not legal. This child(ren) will be referred to as either a “newly eligible stepchild” or “newly eligible stepchildren.”

Employees will have 60 days after submitting documentation (Declaration of Domestic Partnership FEHB/FEDVIP and Certification of Dependent Tax Status for Purposes of Coverage under FEHB and FEDVIP) to their HR office to submit an SF 2809. The HR office will store these documents on the permanent side in the employee's electronic Official Personnel Folder (eOPF). The number of stepchildren should be entered first on the Remarks link on the Health Benefits page - Elections tab.

As State laws change and same-sex marriages become legal in more States, and the couple does not marry, the employee must submit a cancelation document. The Agency should notify the employee of the change.

Note: The child(ren) will remain covered for the remainder of the calendar year (in a State that legalizes same-sex marriage). It is the responsibility of the Agency to notify employees when a State recognizes same-sex marriage, and that the coverage will be canceled after the calendar year.

Premium Conversion

Because the newly eligible stepchild(ren) is not a tax dependent, the newly eligible stepchild(ren) is not eligible for Premium Conversion. The PPS database field Health Benefit Use will be used to retrieve the newly eligible stepchild(ren) that was entered in the first three positions on the Remarks link.

Values on TMGT Table 012, Health Benefits Rates, will be used to calculate the amount of yearly imputed income for each newly eligible stepchild. PAYE will compute the yearly fair market value for the newly eligible stepchild(ren). The Premium Conversion and No Premium Conversion fields are used for this purpose. The full premium is computed by adding the HB-Deduction-Amt and HB-Contribution-Amt fields on TMGT012 and multiplying them by the number of newly eligible stepchildren. This figure is compared with the amount in the HB-Month-Premium field. The lessor of these two amounts is divided by 26 to get the biweekly amount and added to the taxable gross.

FEHB Coverage Codes

FEHB coverage codes are used when processing actions to identify the employee’s eligibility for participation in the FEHB program, and if eligible, whether they are participating. The following new FEHB coverage codes will be used to process FEHB personnel actions for employees who are required by a court or administrative order to provide health benefits coverage for their contributions:

Intermittent, Seasonal, and Temporary Employees

In accordance with OPM Benefits Administration Letter (BAL) dated October 20, 2014, certain intermittent, seasonal, and temporary employees are eligible for FEHB.

Eligibility

There are two categories of eligibility:

  1. Current Federal employees (ineligible to participate in FEHB or currently enrolled in FEHB and paying the full premium or a pro-rated premium)

    With OPM's guidance, Agencies will determine which employees currently on the rolls become eligible.

    Agencies must use the process below to make these employees eligible or waived for FEHB in NFC's Payroll/Personnel System.

    For current employees who were ineligible, but are now eligible, Agencies must:

    • Process a Master File Change document for the newly eligible employee with the FEHB-Part-Time-Coverage-Cd of a 2-Ineligible (PT employee paying as a FT employee). When the Document Type 030 is received and the employee has a FEHB Eligibility code of 2-Ineligible, 3-Waived, 5-Canceled, or 9-Terminated, EmpowHR will update the FEHB Eligibility code to 4-Eligible Pending.
    • Process a health benefits document within 60 days. If no health benefits document is received within 60 days, the employee's FEHB Eligibility Code will become a 3-Waived.

    For a newly eligible employee currently enrolled in FEHB who fall under the new OPM guidance, the Agency must:

    • Process a Master File Change document FEHB-Part-Time-Coverage-Cd to 2-Ineligible (PT employee paying as a FT employee), and if the FEHB Eligibility code is 1-Enrolled, 6-Court Ordered-Enrolled, 7-Court Ordered-Eligible Pend, or 8-Court Ordered-Self to Family, the code will remain the same. The FEHB-Part-Time-Coverage-Cd of a 2-Ineligible (PT employee paying as a FT employee) will treat the employee's health benefits as those of a full-time employee.
  2. New hires (accessions and conversions)

    For accessions and conversions, the Agency must:

    • Use the FEHB Eligibility Code of 4-Eligible-Pending with Remark Code 201, For the purposes of the Affordable Health Care Act this employee is a full time employee and eligible to enroll in FEHB under Section 4980H of the Internal Revenue Code and Treasury Regulations 79 FR 8544, dated Feb 12, 2014. EmpowHR will move a FEHB-Part-Time-Coverage-Cd to 2-Ineligible (PT employee paying as a FT employee).
    • Process a health benefits document within 60 days. If a health benefits document is not processed within 60 days, the FEHB Eligibility Code will become a 3-Waived.

Nature of Action/Authority Codes

For a Data Change action, NOAC 916, Court Ordered FEHB Change, is used to indicate changes to court or administratively ordered FEHB changes.

The following authority codes are used with NOAC 916.

Remarks Codes

The following remark codes will be system-generated automatically with NOAC 916 for processing court or administratively ordered FEHB actions:

The messages for Remarks Codes FE1 and FE2 will be reflected on Form SF 50B, Notification of Personnel Action, when a court or administratively ordered action is processed.

