Effective September 12, 2019, the Postal Service™ is revising the Employee and Labor Relations Manual (ELM), sections 525.1 and 525.2, to align with updates dictated by the Office of Personnel Management (OPM).
Office of Workers’ Compensation Programs (OWCP), an office within the U.S. Department of Labor, is responsible for determining employees’ eligibility to continue health benefits enrollment if employees are receiving workers’ compensation. The following rules apply:
a. Employees’ health benefits enrollment (and coverage of family members under a family enrollment), as well as enrollment of surviving beneficiaries, continue if employees enter on the compensation rolls of the OWCP, provided they meet the following requirements, according to the U.S. Department of Labor:
b. If the employee meets the requirements under 525.111a, while receiving compensation, the employee may continue enrollment during the first 365 days of leave without pay (LWOP). After that period, the employee must meet participation requirements for continuing enrollment after retirement: continuous enrollment (or coverage as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date compensation starts, or for the full period(s) of service since the employee’s first opportunity to enroll (if less than 5 years).
OWCP determines whether any survivors are eligible and wish to continue the enrollment, and continues or terminates the enrollment as appropriate. If survivors elect to receive survivor annuity in lieu of compensation, OWCP transfers the enrollment to the Office of Personnel Management (OPM) for processing.
Until the enrollment transfers, the Postal Service treats the employee receiving compensation, but no salary, as any other employee in nonpay status, for health benefits purposes. Enrollment continues up to and including 365 days. Then HRSSC terminates enrollment if the employee is not eligible to be transferred to OWCP.
When an employee who transferred to OWCP returns to pay status, OWCP transfers the employee’s enrollment to the employing office. OWCP will transfer the enrollment by letter, transmitting the health benefits documentation and providing the date compensation ended.
If the employee is eligible for continued coverage, the enrollment transfer will include a completed SF 2810, Notice of Change in Health Benefits Enrollment. The effective date of the transfer is the day after compensation terminated. If the employee is not eligible for continued coverage, HRSSC will complete a SF 2810, terminating the enrollment effective on the date that compensation ended.
Whether or not OWCP requests enrollment transfer, OWCP makes health benefits withholdings and contributions from the date compensation began, or the date following that on which the employing office withholdings and contributions ceased, whichever is later. OWCP makes no withholdings or contributions when an employee receives compensation for less than 29 days.
However, the employee is still responsible for payment of the premiums. Withholdings and contributions cease when an enrollment is terminated because the person has been in nonpay status for 365 days. After that period, the employee is not eligible to continue enrollment.
a. Explanation. The Health Benefits Refund Program is designed to reimburse injured employees for an overdeduction of health benefits premiums by the OWCP. For the first year of compensable disability, OWCP deducts health benefits premiums at the Postal Service rate. Thereafter, the deduction is made at the standard rate that the Office of Personnel Management (OPM) applies for federal employees.
The OPM premium rate may be higher than the Postal Service rate. Therefore, Postal Service employees enrolled in a health benefits plan and who are in LWOP status for over 1 year and also receiving OWCP compensation may be due a refund for overdeduction of health benefits premiums.
c. Verification of Eligibility. The Postal Service uses the Injury Compensation Performance Analysis System (ICPAS) Health Benefits Report to verify information in a completed PS Form 202, Health Benefits Refund Payment Authorization.
(1) Initiate quarterly a PS Form 202, Health Benefits Refund Payment Authorization (see Exhibit 525.132). In calculating the amount of refund to be paid, ICPAS will subtract the difference between the OPM health benefits premium rate and the Postal Service rate of the health benefits plan that the employee chose.