§ 894.101 Definitions

5 CFR 894.101This part is written as if the reader were an applicant or enrollee. Accordingly, the terms “you,” “your,” etc., refer, as appropriate, to the applicant or enrollee.

5 CFR 894.101 (definition of "Acquiring an eligible child")Acquiring an eligible child means one of the following:

5 CFR 894.101 (definition of "Acquiring an eligible child", paragraph (1))(1) Birth of a child;

5 CFR 894.101 (definition of "Acquiring an eligible child", paragraph (2))(2) Adoption of a child;

5 CFR 894.101 (definition of "Acquiring an eligible child", paragraph (3))(3) Acquisition of a foster child as described in § 890.101(a)(8) of this chapter;

5 CFR 894.101 (definition of "Acquiring an eligible child", paragraph (4))(4) Acquisition of a stepchild who lives with the enrollee in a regular parent-child relationship;

5 CFR 894.101 (definition of "Acquiring an eligible child", paragraph (5))(5) Establishment of a recognized natural child;

5 CFR 894.101 (definition of "Acquiring an eligible child", paragraph (6))(6) Residence change of the enrollee's stepchild or recognized natural child who moves in with the enrollee; and

5 CFR 894.101 (definition of "Acquiring an eligible child", paragraph (7))(7) An otherwise eligible child becoming unmarried due to divorce or annulment of marriage, or death.

5 CFR 894.101 (definition of "Administrator")Administrator means the entity with which the Office of Personnel Management contracts to manage the enrollment and premium payment process for the Federal Employees Dental and Vision Insurance Program (FEDVIP).

5 CFR 894.101 (definition of "Annuitant")Annuitant means an individual defined at 5 U.S.C. 8901(3). Generally, the term means a former employee or employee of the United States Postal Service who is entitled to an immediate annuity or a disability annuity under a retirement system established for employees. The term also generally includes those receiving a survivor annuity due to the death of an employee or employee of the United States Postal Service or annuitant (survivor annuitants) and those receiving compensation from the Office of Workers' Compensation Programs (compensationers). The term does not include former employees who retire with a deferred annuity under 5 U.S.C. 8413, or former spouses of annuitants.

5 CFR 894.101 (definition of "Carrier")Carrier means a company with which the Office of Personnel Management contracts to provide dental and/or vision benefits.

5 CFR 894.101 (definition of "Child")Child means:

5 CFR 894.101 (definition of "Child", paragraph (1))(1) Except as discussed in paragraph (4) of this definition, a child is one of the following:

5 CFR 894.101 (definition of "Child", paragraph (1)(i))(i) A child born within marriage;

5 CFR 894.101 (definition of "Child", paragraph (1)(ii))(ii) An adopted child;

5 CFR 894.101 (definition of "Child", paragraph (1)(iii))(iii) A stepchild or foster child who lives with the enrollee in a regular parent-child relationship; or

5 CFR 894.101 (definition of "Child", paragraph (1)(iv))(iv) A recognized natural child.

5 CFR 894.101 (definition of "Child", paragraph (2))(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).

5 CFR 894.101 (definition of "Child", paragraph (3))(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.

5 CFR 894.101 (definition of "Child", paragraph (4))(4) With respect to a TEl, child means a TEI child.

5 CFR 894.101 (definition of "Compensation")Compensation has the same meaning as found under subchapter I of chapter 81 of title 5, United States Code, which is payable because of an on-the-job injury or disease.

5 CFR 894.101 (definition of "Compensationer")Compensationer means an individual who is receiving compensation and who the Department of Labor determines is unable to return to duty.

5 CFR 894.101 (definition of "Covered position")Covered position means a position in which an employee is not excluded from FEDVIP eligibility by law or regulation.

5 CFR 894.101 (definition of "Days")Days means calendar days.

5 CFR 894.101 (definition of "Dependent")Dependent means an unmarried child who is living with or receiving regular and substantial support from the enrollee.

5 CFR 894.101 (definition of "Employee")Employee means an individual defined in 5 U.S.C. 8901. For the purposes of this subpart, the term employee additionally means an employee of the United States Postal Service and an employee of the District of Columbia courts.

5 CFR 894.101 (definition of "Enrollee")Enrollee means the individual in whose name the FEDVIP enrollment is carried. There is one FEDVIP enrollment for each enrollee in a dental plan, and/or in a vision plan and that enrollment may include family members who may be covered by the enrollment. The term enrollee includes individuals eligible to enroll based upon a status described at subpart C of this part, who enroll and are covered. With respect to the Federal workforce, an enrollee generally means an employee or annuitant. With respect to the United States Postal Service, an enrollee generally means an employee or annuitant of the United States Postal Service. With respect to a TEI, an enrollee generally means the sponsor who is a TEI with respect to a FEDVIP plan; but if the sponsor is not a TEI, or for FEDVIP dental benefits if the sponsor defined at § 894.804 is not enrolled and meets a condition at § 894.309(a)(3)(iii), then enrollee means the TEI certifying family member. A TEI former spouse may be an enrollee only for a self-only FEDVIP vision plan. An enrollee may enroll and elect a FEDVIP dental and/or vision plan, option, and type of enrollment, except as provided at § 894.309.

