Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What references were used when writing this section?
4. Where are the responsibilities listed for this section?
5. What are the procedures for enrollment and enrollment changes?
6. How are disputed health benefits claims reviewed and resolved?
7. What are the procedures for payment of health benefits premiums for periods of non-pay status or insufficient pay?

1. What is the purpose of this section? This section establishes procedures relating to the Federal Employees Health Benefits Program (FEHBP) for the Federal Highway Administration (FHWA). This section is to be used in conjunction with the Federal Employees Health Benefits Handbook.

2. Does this directive cancel an existing FHWA directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What references were used when writing this section?

   1. Title 5, United States Code (U.S.C.), Chapter 89.

   2. Title 5, Code of Federal Regulations (CFR), Part 890, Federal Employees Health Benefits Program.

   3. Federal Employees Health Benefits Handbook.

4. Where are the responsibilities listed for this section? The responsibilities of the servicing personnel and payroll offices are listed in the Federal Employees Health Benefits Handbook.

5. What are the procedures for enrollment and enrollment changes? Specific information regarding employee eligibility for health benefits coverage and all other aspects of the FEHBP is found in the Federal Employees Health Benefits Handbook. The following instructions concern completion of the two forms utilized by FHWA in the administration of this program.

   1. General. Standard Form (SF)-2809, Health Benefits Registration, and SF-2810, Notice of Change in Health Benefits Enrollment, are processed within one week after receipt in the servicing human resources office, except for Open Season changes that are processed directly through Employee Express. This is especially important to the benefit carriers to keep them fully informed of the status of their employee’s enrollment. It is also important to employees in protecting their eligibility for benefits and to FHWA in preventing the need for adjustments in payroll withholdings and Federal government contributions.

   2. Enrollment. The following procedures are used for registration by:

      1. Washington Headquarters employees. The employee submits SF-2809 to the Human Resources Services Group (HAHR-20) where it is immediately dated in Part F2 and reviewed for employee eligibility and completeness of the form.

      2. Resource Center employees. The employee submits SF-2809 to his/her servicing human resources office where it is immediately dated in Part F2 and reviewed for employee eligibility and completeness of the form.

      3. Division Office employees. The employee submits SF-2809 to the administrative manager or his/her designee where it is immediately dated in Part F2 and forwarded to the servicing human resources office for processing as outlined in paragraph 5b(2).

      4. Overseas employees. The employee submits SF-2809 to the Office of International Programs, where it is immediately dated in Part F2 and forwarded to HAHR-20 for processing as outlined in paragraph 5b(1).

   3. Enrollment changes. Guidelines for preparing SF-2810 when an employee makes a change in enrollment are found in the Federal Employees Health Benefits Handbook. HAHR-20 completes the SF-2810 for enrollment changes for employees whose official personnel folder (OPF) is maintained by the Washington Headquarters Office of Human Resources. The field servicing human resources office completes the SF-2810 for enrollment changes for employees whose OPFs they maintain.

6. How are disputed health benefits claims reviewed and resolved?

   1. Employees may have their claims reconsidered by the carrier when benefit claims are denied. Requests for reconsideration must be made within one year of the claim's denial and should state why the employee believes the claim should have been paid. The carrier must make a determination within 30 days unless the carrier requests additional information. The employee has 60 days to supply any requested information. If the claim is again denied or if the carrier fails to respond to a request to reconsider within 30 days of the request, the employee has 90 days in which to request in writing that the Office of Personnel Management (OPM) review the claim.

   2. Requests for OPM review are addressed to Office of Personnel Management, Office of Insurance Services Programs, Health Insurance Group 2, 1900 E Street, NW, Washington, D.C. 20415. Since OPM reviews are based on its contracts with carriers, employees should refer to the plan brochure in all correspondence dealing with denied claims. To expedite processing, attach copies of all information relating to the claim. The OPM will request from the employee any additional information deemed necessary. Requests for information from other parties will be made only with employee's written consent. The OPM will notify the employee and the carrier of its final decision within 30 days after receipt of all information.

7. What are the procedures for payment of health benefits premiums for periods of non-pay status or insufficient pay?

   1. HAHR-20 will notify Washington Headquarters employees in a non-pay status that they are responsible for paying the employee share for their continuing health benefits enrollment during a non-pay status. The field servicing human resources offices will be responsible for notifying field employees of their responsibility for paying the employee share during a non-pay status.

   2. Coverage in a non-pay status may continue up to 365 days. For every pay period in a non-pay status, employees may either pay the premium directly to the FHWA or incur an indebtedness to be paid upon return to pay status, or to be withheld from any other monies owed to the employee by the Federal government.

   3. Employees also have the option of canceling their health benefits at anytime or during an extended period of non-pay status.

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing directive?
3. What references were used when writing this section?
4. What are the responsibilities for this section?
5. Who is covered by CSRS?
6. What is the basic annuity plan?
7. What is the Thrift Savings Plan?
8. How do I request an annuity computation?
9. What are the procedures for applying for retirement?
10. What are my health insurance benefits?
11. What are my life insurance benefits?
12. What is a refund of retirement deductions?
13. What are deposits and redeposits to the retirement fund?

1. What is the purpose of this section? This section establishes responsibilities and procedures related to retirement, insurance, and income protection for employees under the Civil Service Retirement System (CSRS). This section is designed to be used in conjunction with the Civil Service Retirement System and Federal Employees Retirement System Handbook for Personnel and Payroll Offices (CSRS/FERS Handbook).

2. Does this directive cancel an existing directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What references were used when writing this section?

