PRIA, Government Policy, Made Personal

Summary

Lets people covered by federal group life insurance get a one-time lump-sum "living benefit" if a doctor says they are terminally ill with a life expectancy of 9 months or less. The Office of Personnel Management (OPM) must write rules for how to apply. The lump sum equals the full insurance amount (or a portion the person picks) as it would be figured under the rules, using a date set by OPM (but no later than 30 days after the claim is approved), and assuming coverage continues. That amount is reduced as needed so the payment does not increase the actuarial value of the benefit. If someone takes the lump sum, no further life insurance pays at death unless they took only part of the benefit. If only part was taken, the remaining death benefit is cut by the same percentage, and the new basic amount is rounded to the nearest $1,000 (if exactly halfway, round up). Payroll deductions and agency contributions stop or are reduced to match, effective for amounts due on or after the payment date. The person may still buy optional coverage if they pay the full cost. Applications must include medical proof that life expectancy is 9 months or less, and agencies may require an exam at no cost to the person. The choice is final, can be made only once, may be for a multiple of $1,000 if allowed, and OPM must have rules for people age 65 and older. Decisions are not subject to administrative review.

Title 5, §8714d

Government Organization and Employees, Source: USLM XML via OLRC

(a)For the purpose of this section, an individual shall be considered to be “terminally ill” if such individual has a medical prognosis that such individual’s life expectancy is 9 months or less.

(b)The Office of Personnel Management shall prescribe regulations under which any individual covered by group life insurance under section 8704(a) may, if such individual is terminally ill, elect to receive a lump-sum payment equal to—

(1)the full amount of insurance under section 8704(a) (or portion thereof designated for this purpose under subsection (d)(4)) which would otherwise be payable under this chapter (on the establishment of a valid claim)—

(A)computed based on a date determined under regulations of the Office (but not later than 30 days after the date on which the individual’s application for benefits under this section is approved or deemed approved under subsection (d)(3)); and

(B)assuming continued coverage under this chapter at that time;

reduced by

(2)an amount necessary to assure that there is no increase in the actuarial value of the benefit paid (as determined under regulations of the Office).

(c)(1)If a lump-sum payment is taken under this section—

(A)no insurance under the provisions of section 8704(a) or (b) shall be payable based on the death or any loss of the individual involved, unless the lump-sum payment represents only a portion of the total benefits which could have been taken, in which case benefits under those provisions shall remain in effect, except that the basic insurance amount on which they are based—

(i)shall be reduced by the percentage which the designated portion comprised relative to the total benefits which could have been taken (rounding the result to the nearest multiple of $1,000 or, if midway between multiples of $1,000, to the next higher multiple of $1,000); and

(ii)shall not be subject to further adjustment; and

(B)deductions and withholdings under section 8707, and contributions under section 8708, shall be terminated with respect to such individual (or reduced in a manner consistent with the percentage reduction in the individual’s basic insurance amount, if applicable), effective with respect to any amounts which would otherwise become due on or after the date of payment under this section.

(2)An individual who takes a lump-sum payment under this section (whether full or partial) remains eligible for optional benefits under section 8714a–8714c (subject to payment of the full cost of those benefits in accordance with applicable provisions of the section or sections involved, to the same extent as if no election under this section had been made).

(d)(1)The Office’s regulations shall include provisions regarding the form and manner in which an application under this section shall be made and the procedures in accordance with which any such application shall be considered.

(2)An application shall not be considered to be complete unless it includes such information and supporting evidence as the regulations require, including certification by an appropriate medical authority as to the nature of the individual’s illness and that the individual is not expected to live more than 9 months because of that illness.

(3)(A)In order to ascertain the reliability of any medical opinion or finding submitted as part of an application under this section, the covered individual may be required to submit to a medical examination under the direction of the agency or entity considering the application. The individual shall not be liable for the costs associated with any examination required under this subparagraph.

(B)Any decision by the reviewing agency or entity with respect to an application for benefits under this section (including one relating to an individual’s medical prognosis) shall not be subject to administrative review.

(4)(A)An individual making an election under this section may designate that only a limited portion (expressed as a multiple of $1,000) of the total amount otherwise allowable under this section be paid pursuant to such election.

(B)A designation under this paragraph may not be made by an individual described in paragraph (1) or (2) of section 8706(b).

(5)An election to receive benefits under this section shall be irrevocable, and not more than one such election may be made by any individual.

(6)The regulations shall include provisions to address the question of how to apply section 8706(b)(3)(B) in the case of an electing individual who has attained 65 years of age.

Statutory Notes and Related Subsidiaries

Effective Date

of 1994 Amendment Pub. L. 103–409, § 3(a), Oct. 25, 1994, 108 Stat. 4232, provided that: “The

Amendments

made by section 2 [enacting this section] shall take effect 9 months after the date of the enactment of this Act [Oct. 25, 1994].”

§8714d Option to Receive “living Benefits”

Summary

Title 5, §8714d

Notes & Related Subsidiaries

Statutory Notes and Related Subsidiaries

Effective Date

Amendments

Citations & Metadata