Premium Conversion

Most employees whose Agency has an Approved Adoption Agreement with OPM are eligible to have their FEHB premiums paid under the premium conversion plan. Reemployed annuitants enrolled in the FEHB will automatically participate in the premium conversion, provided they are employed:

Participation in HB-PC is automatic unless an employee chooses to waive coverage. The part of an employee’s salary that is deducted for health insurance premiums is non-taxable. As a result, health benefits premiums are not subject to Federal income, Medicare, or Social Security taxes. In most cases, State and local taxes are also not applicable.

Agencies must deduct FEHB premiums on a pre-tax basis from the pay of these individuals unless they waive participation in premium conversion. HB-PC has no effect on the:

Changes in participation in premium conversion may be affected during the annual FEHB open enrollment period in conjunction with a qualifying life event.

Qualifying life events include:

Open Season

FEHB open season occurs annually. New enrollments and changes for the open season are effective the first pay period of the calendar year. All open season data should be entered as early as possible. The data will be retained in the future file until processing begins for the designated pay period.

If an employee plans to retire and requests an open season change on or before the effective date for an open season enrollment period, do not enter the health benefits data in PPS; include the SF 2809 with the employee’s retirement package. The employee should complete the SF 2809 but the Agency certifying office should only initial and date Part G to show timely submission. The name of the Agency and the signature of its certifying officer should not appear on the SF 2809. OPM uses the SF 2809 to complete the processing of the employee’s retirement request. Also include a memorandum with the retirement package to verify the employee’s eligibility to transfer health benefits coverage from PPS to OPM.

New Transfer Enrollments

Certain temporary employees are eligible to participate in the FEHB program. Agencies must verify the employee’s eligibility for FEHB coverage. PPS produces Report AE037U4, Temporary Employees-FEHB Coverage Eligibility, to identify eligible temporary employees. Agencies should supply eligible employees with the Enrollment Information Guide and Plan Comparison Chart, RI 70-5, and the SF 2809. To verify the Temporary FEHB Service Computation Date (SCD) recorded in the database, use IRIS Program IR115. If the FEHB effective data requires an adjustment, complete the Temporary FEHB-TEMP-SCD field on the Multi Element Update document.

When a new employee entered on duty (EOD) in the middle of the biweekly pay cycle from another Federal Department having a different biweekly pay cycle, the employee is not charged for benefits from both Departments. PPS automatically adjusts the employee’s FEHB on a prorated basis based on the effective date. The cost for part-time career employees is also prorated depending on Agency regulations. If an employee has a dual appointment, both Agencies contribute to the cost of FEHB.

If the effective date of the SF 2809 is prior to the effective date of the processing pay period and the employee is not currently enrolled, the uncollected premiums can be paid in a lump sum in one pay period or prorated. The Retro Collection by NFC field is used to indicate the choice of payment.

Premiums During Non-Pay Status

There are two cases when employees on LWOP should not be billed for health benefits premiums:

FEHB coverage cannot be continued if an employee reaches 26 consecutive pay periods of LWOP or LWOP pending OWCP.

Note: When FEHB coverage is canceled due to 365 days of LWOP status, the FEHB coverage code changes to 5 (canceled) after the personnel action is processed and the employee is automatically billed.

If a personnel action was processed for LWOP in excess of 30 days, timekeepers should not transmit after 30 days. A bill is generated for the health benefits premiums if Time and Attendance (T&A) reports are transmitted.

If an employee in non-pay status chooses not to pay their share of the health benefits premium before returning to work, the payroll office sends a letter to the employee indicating the amount owed. When the employee returns to duty, the entire amount may be automatically deducted each pay period, until the debt is repaid. For more information, see Title I, Chapter 11, Non-automated Processing.

If an employee separates from an Agency owing FEHB premiums, the amount due will be withheld from the employee’s final salary. If this amount is insufficient, it will be considered indebtedness due to the United States. Recovery of the funds is made from any lump sum payment due the employee, retirement deductions, annuities, or other monies owed to the employee by the Federal Government. For more information, see Title I, Chapter 8, Special Payroll Processing System (SPPS).

System-Generated SF 2810

Information on the SF 2810, Notice of Change in Health Benefits Enrollment, should not be entered in PPS under certain conditions. PPS generates the SF 2810 when one of the following personnel actions is processed, and the carrier copy is sent to the carrier.

New Enrollment

This section will show how to enter an employee’s SF 2809.

Note: Before the FEHB enrollment data can be entered in this module; FEHB Coverage must be established (i.e., FEHB Coverage Code 4, Eligible-Pending) in Benefits Data of the EmpowHR PAR module.

Before beginning, the following information is needed (refer to the SF 2809):

In This Section

Entering Health Benefits

Change in FEHB Enrollment

Cancel FEHB Enrollment

Verifying SF 2809 Data