   1. Title 5, United States Code (U.S.C.), Chapter 83.

   2. Title 5, Code of Federal Regulations (CFR), Part 831, Retirement.

   3. CSRS/FERS Handbook.

   4. Summary of the Thrift Savings Plan for Federal Employees.

4. What are the responsibilities for this section?

   1. The servicing human resources office is responsible for:

      1. Determining employee's eligibility for CSRS coverage;

      2. Counseling and informing employees of their benefits, obligations, required forms, and procedures, and providing assistance in completing required forms;

      3. Making creditable service determinations for computation purposes;

      4. Considering position reassignment options, if possible, when the employee applies for disability retirement;

      5. Providing counseling assistance to the family of a deceased employee; and

      6. Reviewing and processing completed retirement forms and resolving any problems that may arise.

   2. Supervisors are responsible for:

      1. Preparing the Standard Form (SF)-52, Request for Personnel Action, for each retiring employee and submitting it with other required forms to the servicing human resources office for processing;

      2. Arranging for the servicing human resources office to provide counseling assistance to the employee's family upon death of an employee; and

      3. Furnishing a supervisor's statement in connection with any Application for Disability Retirement.

   3. Employees are responsible for:

      1. Completing the required forms and providing other information when applying for retirement;

      2. Obtaining retirement counseling, annuity estimates, required forms, and other desired information; and

      3. Keeping the servicing human resources office apprised of any change in personal status affecting retirement entitlements.

5. Who is covered by CSRS? All career or career-conditional employees hired prior to January 1, 1984, are automatically covered under CSRS, unless specifically excluded by law or regulation. Employees previously covered under CSRS who are rehired after a break in service of less than 365 days will be covered by CSRS. Employees who: (1) were previously covered by the CSRS for five or more years, and (2) leave Federal service and return after a break in service of more than 365 days will be covered by the CSRS Offset Plan. This means that the employee will be covered by Social Security and the CSRS.

6. What is the basic annuity plan?

   1. Employee contributions

      1. CSRS employees will be required to contribute 7 percent of their total salary into the retirement fund, plus 1.45 percent of their total salary for Medicare. The Social Security Administration periodically adjusts the Medicare contribution percentage.

      2. CSRS Offset employees will contribute 8.45 percent of their total salary, the same as for a CSRS employee. Specific information on employee contributions is listed in the CSRS/FERS Handbook.

      3. Employees may, at their option, make voluntary contributions to the Thrift Savings Plan. Specific information regarding the Thrift Savings Plan is found in paragraph 7 of this section.

   2. Retirement eligibility. Under the CSRS, employees may retire and receive an immediate annuity if they have a combination of age and Federal service as shown in the Attachment 1 at the end of this section.

   3. Annuity formula. The basic annuity is a percentage of the employee's "high-3"; average salary. The "high-3"; average salary is based on the highest 3 years of base pay or salary earned in any consecutive 3-year period (usually the employee's last 3 years).

      1. The "high-3"; percentage is determined by a three-part formula based on the length of creditable service. The employee earns:

         • 1.50% per year for the first 5 years or 7.50% plus

         • 1.75% per year for the next 5 years or 8.75% =

         • 16.25% plus

         • 2.00% per year for service over 10 years

      2. By law, the percentage is limited to 80% (reached after 41 years and 11 months of service); however unused sick leave can be used with the formula to produce a higher annuity. Unused sick leave is converted into months and days and added to the employee's other service. Credit is given for whole months only in 30 days increments. However, the time representing days of unused sick leave is not counted toward the employee's "high-3"; years average salary or for establishing eligibility for retirement.

      3. An employee can increase his/her retirement income by buying additional annuity through voluntary contributions to the retirement system. The servicing human resources office can provide specific information on buying additional annuity. Further information can be found in the CSRS publication Retirement Facts 10, Voluntary Contributions under the Civil Service Retirement System.

      4. When reaching age 62, employees under the CSRS Offset Plan will have their annuity reduced by the amount of their Social Security benefit attributable to their dually-covered service.

   4. Disability retirement. If an employee retires on disability, the employee is guaranteed a minimum basic annuity that amounts to the lesser of:

      1. 40 percent of the "high-3" average pay, or

      2. the earned annuity if the length of service was extended to age 60.

   5. Retirement before age 55. If an employee voluntarily retires during a major reduction-in-force or is involuntarily separated and is younger than age 55, the annuity will be reduced by 1/6 of 1 percent (2% per year) for each month under age 55. There is no age reduction of an employee who retires under the disability provision.

   6. Death benefits.

      1. If an employee dies after 18 months or more of Federal civilian service, the widow or widower will automatically get an annuity, provided they were married at least nine months (or if there is a child from the marriage). The widow or widower is entitled to a guaranteed minimum yearly annuity, which is 55 percent of the lesser of:

         1. 22 percent of the employee's "high-3" average pay, or

         2. 55 percent of the amount the annuity would have been if the employee had continued working until age 60 at the same "high-3."

      2. A spouse's survivor annuity begins on the day after the employee's death. It ends at the end of the month preceding the month in which the survivor dies or remarries before age 55.

      3. Unmarried dependent children will also be entitled to annuities if an employee dies while in service. Their annuities will continue until they reach age 18, or age 22 if they are full-time students. A child declared incapable of self-support by reason of mental or physical disability incurred before age 18 will continue to receive an annuity. The Office of Personnel Management (OPM) will arrange for a physical examination to make the determination.

7. What is the Thrift Savings Plan? All CSRS and CSRS Offset employees are eligible to participate in the Thrift Savings Plan. Participation is totally voluntary. Please refer to the Summary of the Thrift Savings Plan for Federal Employees for specific information about this program.

8. How do I request an annuity computation? Employees may request an estimate of their annuity or other retirement information from their servicing human resources office.

9. What are the procedures for applying for retirement?

   1. Employees should contact their servicing human resources office for a complete explanation and copies of the required retirement forms.

   2. Employees should submit the completed retirement forms to their supervisor prior to separation to apply for retirement benefits. The supervisor should forward these forms, along with a completed SF-52, Request for Personnel Action, to the servicing human resources office for processing.

