B-152851, JAN. 9, 1964

B-152851: Jan 9, 1964

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REPRESENTING FEDERAL EMPLOYEES HEALTH BENEFITS PREMIUMS THAT WERE WITHHELD FROM HER FINAL COMPENSATION PAYMENT AT THE TIME OF HER SEPARATION FROM THE FEDERAL HOUSING ADMINISTRATION. THE INFORMATION FURNISHED SHOWS THAT MISS MIGLIETTA WAS ENROLLED UNDER THE SERVICE BENEFIT PLAN OF THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT ON JULY 10. THE ORIGINAL OF THE FORM WAS GIVEN TO MISS MIGLIETTA AND A PROPER DISTRIBUTION OF THE REMAINING COPIES WAS MADE. THIS FOLDER WAS ROUTED DIRECT TO THE WASHINGTON HEADQUARTERS AND THE BOSTON OFFICE WAS UNABLE TO DETERMINE. THIS MISUNDERSTANDING APPARENTLY AROSE BECAUSE SHE WAS UNDER THE IMPRESSION THAT THE PROCESSING CLERK WAS REFERRING TO COVERAGE UNDER THE FEDERAL EMPLOYEES GROUP LIFE INSURANCE ACT.

B-152851, JAN. 9, 1964

TO MR. LESTER H. THOMPSON, AUTHORIZED CERTIFYING OFFICER, FEDERAL HOUSING ADMINISTRATION:

THIS REFERS TO YOUR LETTER OF NOVEMBER 5, 1963, REFERENCE FB:GV, WITH ENCLOSURES, WHEREIN YOU REQUEST OUR DECISION WHETHER YOU MAY CERTIFY FOR PAYMENT A VOUCHER IN FAVOR OF MISS JOSEPHINE MIGLIETTA, IN THE AMOUNT OF $56.97, REPRESENTING FEDERAL EMPLOYEES HEALTH BENEFITS PREMIUMS THAT WERE WITHHELD FROM HER FINAL COMPENSATION PAYMENT AT THE TIME OF HER SEPARATION FROM THE FEDERAL HOUSING ADMINISTRATION.

THE INFORMATION FURNISHED SHOWS THAT MISS MIGLIETTA WAS ENROLLED UNDER THE SERVICE BENEFIT PLAN OF THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT ON JULY 10, 1960, WHILE EMPLOYED BY THE BOSTON ORDNANCE DISTRICT, DEPARTMENT OF THE ARMY, AND THAT SHE TRANSFERRED TO THE FEDERAL HOUSING ADMINISTRATION EFFECTIVE JUNE 10, 1962, WITHOUT A BREAK IN SERVICE OF MORE THAN 3 DAYS. AT THE TIME OF MISS MIGLIETTA'S TRANSFER TO THE FEDERAL HOUSING ADMINISTRATION, THE DEPARTMENT OF THE ARMY ISSUED A NOTICE OF CHANGE IN HEALTH BENEFITS ENROLLMENT, TRANSFERRING HER ENROLLMENT TO THE WASHINGTON OFFICE. THE ORIGINAL OF THE FORM WAS GIVEN TO MISS MIGLIETTA AND A PROPER DISTRIBUTION OF THE REMAINING COPIES WAS MADE, INCLUDING THE INSERTION OF A COPY IN THE OFFICIAL PERSONNEL FOLDER. THIS FOLDER WAS ROUTED DIRECT TO THE WASHINGTON HEADQUARTERS AND THE BOSTON OFFICE WAS UNABLE TO DETERMINE, FROM THIS SOURCE, HER STATUS UNDER THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT.

DUE TO A MISUNDERSTANDING AT THE TIME OF MISS MIGLIETTA'S ENTRANCE ON DUTY IN THE BOSTON OFFICE SHE ADVISED THE PROCESSING CLERK THAT SHE HAD NO INSURANCE. THIS MISUNDERSTANDING APPARENTLY AROSE BECAUSE SHE WAS UNDER THE IMPRESSION THAT THE PROCESSING CLERK WAS REFERRING TO COVERAGE UNDER THE FEDERAL EMPLOYEES GROUP LIFE INSURANCE ACT. IN OCTOBER 1962 MISS MIGLIETTA NOTED THAT NO DEDUCTIONS WERE BEING MADE FROM HER SALARY FOR HEALTH INSURANCE BENEFITS. SHE CALLED THIS MATTER TO THE ATTENTION OF THE TIME CLERK AND PRESENTED THE NOTICE OF CHANGE IN HEALTH BENEFITS ENROLLMENT WHICH SHE HAD RECEIVED FROM THE DEPARTMENT OF THE ARMY. THE TIME CLERK INFORMED HER THAT SINCE SHE HAD STATED AT THE TIME OF ENTERING ON DUTY THAT SHE WAS NOT COVERED THERE WOULD BE NO DEDUCTIONS. MISS MIGLIETTA REQUESTED THAT A LETTER BE WRITTEN TO THE WASHINGTON OFFICE TO DETERMINE HER STATUS; HOWEVER, THE BOSTON OFFICE FAILED TO MAKE THE INQUIRY AS IT FELT IT WAS UNNECESSARY.

