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1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What references were used when writing this section?
4. Where are the responsibilities listed for this section?
5. What are the procedures for enrollment and enrollment changes?
6. How are disputed health benefits claims reviewed and resolved?
7. What are the procedures for payment of health benefits premiums for periods of non-pay status or insufficient pay?

1. What is the purpose of this section? This section establishes procedures relating to the Federal Employees Health Benefits Program (FEHBP) for the Federal Highway Administration (FHWA). This section is to be used in conjunction with the Federal Employees Health Benefits Handbook.

2. Does this directive cancel an existing FHWA directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What references were used when writing this section?

   1. Title 5, United States Code (U.S.C.), Chapter 89.

   2. Title 5, Code of Federal Regulations (CFR), Part 890, Federal Employees Health Benefits Program.

   3. Federal Employees Health Benefits Handbook.

4. Where are the responsibilities listed for this section? The responsibilities of the servicing personnel and payroll offices are listed in the Federal Employees Health Benefits Handbook.

5. What are the procedures for enrollment and enrollment changes? Specific information regarding employee eligibility for health benefits coverage and all other aspects of the FEHBP is found in the Federal Employees Health Benefits Handbook. The following instructions concern completion of the two forms utilized by FHWA in the administration of this program.

   1. General. Standard Form (SF)-2809, Health Benefits Registration, and SF-2810, Notice of Change in Health Benefits Enrollment, are processed within one week after receipt in the servicing human resources office, except for Open Season changes that are processed directly through Employee Express. This is especially important to the benefit carriers to keep them fully informed of the status of their employee’s enrollment. It is also important to employees in protecting their eligibility for benefits and to FHWA in preventing the need for adjustments in payroll withholdings and Federal government contributions.

   2. Enrollment. The following procedures are used for registration by:

      1. Washington Headquarters employees. The employee submits SF-2809 to the Human Resources Services Group (HAHR-20) where it is immediately dated in Part F2 and reviewed for employee eligibility and completeness of the form.

      2. Resource Center employees. The employee submits SF-2809 to his/her servicing human resources office where it is immediately dated in Part F2 and reviewed for employee eligibility and completeness of the form.

      3. Division Office employees. The employee submits SF-2809 to the administrative manager or his/her designee where it is immediately dated in Part F2 and forwarded to the servicing human resources office for processing as outlined in paragraph 5b(2).

      4. Overseas employees. The employee submits SF-2809 to the Office of International Programs, where it is immediately dated in Part F2 and forwarded to HAHR-20 for processing as outlined in paragraph 5b(1).

   3. Enrollment changes. Guidelines for preparing SF-2810 when an employee makes a change in enrollment are found in the Federal Employees Health Benefits Handbook. HAHR-20 completes the SF-2810 for enrollment changes for employees whose official personnel folder (OPF) is maintained by the Washington Headquarters Office of Human Resources. The field servicing human resources office completes the SF-2810 for enrollment changes for employees whose OPFs they maintain.

6. How are disputed health benefits claims reviewed and resolved?

   1. Employees may have their claims reconsidered by the carrier when benefit claims are denied. Requests for reconsideration must be made within one year of the claim's denial and should state why the employee believes the claim should have been paid. The carrier must make a determination within 30 days unless the carrier requests additional information. The employee has 60 days to supply any requested information. If the claim is again denied or if the carrier fails to respond to a request to reconsider within 30 days of the request, the employee has 90 days in which to request in writing that the Office of Personnel Management (OPM) review the claim.

   2. Requests for OPM review are addressed to Office of Personnel Management, Office of Insurance Services Programs, Health Insurance Group 2, 1900 E Street, NW, Washington, D.C. 20415. Since OPM reviews are based on its contracts with carriers, employees should refer to the plan brochure in all correspondence dealing with denied claims. To expedite processing, attach copies of all information relating to the claim. The OPM will request from the employee any additional information deemed necessary. Requests for information from other parties will be made only with employee's written consent. The OPM will notify the employee and the carrier of its final decision within 30 days after receipt of all information.

7. What are the procedures for payment of health benefits premiums for periods of non-pay status or insufficient pay?

   1. HAHR-20 will notify Washington Headquarters employees in a non-pay status that they are responsible for paying the employee share for their continuing health benefits enrollment during a non-pay status. The field servicing human resources offices will be responsible for notifying field employees of their responsibility for paying the employee share during a non-pay status.

   2. Coverage in a non-pay status may continue up to 365 days. For every pay period in a non-pay status, employees may either pay the premium directly to the FHWA or incur an indebtedness to be paid upon return to pay status, or to be withheld from any other monies owed to the employee by the Federal government.

   3. Employees also have the option of canceling their health benefits at anytime or during an extended period of non-pay status.