10. What are my health insurance benefits? Specific information regarding eligibility for continuing health benefits coverage during retirement and other aspects of the Federal Employees Health Benefits (FEHB) Program as it relates to the retiring employee is found in the FEHB Handbook.

11. What are my life insurance benefits? Specific information regarding eligibility for continuance of life insurance coverage during retirement and other aspects of the Federal Employees Group Life Insurance (FEGLI) Program as it relates to retiring employees is found in the FEGLI Program Handbook.

12. What is a refund of retirement deductions? An employee who separates from the Federal service may request the refund of retirement deductions by submitting the SF-2802, Application for Refund of Retirement Deductions, to the servicing human resources office or, if he or she has been separated more than 30 days, directly to the OPM. If the employee is (was) married while contributing under CSRS, notification of the employee's current (or former) spouse is required.

13. What are deposits and redeposits to the retirement fund? The SF-2803, Application to Make Deposit or Redeposit, is to be completed by the employee when applying to make a deposit to the retirement fund for creditable service when deductions were not made or to make a redeposit when deductions were previously withdrawn. The SF-2803 should be forwarded to the servicing human resources office for processing.

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What references were used when writing this section?
4. What are the responsibilities for this section?
5. What is the coverage for this section?
6. What is the basic annuity plan?
7. What is the Thrift Savings Plan?
8. What are death benefits?
9. How do I request an annuity computation?
10. What are the procedures for applying for retirement?
11. What are my health insurance benefits?
12. What are my life insurance benefits?
13. What is a refund of retirement deductions?
14. What are deposits and redeposits to the retirement fund?

1. What is the purpose of this section? This section establishes responsibilities and procedures for the Federal Employees Retirement System (FERS), the Basic Annuity Plan, and the Thrift Savings Plan.

2. Does this directive cancel an existing FHWA directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What references were used when writing this section?

   1. Title 5, United States Code (U.S.C.), Chapter 84.

   2. Title 5, Code of Federal Regulations (CFR), Part 841, Federal Employment Retirement System.

   3. The Civil Service Retirement System and Federal Employees Retirement System Handbook for Personnel and Payroll Offices (CSRS/FERS Handbook)

4. What are the responsibilities for this section?

   1. The servicing human resources office is responsible for:

      1. Determining the employee's eligibility for coverage;

      2. Counseling and informing the employees of their benefits, obligations, required forms, procedures, and providing assistance in completing required forms;

      3. Making creditable service determinations for computation purposes;

      4. Considering the position reassignment options, if possible, when the employee applies for disability retirement;

      5. Providing counseling assistance to the family of a deceased employee; and

      6. Reviewing and processing the completed retirement forms and resolving any problems that may arise.

   2. Supervisors are responsible for:

      1. Preparing the Standard Form (SF)-52, Request for Personnel Action, for each retiring employee and submitting it with other required forms to the servicing human resources office for processing;

      2. Arranging for the servicing human resources office to provide counseling assistance to employee's family upon death of an employee; and

      3. Furnishing a supervisor's statement in connection with the application for disability retirement.

   3. Employees are responsible for:

      1. Completing the required forms and providing other information when applying for retirement;

      2. Obtaining retirement counseling, annuity estimates, required forms, and other desired information; and

      3. Keeping the servicing human resources office apprised of any change in personal status affecting retirement entitlements.

5. What is the coverage for this section? On June 6, 1986, the President signed the Federal Employees' Retirement System Act of 1986. FERS bases future pension benefits on a combination of Social Security, a FERS retirement annuity, and earnings from a tax-deferred savings plan. Those employees covered by FERS include:

   1. New employees first hired into the Federal government on or after January 1, 1984.

   2. Employees with a break in service of more than 365 days with less than five years under the Civil Service Retirement System (CSRS).

   3. Current CSRS employees who elected to transfer to FERS during the open seasons which occurred during July 1 through December 31, 1987, or July 1, 1998, through December 31, 1998.

   4. Employees rehired after December 31, 1986, with more than five years of service under the CSRS ("five-year rule") who elect to transfer to FERS. These employees will have an immediate six-month open season during which they may elect to transfer to FERS.

   5. Employees, serving on "Term, Temporary Appointment Pending Establishment of a Register (TAPER), or Indefinite" appointments, unless excluded because of the "five-year rule".

6. What is the basic annuity plan?

   1. Employee contributions. Employee contributions to the Basic Benefit Plan is the difference between 7% of the employee's basic pay and Social Security's old age, survivor, and disability insurance tax rate, or 0.8%. Employee contributions into the Thrift Savings Plan are voluntary.

   2. Retirement eligibility. Under the FERS, employees may retire and receive an immediate annuity if they have at least the amount of Federal service shown in the Attachment 1 at the end of this section.

   3. Annuity formula. The basic annuity is computed on factors of length of service (no credit will be given for unused sick leave except for transferees from CSRS) and "high-3" average pay. "High-3" average pay is the largest annual rate of pay resulting from averaging over any period of three consecutive years of creditable service. The annual annuity is computed by multiplying 1 percent of "high-3" pay times years of service, or 1.1 percent if retiring after age 62 with 20 years or more of service.

   4. Amount of annuity

      1.	Optional		Based on accrual rate, without reduction if the employee meets all minimum age and service requirements.
      2.	MRA + 10		Reduced 5 percent for each year under age 62 if employee has reached the Minimum Retirement Age (MRA) with at least 10 but less than 30 years of service.
      3.	Discontinued		Based on accrual rate without reduction.
      4.	Deferred		Full accrued benefit vested payable at age 62 with five years of service, age 60 with 20 years of service, or MRA with 30 years of service. Reduced benefit can be elected at MRA by a former employee with 10 years of service.
      5.	Disability
      	a	In first year of payments	60 percent of "high-3" minus year of 100 percent of any Social Security benefit payable to the employee.
      	b	After first year up to age 62	40 percent of "high-3" minus 60 percent of initial Social Security benefit payable to the employee, increased by annual Cost of Living Adjustment (COLA) percentage.
      	c	After age 62	Recomputed from basic annuity formula, but limited to benefit payable to individual who gets Social Security (40 percent-less-60 percent formula stated above).