IN MAY 1963 IT WAS DISCOVERED THAT NEITHER A HEALTH BENEFITS REGISTRATION FORM NOR A NOTICE OF CHANGE IN HEALTH BENEFITS ENROLLMENT WAS ON FILE FOR MISS MIGLIETTA. AT THAT TIME THE BOSTON OFFICE WAS REQUESTED TO INVESTIGATE AND A CANCELLATION FORM WAS COMPLETED TO REFLECT MAY 27, 1963, AS THE DATE RECEIVED IN THE EMPLOYING OFFICE, AND JUNE 22, 1963, AS THE EFFECTIVE DATE OF CANCELLATION.

THE VOUCHER IN THE AMOUNT OF $56.97 REPRESENTS REFUNDS OF HEALTH BENEFITS FOR THE PERIOD JUNE 10, 1962, THROUGH JUNE 22, 1963. SECTION 10/B) OF THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT OF 1959, PUB.L. 5 U.S.C. 3009/B) 861382, 73 STAT. (15, AUTHORIZED THE CIVIL SERVICE COMMISSION TO PROMULGATE REGULATIONS WITH RESPECT TO THE BEGINNING AND ENDING OF DATES OF COVERAGE OF EMPLOYEES AND ANNUITANTS AND MEMBERS OF THEIR FAMILIES UNDER HEALTH BENEFITS PLANS. SECTION 89.6 OF THE REGULATIONS PERTAINING TO THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM CONTAINED IN THE FEDERAL PERSONNEL MANUAL, PAGE ZI-405, PROVIDES THAT AN ENROLLED EMPLOYEE COVERED UNDER THE HEALTH BENEFITS PROGRAM WHO DESIRES TO TERMINATE HIS ENROLLMENT IS REQUIRED TO FILE WITH HIS EMPLOYING OFFICE A PROPERLY COMPLETED HEALTH BENEFITS REGISTRATION FORM. THE CANCELLATION BECOMES EFFECTIVE ON THE LAST DAY OF THE PAY PERIOD FOLLOWING THE PAY PERIOD IN WHICH THE HEALTH BENEFITS REGISTRATION FORM CANCELLING HIS ENROLLMENT IS RECEIVED BY HIS EMPLOYING OFFICE. THE REGULATION CITED ABOVE WAS PROMULGATED PURSUANT TO THE ABOVE STATUTORY AUTHORITY AND HAS THE FORCE AND EFFECT OF LAW. EVEN IF THE MISUNDERSTANDING IN THE MATTER WAS PRIMARILY THE FAULT OF AN EMPLOYEE THE AGENCY, NEVERTHELESS, THE REGULATION WAS STILL BIDING ON MISS MIGLIETTA AS WELL AS THE AGENCY. MOREOVER, HER POLICY WOULD STILL HAVE BEEN OPERABLE DURING THE PERIOD IN QUESTION IN THE EVENT SHE HAD INCURRED ANY ILLNESS OTHERWISE COVERED THEREBY.

SINCE THE PROPER STEPS WERE NOT TAKEN BY MISS MIGLIETTA TO CANCEL HER PARTICIPATION PRIOR TO MAY 27, 1963, IN THE HEALTH BENEFITS PROGRAM AND AS SHE WAS COVERED BY THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT DURING THE PERIOD IN QUESTION IT WAS NECESSARY THAT HEALTH PREMIUMS BE COLLECTED FROM HER.

ACCORDINGLY, THE VOUCHER WHICH IS RETURNED, TOGETHER WITH ACCOMPANYING PAPERS, MAY NOT BE CERTIFIED FOR PAYMENT.