5 CFR 894.101 (definition of "Enrollment reconsideration")Enrollment reconsideration means the Administrator's review of its initial enrollment decision to determine if it followed the law and regulations correctly in making the initial decision concerning FEDVIP eligibility.

5 CFR 894.101 (definition of "Family member")Family member means a spouse (including a spouse under a valid common law marriage) and/or unmarried dependent child(ren) under age 22 or beyond age 22, if incapable of self-support because of mental or physical disability which existed before reaching age 22, as defined at 5 U.S.C. 8901(5). With respect to a TEI, the term family member means a TEI family member.

5 CFR 894.101 (definition of "OPM")OPM means the Office of Personnel Management.

5 CFR 894.101 (definition of "OWCP")OWCP means the Office of Workers' Compensation Programs, U.S. Department of Labor.

5 CFR 894.101 (definition of "Premium conversion")Premium conversion means the payment of FEDVIP premiums by an employee or United States Postal Service employee using pre-tax dollars. See § 892.102 of this chapter for a discussion of how premium conversion works.

5 CFR 894.101 (definition of "QLE")QLE means a qualifying life event.

5 CFR 894.101 (definition of "Recognized natural child")Recognized natural child means a biological child born outside of marriage. A recognized natural child is an eligible family member if the child lives with the enrollee or receives financial support from the enrollee.

5 CFR 894.101 (definition of "Regular parent-child relationship")Regular parent-child relationship means that the enrollee is exercising parental authority, responsibility, and control over the child; is caring for, supporting the child; and is making the decisions about the child's education and medical care.

5 CFR 894.101 (definition of "Sponsor")Sponsor generally means 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 members of the National Guard and Reserves), in accordance with § 894.804.

5 CFR 894.101 (definition of "Stepchild")Stepchild means your spouse's child born within or outside marriage or their adopted child. The child of your spouse shall continue to be considered your stepchild after your divorce from your spouse or the death of your spouse so long as the child continues to live with you in a regular parent-child relationship.

5 CFR 894.101 (definition of "TEI")TEI means TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) or a TRICARE-eligible individual for FEDVIP vision benefits (TEI-V).

5 CFR 894.101 (definition of "TEI certifying family member")TEI certifying family member means, where the sponsor is not an enrollee under § 894.309, the TEI family member who may accept responsibility to self-certify as an enrollee in accordance with § 894.809.

5 CFR 894.101 (definition of "TEI child")TEI child means an individual who is a TEI and who meets the definition of dependent in 10 U.S.C. 1072(2)(D) or (I) with respect to a sponsor.

5 CFR 894.101 (definition of "TEI family member")TEI family member means a TEI who is a dependent with respect to a sponsor, as defined in 10 U.S.C. 1072(2)(A) (spouse), 10 U.S.C. 1072(2)(B) (unremarried widow), 10 U.S.C. 1072(2)(C) (unremarried widower), 10 U.S.C. 1072(2)(D) (child), or 10 U.S.C 1072(2)(I) (unmarried person).

5 CFR 894.101 (definition of "TEI former spouse")TEI former spouse means a TEI who is an unremarried former spouse as defined in 10 U.S.C. 1072(2)(F), (G), or (H) and is entitled to medical care under 10 U.S.C. 1086(c) or (d).

5 CFR 894.101 (definition of "TRICARE-eligible individual (TEI)")TRICARE-eligible individual (TEI) means a TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) or a TRICARE-eligible individual for FEDVIP vision benefits (TEI-V), as the case may be.

5 CFR 894.101 (definition of "TRICARE-eligible individual for FEDVIP dental benefits")TRICARE-eligible individual for FEDVIP dental benefits (TEI-D) means an individual who is eligible for FEDVIP dental coverage based on the individual's eligibility to enroll or be covered under the TRICARE Retiree Dental Program, 10 U.S.C. 1076c(b) in accordance with § 894.802.

5 CFR 894.101 (definition of "TRICARE-eligible individual for FEDVIP vision benefits")TRICARE-eligible individual for FEDVIP vision benefits (TEI-V) means an individual who is eligible for FEDVIP vision coverage based on the individual's enrollment in a specified TRICARE health plan in accordance with § 894.803.

5 CFR 894.101 (definition of "Type of enrollment")Type of enrollment means one of the following:

5 CFR 894.101 (definition of "Type of enrollment", paragraph (1))(1) Self only;

5 CFR 894.101 (definition of "Type of enrollment", paragraph (2))(2) Self plus one; or

5 CFR 894.101 (definition of "Type of enrollment", paragraph (3))(3) Self and family.