   5. Annuity Supplement Payable to Age 62. Employees who retire after reaching the MRA with 30 years of service, or age 60 with 20 years of service, will receive until age 62 an Annuity Supplement equal to an estimated Social Security benefit earned in the Federal service. The supplement is subject to an earnings test, similar to the test used by Social Security at age 62, which will reduce annual payments by one-half of the retiree's earned income above an annual exempt amount. However, it differs from Social Security in that earnings from one year reduces the supplement the following year. The annuity supplement is not subject to COLA increases.

7. What is the Thrift Savings Plan? All FERS employees are eligible to participate in the Thrift Savings Plan. Participation is totally voluntary. Please refer to the Summary of the Thrift Savings Plan for Federal Employees for specific information about this program.

8. What are death benefits?

   1. Upon the death of a married employee with 18 months or more of civilian service, the surviving spouse will receive:

      1. A lump sum payment of the employee's retirement deductions plus the higher of ½ of the employee's annual pay rate at death or ½ of the employee's "high-3" average pay.

      2. An annuity equal to 50 percent of the spouse's accrued annuity, if the employee had 10 or more years of service.

   2. These benefits will be paid in addition to any Social Security, group life insurance, or Thrift Savings Plan death benefits.

9. How do I request an annuity computation? Employees may request an estimate of their annuity or other retirement information from their servicing human resources office.

10. What are the procedures for applying for retirement?

    1. Employees should contact their servicing human resources office for a complete explanation and copies of the required retirement forms.

    2. Employees should submit the completed retirement forms to their supervisor prior to separation to apply for retirement benefits. The supervisor should forward these forms, along with a completed SF-52, Request for Personnel Action, to the servicing human resources office for processing.

11. What are my health insurance benefits? Specific information regarding eligibility for continuing health benefits coverage during retirement and other aspects of the Federal Employees Health Benefits (FEHB) Program as it relates to the retiring employee is found in the FEHB Handbook.

12. What are my life insurance benefits? Specific information regarding eligibility for continuing life insurance coverage during retirement and other aspects of the Federal Employees Group Life Insurance (FEGLI) Program as it relates to retiring employees is found in the FEGLI Program Handbook.

13. What is a refund of retirement deductions? An employee who separates from the Federal service may request the refund of retirement deductions by submitting the SF-2802, Application for Refund of Retirement Deductions, to the servicing human resources office, or if he or she has been separated more than 30 days, directly to the OPM. Refunds under FERS may not be redeposited, and the employee permanently forfeits rights to any FERS benefits from the refunded service. If married, notification of the employee's current (or former) spouse is required.

14. What are deposits and redeposits to the retirement fund? The SF-2803, Application to Make Deposit or Redeposit, is to be completed by the employee when applying to make a deposit to the retirement fund for creditable service when deductions were not made. The SF-2803 should be forwarded to the servicing human resources office for processing. There are no provisions to make redeposits when deductions were previously withdrawn.

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What references were used when writing this section?
4. What are the key definitions used in this section?
5. How does Workers’ Compensation affect FHWA employees?
6. What forms are needed for the proper recording and reporting of injuries?
7. Who is responsible for the various facets of the Workers’ Compensation program?
8. How do I make a report?
9. What type of compensation does a person receive while on Workers’ Compensation?
10. How does continuation of pay work?

1. What is the purpose of this section? This section establishes responsibilities and reporting procedures relating to Federal Highway Administration (FHWA) employee injuries or deaths while on the job.

2. Does this directive cancel an existing FHWA directive? Yes. This section cancels FHWA Personnel Management Manual (PMM) Part 1, Chapter 10, Section 1, On-the-Job Injury Compensation, dated June 28, 1996.

3. What references were used when writing this section?

   1. Title 5, United States Code (U.S.C.), Sections 810l-8193.

   2. Departmental Personnel Manual Letter 810-1, dated August 3, 1992.

   3. Injury Compensation for Federal Employees, U.S. Department of Labor (DOL) Publication, dated January 1999.

   4. Federal Employee’s Compensation Act (FECA).

   5. Title 29, Code of Federal Regulations (CFR), Part 1904, Recording and Reporting Occupational Injuries and Illnesses.

   6. Title 29, CFR, Section 1960, Federal Employees Programs.

   7. Department of Transportation (DOT) Order 3903.1, Occupational Safety and Health: Incident Investigation, Reporting and Recordkeeping, dated November 10, 2004.

4. What are the key definitions used in this section?

   1. Traumatic injuries. Wounds or other adverse conditions of the body caused by external force, including stress or strain. The injury must be identifiable as to time and place of occurrence and member or function of the body affected, and it must be caused by a specific event or incident or series of events or incidents within a single day or work shift. Traumatic injuries also include damage or destruction to prosthetic devices or appliances, exclusive of eyeglasses or hearing aids unless they were damaged incidental to a personal injury requiring medical services.

   2. Non-traumatic injuries. Occupational diseases and illnesses caused by systemic infections; continued or repeated stress or strain; exposure to toxins, poisons, fumes, etc., or other continued and repeated exposure to conditions of the work environment over a longer period of time.

   3. Continuation of pay. Full payment of salary for a period not to exceed 45 calendar days to an employee who sustains a disabling job-related traumatic injury.

   4. Controversion of pay. The option of the Agency to oppose continuation of pay.

   5. Compensation. Partial payment to the employee who is disabled on the job and in a non-pay status for more than three calendar days or is unable to resume his/her usual work.

