Request for Waiver of Collection of Health Benefits Premiums

A Federal employee appealed a Claims Group settlement which denied his request for waiver of collection of elective health benefits premiums. The employee was enrolled in a family plan health benefits program. Through an administrative error incident to his transfer and promotion, his payroll deduction for health benefits was coded at the self-only rate. As a result, until he discovered and reported the under-deduction, he was erroneously overpaid. The Claims Group denied a request for waiver of the overpayments because the employee should have noticed that his deduction for health benefits coverage decreased after his transfer. Since he was not expecting such a decrease, he should have promptly questioned officials and, until his pay was resolved, retained the excess amounts for refund to the government. The Claims Group concluded that the employee's failure to take the proper, prudent actions in this matter placed him at least partially at fault, which precluded waiver of the claim. The employee contended that the mistake was the agency's administrative error and, thus, any fault in the matter was equally upon the government. He also felt that his prompt reporting of the matter indicated a lack of fraud, misrepresentation, and fault. The costs of the health benefits coverage were known to the employee, or could at least be ascertained, and the employee's earnings statements clearly indicated the amount which was being deducted per pay period. Therefore, the employee could have easily deduced the error. The employee was at least partially at fault in failing to notice the error, and the indication of fault precludes favorable waiver consideration. The employee was entitled to health services at the family plan coverage level during the period when self-only premiums were being collected. Thus, it was not against equity and good conscience to require payment for the health benefits coverage provided for the period in question. Accordingly, GAO sustained the action of the Claims Group denying the request for waiver.