   6. Schedule awards. Awards for permanent impairment of certain members or functions of the body, including certain internal and external organs (such as loss of use of an eye, arm, or function or removal of a kidney due to an injury); or for serious disfigurement of the head, face, or neck.

5. How does Workers' Compensation affect FHWA employees? The FECA is the law that requires Federal agencies to pay compensation benefits to civilian employees of the United States for disability due to personal injury (including occupational disease) sustained while in the performance of duty. Damage to or destruction of medical braces, artificial limbs, and other prosthetic devices incidental to a personal injury is also compensable. The FECA also provides for the payment of benefits to dependents if job-related injury or disease causes the employee's death. The FECA is administered by the Office of Workers’ Compensation Programs (OWCP), DOL, through district offices located throughout the United States.

6. What forms are needed for the proper recording and reporting of injuries? The following OWCP forms, maintained by the servicing human resources office, are needed for the proper recording and reporting of injuries:

   CA-1:	Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
   CA-2:	Federal Employee's Notice of Occupational Disease and Claim for Compensation
   CA-2a	Notice of Employee's Recurrence of Disability and Claim for Pay/Compensation
   CA-3	Report of Termination of Disability and/or Payment
   CA-5	Claim for Compensation by Widow, Widower and/or Children
   CA-5b	Claims for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
   CA-6	Official Superior's Report of Employee's Death
   CA-7	Claim for Compensation on Account of Traumatic Injury or Occupational Disease
   CA-8	Claim for Continuing Compensation on Account of Disability
   CA-16	Authorization for Examination and/or Treatment
   CA-17	Duty/Status Report
   CA-20	Attending Physicians’ Report

7. Who is responsible for the various facets of the Workers’ Compensation program?

   1. Servicing human resources offices are responsible for:

      1. Assisting and advising employees and supervisors in carrying out responsibilities under the FECA;

      2. Determining who should conduct the investigation of the accident;

      3. Reviewing and processing OWCP claims forms as needed, and preparing the cover letter to send materials to OWCP by giving a general review of the claim;

      4. Establishing an OWCP file for injured employees;

      5. Advising the supervisor, the appropriate collateral duty Safety Officer, and the servicing payroll office of each reported on-the-job injury; whether pay is continued or loss of wages occurs; and the date the employee returns to duty; and

      6. Recording and reporting occupational injuries and illnesses in accordance with DOT Order 3903.1, Occupational Safety and Health: Incident Investigation, Reporting and Recordkeeping.

   2. The FHWA Washington Headquarters Office of Human Resources will submit the annual safety report to the Assistant Secretary for Administration, Office of the Secretary of Transportation (OST), when requested.

   3. Supervisors are responsible for:

      1. Ensuring that all on-the-job injuries are promptly reported to the servicing human resources office;

      2. Authorizing necessary medical care for the injured employee on Form CA-16;

      3. Providing the employee with Form CA-1 for reporting the injury or Form CA-2 for reporting the occupational disease. (When the employee returns the completed form, the supervisor should complete the supervisor's portion and return the Receipt of Notice of Injury which is attached to the Form CA-1 and Form CA-2.);

      4. Advising the employee of his/her right to: (a) elect continuation of regular pay (traumatic injuries only), or (b) request use of sick or annual leave, if the injury is disabling;

      5. Informing the employee whether continuation of pay will be "controverted" and, if so, whether it will be terminated along with the basis for such action;

      6. Assisting the employee in the completion and submission of forms to the servicing human resources office;

      7. Notifying the servicing human resources office when the employee returns to work by filing Form CA-3, unless this information has been previously submitted on Form CA-1 or Form CA-2;

      8. Completing Form CA-17, in accordance with instructions printed on the form; and

      9. Completing an accident report on Form CA-1 or Form CA-2.

   4. Employees are responsible for:

      1. Immediately reporting to the supervisor all injuries sustained in the performance of duty;

      2. Obtaining medical attention as soon as possible;

      3. Completing and forwarding all necessary forms to the supervisor; and

      4. Submitting medical examination reports as required to OWCP at the DOL.

8. How do I make a report? Instructions for completing claims are printed on the claim forms. It is important that all forms be properly completed and that all information requested be submitted, otherwise processing the claim will be delayed. Claim forms should include the FHWA agency code “253100.” All claims for benefits under the FECA are reviewed and transmitted to OWCP by the servicing human resources office.

   1. Traumatic injuries

      1. The employee, or someone acting on his/her behalf, should complete Form CA-1, items 1 through 15, and submit it along with any available medical bills incurred in connection with this injury to the employee's supervisor for completion of items 17 through 38. Item 16 is to be completed by a witness to the injury. The supervisor submits the completed Form CA-1, with medical bills attached to it, to the servicing human resources office for transmittal to OWCP. However, submission of the Form CA-1 should not be delayed pending receipt of medical bills, as they may be transmitted separately.

      2. When the disability continues beyond the 45 days of continuation of pay, the employee and supervisor must complete Form CA-7. The employee must also submit a medical report showing continued disability for work beyond the end of the 45-day period in order to request compensation for wage loss. The supervisor submits Form CA-7 to the servicing human resources office for transmittal to OWCP.

      3. Form CA-8 is used to claim compensation for additional periods of wage loss not covered by Form CA-7. The employee and supervisor should complete Form CA-8 in accordance with instructions on the form and submit it to the attending physician. The physician will complete the attached Form CA-20. Form CA-20 is returned to the servicing human resources office where it is reviewed and submitted to OWCP.

      4. When the injured employee returns to work or when disability ceases, the supervisor sends Form CA-3 to the servicing human resources office.

   2. Non-traumatic injuries

      1. The employee or someone acting on his/her behalf should complete Form CA-2, items 1 through 18. The supervisor will complete items 19 through 35. The employee and supervisor should follow instructions attached to Form CA-2. The supervisor should submit the completed Form CA-2 and related statements to the servicing human resources office for transmittal to OWCP.

      2. Claims for compensation for wage loss or permanent disability are made on Form CA-7. This form must be completed by the employee, supervisor, and physician. The claim should be filed with OWCP as soon as pay stops or upon the employee's return to work, whichever occurs first.

      3. Form CA-8 is used to claim compensation when loss of pay goes beyond the time covered in Form CA-7. The employee and supervisor should complete Form CA-8 in accordance with instructions on the form and submit it to the attending physician, who will return it to the servicing human resources office. The servicing human resources office will review Form CA-8 for completeness prior to its submission to OWCP.

      4. When the injured employee returns to work or when disability ceases, the supervisor must send Form CA-3 to the servicing human resources office.

   3. Schedule awards. Form CA-7 is used when an injured employee suffers a permanent impairment (see paragraph 4f). The supervisor submits the completed Form CA-7 and attached Form CA-20 to the servicing human resources office for transmittal to OWCP.

   4. Recurrence of traumatic injury

      1. Form CA-2a is used if, after returning to work, an employee is again disabled and must stop work as a result of the original injury.

      2. The employee may continue to receive regular pay or request the use of sick or annual leave for the period of absence. Pay may be continued provided that the 45 calendar days were not all used during the initial period of disability and the disability recurred during a 6 month period beginning from the date the employee first returned to work following the initial disability.

      3. If the disability recurred after 6 months have passed or if the 45-day continuation of pay period has been exhausted, Form CA-7 may be filed to claim any wage loss to their servicing human resources office.

      4. When the employee returns to work, the supervisor must send Form CA-3 to the servicing human resources office.

   5. Recurrence of non-traumatic injury

      1. Form CA-2a must be submitted to the servicing human resources office when, after returning to work, an employee is again disabled and stops work as a result of the occupational disease.

      2. The employee may claim compensation by completing Form CA-7 if one was not submitted following the original injury. If Form CA-7 was previously submitted, the claim for compensation is made by sending Form CA-8, with supporting medical evidence, to the servicing human resources office.

      3. The supervisor must send Form CA-3 to the servicing human resources office when the employee returns to work.

   6. Death benefits

      1. When an employee dies because of a personal injury incurred while in the performance of duty, the supervisor reports the death by filing Form CA-6 with the servicing human resources office.

      2. Dependents may claim compensation from OWCP by filing Form CA-5 or Form CA-5a, or both. Instructions regarding the purpose and procedures for completing these forms are printed on the forms.

9. What type of compensation does a person receive while on Workers' Compensation?

   1. Compensation based on loss of wages is payable after a three-day waiting period. However, no waiting period is required when there is permanent disability or where the disability that caused wage loss exceeds 14 days.

   2. Compensation generally is payable at the rate of 2/3 of the employee's salary if there is no dependent, or 3/4 of the salary if there are one or more dependents.

10. How does continuation of pay work?

    1. When an employee sustains a disabling job-related traumatic injury, his/her pay may be continued for a period not to exceed 45 calendar days with no charge to his/her leave record. This pay is subject to income tax, retirement, and other deductions.

    2. To be eligible for continuation of pay, Form CA-1 must be sent to the servicing human resources office within 30 days following the injury; however, to avoid possible interruption of pay, the form should be filed within two working days. If the form is not filed within 30 days, compensation will be substituted for continuing pay.

    3. The employee remains in a pay status for any fraction of a workday on which the disability occurs with no charge to the 45 day continuation of pay period. The period starts at the beginning of the first full workday following the date of the injury.

    4. Pay continues until (1) the employee is no longer disabled, (2) FHWA is notified by OWCP that pay should be terminated, or (3) at the expiration of 45 calendar days.

    5. If the employee works only a portion of a workday (other than the workday when disability began), that workday will be considered as one calendar day against the 45-day maximum period for continuation of pay.

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What reference was used when writing this section?
4. What is the FSA Program?
5. Who is the administrator for the FSA Program?
6. How do I enroll in the FSA Program?

1. What is the purpose of this section? This section establishes procedures for the Flexible Spending Account (FSA).

2. Does this directive cancel an existing FHWA directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What reference was used when writing this section? The FSA website was used when writing this section.

4. What is the FSA Program? The FSA Program is a program for Federal employees that can help save them money on health and dependent care. The FSA Program allows employees to set funds aside before taxes to pay for a wide range of common expenses. The FSA Program offers two kinds of flexible spending accounts:

   1. The Health Care Flexible Spending Account (HCFSA). The HCFSA can be used to pay for health care expenses not covered by the Federal Employees Health Benefits Program (FEHB) or any other insurance. The HCFSA covers eligible health care expenses for employees, their spouses, and their dependents.

   2. The Dependent Care Flexible Spending Account (DCFSA). The DCFSA can be used to pay for dependent care expenses that allow the employee, and his/her spouse, if married, to work, look for work, or attend school full-time. The DCFSA covers eligible expenses for care of:

      1. Dependent children under age 13; and/or

      2. A person of any age whom the employee claims as a dependent on his/her Federal income tax return and who is mentally or physically incapable of caring for himself/herself.

5. Who is the administrator for the FSA Program? The Office of Personnel Management selected Strategic Health and Productivity Solutions (SHPS), Inc., as the third party administrator to manage the day-to-day FSA Program.

6. How do I enroll in the FSA Program? Employees may enroll in the FSA Program either by phone at 1-877-372-3337 or via the FSA website.

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What reference was used when writing this section?
4. What is the Federal Long Term Care Insurance Program?
5. Who is responsible for the Federal Long Term Care Insurance Program?
6. How do I find more information and/or enroll in the Federal Long Term Care Insurance Program?

1. What is the purpose of this section? This section establishes procedures for the Federal Long Term Care Insurance Program.

2. Does this directive cancel an existing FHWA directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What reference was used when writing this section? The Federal Long Term Care Insurance Program website was used when writing this section.

4. What is the Federal Long Term Care Insurance Program? The Federal Long Term Care Insurance Program provides ongoing care for people who become unable to care for themselves and need help doing everyday things like dressing, eating, and bathing. The need for the Federal Long Term Care Insurance Program can arise from an illness, injury, or a severe cognitive impairment such as Alzheimer’s Disease. As its name implies, the Federal Long Term Care Insurance Program provides care for a lengthy period of time, either in the employee’s home or in a facility that provides Federal Long Term Care Insurance Program services.

5. Who is responsible for the Federal Long Term Care Insurance Program? The Federal Long Term Care Insurance Program is sponsored by the U.S. Office of Personnel Management, and it is offered by the John Hancock and MetLife Insurance companies. The administrator of the program is Federal Long Term Care Insurance Program Partners, LLC.

6. How do I find more information and/or enroll in the Federal Long Term Care Insurance Program? Employees may obtain more information and/or enroll in the Federal Long Term Care Insurance Program by contacting the Federal Long Term Care Insurance Program Partners either by phone at 1-800-843-3337 or by visiting the Federal Long Term Care Insurance Program website.

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What references were used when writing this section?
4. What is the FHWA policy on health and fitness services?
5. What do the FHWA health and fitness programs include, and how are they made available?
6. Who has responsibility for these service programs?
7. How can offices obtain these services for their employees?
8. Who is eligible to participate?
9. How are absences for participation in health programs handled?

1. What is the purpose of this section? The purpose of this section is to provide procedures for the administration of the Federal Highway Administration (FHWA) preventive health services and fitness efforts under the FHWA Worklife Wellness Program.

2. Does this directive cancel an existing FHWA directive? No. This is a new section that has been added to the Personnel Management Manual (PMM).

3. What references were used when writing this section?

   1. Occupational Health and Safety Act of 1970.

   2. Public Law 79-658, Title 5, United States Code (U.S.C.), Section 7901.

   3. Title 41, Code of Federal Regulations (CFR), Part 101-17, Temporary Regulation D-76.

   4. Executive Order 12345, dated February 2, 1982.

   5. Comptroller General Decision B-240371.

4. What is the FHWA policy on health and fitness services? The FHWA regards its employees as it's most important asset. The FHWA supports and encourages physical fitness and other preventative health programs, as well as programs dealing with disease prevention. These are all essential elements of an effective Worklife Wellness Program. The positive impact of good health on maintaining effective performance and productivity has been well established and is endorsed by the FHWA. Providing the means to help employees ensure their health and fitness is therefore a very necessary and integral part of the FHWA Human Resources Management Program.

5. What do the FHWA health and fitness programs include, and how are they made available?

   1. These services consist of:

      1. Emergency treatment of illness or injury on the job.

      2. Specific disease screening (blood pressure monitoring and cholesterol screening).

      3. Follow-up treatments, as feasible, under the direction of a private physician.

      4. Health education.

      5. Stress management education.

      6. Periodic physical examinations for full-time employees age 40 and over.

      7. Periodic health screenings for employees under age 40.

      8. Immunizations.

      9. Environmental health hazards appraisals.

      10. Physical fitness programs and facilities.

      11. Health services and intervention programs.

   2. Washington Headquarters employees can obtain these services through the Civilian Health Unit and the Employee Fitness Center.

   3. Availability of these services for field employees is contingent upon local arrangements.

6. Who has responsibility for these service programs?

   1. The Director of the Office of Human Resources is responsible for developing FHWA's policy and service programs for Washington Headquarters employees.

   2. The Resource Center Director, Federal-aid Division Administrators, and Federal Lands Division Engineers are responsible for the establishment and review of health services programs in their respective organizations. To the extent practical, offices are encouraged to partner with other Federal agencies to provide these services to employees.

   3. Managers are encouraged to consider FHWA mission responsibilities and financial resources when developing individual programs.

7. How can offices obtain these services for their employees?

   1. Offices can explore various methods for obtaining health services for employees who work in groups of 300 or more, which may include employees of all Departments or Agencies who are scheduled to be on duty at one time in the same locality. In this situation, a health services program may be established within the following framework:

      1. If FHWA staff or facilities are not adequate to provide needed services, management may consider entering into an agreement to use existing facilities of another Federal government agency.

      2. If neither FHWA nor another Agency has adequate facilities available, management may consider:

         1. jointly establishing a professional health unit and/or fitness facility to service the FHWA and the other participating Agencies, or

         2. entering into an agreement with qualified private or public organizations for professional services.

   2. Health services may be provided for employees who work in groups of less than 300 if it is determined that such services are in the Federal government’s best interest and a reasonable basis for that determination is recorded.

   3. Methods for providing these services include arrangements with local hospitals, private and public health clinics, private physicians, multiphase screening programs, and voluntary health organizations. Field offices desiring to implement a health program in field operating divisions under their jurisdiction should contact the Worklife Wellness representative in their servicing human resources office. Field offices are reminded that the purchase of fitness club memberships for the use of employees on a continuing basis should be undertaken only where all other resources have been considered and rejected, and where employee use of the program will be carefully monitored as part of a bona fide preventive program related to health.

   4. Attachment 1 provides a discussion of activities and services that are appropriate for payment under the FHWA Worklife Wellness Program. The list is not meant to be all inclusive. Employees should consult with the appropriate Worklife Wellness Coordinator concerning other activities that may be acceptable for payment.

8. Who is eligible to participate? All FHWA employees are eligible to participate in the FHWA sponsored health and fitness programs with the permission of their physicians. Employees with Flexible Spending Accounts must consider the tax implications of using Federal funds for health and fitness activities as opposed to funds set aside in this pre-tax program.

9. How are absences for participation in health programs handled?

   1. Employees may be excused from duty for the length of time necessary to participate in Agency-sponsored preventative medical programs (e.g., physical examinations or screenings, immunizations, and health education programs).

   2. Employees interested in participating in lunchtime exercise programs should consult with their supervisors to arrange their working hours to accommodate the extra time needed for exercise.

Attachment 1

Acceptable Wellness Activities

• Preventative medical services (i.e., cholesterol screening, blood pressure monitoring, flu immunizations, mammogram screening, hearing test, glaucoma screening).
• Physical examinations excluding reimbursed items by health insurance plans for employees over 40.
• Health screenings excluding reimbursed items by health insurance plans for employees under 40.
• Health and nutrition classes.
• Stress/life management programs.
• Smoking cessation programs.
• Weight management programs.
• Purchasing health related equipment for local Federal fitness facilities.
• Aerobics or dance classes for exercise (limited availability. If this is done individually, then it must be part of a fitness contract and must be monitored by a responsible official in the office).
• Health magazine subscription for the office.
• Federal or private sector health and fitness facilities membership for the office. The Office of Human Resources can only pay partial individual membership costs if the employee has a fitness contract with the office. The contract agreement has to be monitored by someone in authority from the office.
• Emergency/first-aid equipment.
• Ergonomic analysis.
• Defensive driving course (for the office staff).

Activities not acceptable under the Wellness Program

• Dental examination (including teeth cleaning).
• Eye examination.
• Personal equipment needed for participation (i.e., gloves, cleats/shoes/boots/sneakers, uniforms, bats, clubs, balls).
• Purchase of fitness equipment for personal use at home.
• Therapy equipment.
• Eyewear.
• Organized sports registration.
• Bottled or filtered water in the office.

Wellness activities must be designed to enhance the Agency's mission. For example, bottled water for the office is a personal preference. Washington Headquarters’ offices that use bottled water normally request that their employees pay a monthly fee for this service. In addition, organized sports registration may enhance office morale, but this, too, is a personal preference.

Par.

1. What is the purpose of this section?
2. Does this directive cancel an existing FHWA directive?
3. What reference was used when writing this section?
4. What are the responsibilities for this section?
5. What form must the supervisor complete?

1. What is the purpose of this section? This section establishes the Federal Highway Administration (FHWA) procedures for processing death cases.

2. Does this directive cancel an existing FHWA directive? Yes. This section cancels the FHWA's Personnel Management Manual (PMM), Part 1, Chapter 10, Section 2, dated June 28, 1996.

3. What reference was used when writing this section? Section 651 of Public Law 104-208, the Omnibus Consolidated Appropriations Act, effective September 30, 1996, was used when writing this section.

4. What are the responsibilities for this section? When an employee dies, sympathetic assistance will be furnished to survivors in settling matters relating to employment at the earliest appropriate time. The decedent's survivor(s) may have entitlements such as: compensation due the decedent but not actually paid; life insurance proceeds; monthly survivor annuity or lump sum payment from Civil Service Retirement fund; continued health benefits coverage; burial and associated allowances; and transportation of remains, and family and household goods at Federal government expense. The claim forms necessary to obtain such funds and benefits should be delivered to the next of kin within one week after the death of an employee.

   1. The supervisor is responsible for:

      1. Reporting the death of an employee immediately by telephone to the servicing human resources office. The telephone report shall include the deceased employee's name, whether death occurred as a result of an on-the-job injury, and, if known, date of death, next of kin, address of next of kin, and cause of death;

      2. Furnishing assistance, in coordination with the servicing human resources office, to the decedent's survivors in settling matters relating to employment; and

      3. Returning Federal government property to the office, such as laptop desktops, travel credit cards, Federal government phone cards, or any other Federal government property.

   2. The servicing human resources office is responsible for:

      1. Field servicing human resources office personnel shall immediately report the death of an employee by telephone to the Human Resources Services Group (HAHR-20) and to the field payroll office, if the decedent's salary was paid by that office. The report shall include the deceased employee's name, whether death occurred as a result of an on-the-job injury, and if known, date of death, next of kin, address of next of kin, and cause of death;

      2. HAHR-20 shall immediately report the death of an employee (in the field or Washington Headquarters) to the Washington Headquarters payroll office and prepare a letter of condolence from the Federal Highway Administrator;

      3. The deceased employee's servicing human resources office shall:

         1. Prepare the Standard Form (SF)-56, Agency Certification of Insurance Status, in triplicate, and SF-2810, Notice of Change in Health Benefits Enrollment;

         2. Prepare Form FHWA-192, Claim Form for Next of Kin or Designate Beneficiary. When the decedent's Official Personnel Folder is centralized, HAHR-20 will provide, upon request by the field personnel office, the name of any designated beneficiary and any information necessary for the preparation of Form FHWA-192;

         3. Forward the completed Form FHWA-192 to the official responsible for personal delivery. If personal delivery is not possible, mail the Form FHWA-192 to the next of kin or designated beneficiary;

         4. Serve as a source of information about the completion of claim forms contained in Form FHWA-192; and

         5. Take appropriate action upon completion of the claim forms returned by the next of kin.

   3. If the decedent was a field employee, the field office shall arrange for designation of the official responsible for delivery of the claim forms to the next of kin or designated beneficiary. If the decedent was a Washington Headquarters employee, the employee's Associate Administrator or equivalent will arrange for the designation of the official responsible for personal delivery of the claim forms.

   4. If death occurred while the employee was in travel status away from his/her official duty station, the ranking official of the local FHWA office shall immediately notify by telephone the servicing human resources office and the ranking official at the employee's official duty station who in turn will: (1) notify the employee's supervisor; (2) make arrangements for the notification of next of kin, and (3) provide every reasonable assistance in arranging for the preparation and transportation of the remains.

5. What form must the supervisor complete? The supervisor must complete Form CA-6, Official Superior's Report of Employee's Death.