5 CFR Part 890
PART 890—FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
- PART 890—FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
- Chapter I—Office of Personnel Management › Subchapter B—Civil Service Regulations
- Subpart A—Administration and General Provisions
- § 890.101 Definitions; time computations.
- § 890.102 Coverage.
- § 890.103 Correction of errors.
- § 890.104 Initial decision and reconsideration on enrollment.
- § 890.105 Filing claims for payment or service.
- § 890.106 Carrier entitlement to pursue subrogation and reimbursement recoveries.
- § 890.107 Court review.
- § 890.108 Will OPM waive requirements for continued coverage during retirement?
- § 890.109 Exclusion of certain periods of eligibility when determining continued coverage during retirement.
- § 890.110 Enrollment reconciliation.
- § 890.111 Continuation of eligibility for former Federal employees of the Civilian Marksmanship Program.
- § 890.112 Continuation of coverage for certain Senate Restaurants employees.
- § 890.113 Designation of FEHB Program services as emergency services under the Antideficiency Act.
- § 890.114 Surprise billing and transparency.
- § 890.115 Special provisions for Postal Service employees, Postal Service annuitants, and their eligible family members.
- Subpart B—Health Benefits Plans
- § 890.201 Minimum standards for health benefits plans.
- § 890.202 Minimum standards for health benefits carriers.
- § 890.203 Application for approval of, and proposal of amendments to, health benefit plans.
- § 890.204 Withdrawal of approval of health benefits plans or carriers.
- § 890.205 Nonrenewal of contracts of health benefits plans.
- Subpart C—Enrollment
- § 890.301 Opportunities for employees to enroll or change enrollment; effective dates.
- § 890.302 Coverage of family members.
- § 890.303 Continuation of enrollment.
- § 890.304 Termination of enrollment.
- § 890.305 Reinstatement of enrollment after military service.
- § 890.306 When can annuitants or survivor annuitants change enrollment or reenroll and what are the effective dates?
- § 890.307 Waiver or suspension of annuity or compensation.
- § 890.308 Disenrollment and removal from enrollment.
- Subpart D—Temporary Extension of Coverage and Conversion
- § 890.401 Temporary extension of coverage and conversion.
- Subpart E—Contributions and Withholdings
- § 890.501 Government contributions.
- § 890.502 Withholdings, contributions, LWOP, premiums, and direct premium payment.
- § 890.503 Reserves.
- § 890.504 Disposition of contingency reserves upon reorganization or merger of plans.
- § 890.505 Recurring premium payments to carriers.
- Subpart F—Transfers From Retired Federal Employees Health Benefits Program
- § 890.601 Coverage.
- § 890.602 Opportunity to change enrollment.
- § 890.603 Effective date.
- § 890.604 [Reserved]
- § 890.605 Persons confined on effective date.
- Subpart G [Reserved]
- Subpart H—Benefits for Former Spouses
- § 890.801 Introduction.
- § 890.802 Definition.
- § 890.803 Who may enroll.
- § 890.804 Coverage.
- § 890.805 Application time limitations.
- § 890.806 When can former spouses change enrollment or reenroll and what are the effective dates?
- § 890.807 When do enrollments terminate, cancel or suspend?
- § 890.808 Employing office responsibilities.
- Subpart I—Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments
- § 890.901 Purpose.
- § 890.902 Definition.
- § 890.903 Covered services.
- § 890.904 Determination of FEHB benefit payment.
- § 890.905 Limits on inpatient hospital and physician charges.
- § 890.906 Retired enrolled individuals coinsurance payments.
- § 890.907 Effective dates.
- § 890.908 Notification of HHS.
- § 890.909 End-of-year settlements.
- § 890.910 Provider information.
- Subpart J—Administrative Sanctions Imposed Against Health Care Providers
- General Provisions and Definitions
- § 890.1001 Scope and purpose.
- § 890.1002 Use of terminology.
- § 890.1003 Definitions.
- Mandatory Debarments
- § 890.1004 Bases for mandatory debarments.
- § 890.1005 Time limits for OPM to initiate mandatory debarments.
- § 890.1006 Notice of proposed mandatory debarment.
- § 890.1007 Minimum length of mandatory debarments.
- § 890.1008 Mandatory debarment for longer than the minimum length.
- § 890.1009 Contesting proposed mandatory debarments.
- § 890.1010 Debarring official's decision of contest.
- Permissive Debarments
- § 890.1011 Bases for permissive debarments.
- § 890.1012 Time limits for OPM to initiate permissive debarments.
- § 890.1013 Deciding whether to propose a permissive debarment.
- § 890.1014 Notice of proposed permissive debarment.
- § 890.1015 Minimum and maximum length of permissive debarments.
- § 890.1016 Aggravating and mitigating factors used to determine the length of permissive debarments.
- § 890.1017 Determining length of debarment based on revocation or suspension of a provider's professional licensure.
- § 890.1018 Determining length of debarment for an entity owned or controlled by a sanctioned provider.
- § 890.1019 Determining length of debarment based on ownership or control of a sanctioned entity.
- § 890.1020 Determining length of debarment based on false, wrongful, or deceptive claims.
- § 890.1021 Determining length of debarment based on failure to furnish information needed to resolve claims.
- § 890.1022 Contesting proposed permissive debarments.
- § 890.1023 Information considered in deciding a contest.
- § 890.1024 Standard and burden of proof for deciding contests.
- § 890.1025 Cases where additional fact-finding is not required.
- § 890.1026 Procedures if a fact-finding proceeding is not required.
- § 890.1027 Cases where an additional fact-finding proceeding is required.
- § 890.1028 Conducting a fact-finding proceeding.
- § 890.1029 Deciding a contest after a fact-finding proceeding.
- Suspension
- § 890.1030 Effect of a suspension.
- § 890.1031 Grounds for suspension.
- § 890.1032 Length of suspension.
- § 890.1033 Notice of suspension.
- § 890.1034 Counting a period of suspension as part of a subsequent debarment.
- § 890.1035 Provider contests of suspensions.
- § 890.1036 Information considered in deciding a contest.
- § 890.1037 Cases where additional fact-finding is not required.
- § 890.1038 Deciding a contest without additional fact-finding.
- § 890.1039 Cases where additional fact-finding is required.
- § 890.1040 Conducting a fact-finding proceeding.
- § 890.1041 Deciding a contest after a fact-finding proceeding.
- Effect of Debarment
- § 890.1042 Effective dates of debarments.
- § 890.1043 Effect of debarment on a provider.
- Notifying Outside Parties About Debarment and Suspension Actions
- § 890.1044 Entities notified of OPM-issued debarments and suspensions.
- § 890.1045 Informing persons covered by FEHBP about debarment or suspension of their provider.
- Exceptions to the Effect of Debarments
- § 890.1046 Effect of debarment or suspension on payments for services furnished in emergency situations.
- § 890.1047 Special rules for institutional providers.
- § 890.1048 Waiver of debarment for a provider that is the sole source of health care services in a community.
- Special Exceptions To Protect Covered Persons
- § 890.1049 Claims for non-emergency items or services furnished by a debarred or suspended provider.
- § 890.1050 Exception to a provider's debarment for an individual enrollee.
- Reinstatement
- § 890.1051 Applying for reinstatement when period of debarment expires.
- § 890.1052 Reinstatements without application.
- § 890.1053 Table of procedures and effective dates for reinstatements.
- § 890.1054 Agencies and entities to be notified of reinstatements.
- § 890.1055 Contesting a denial of reinstatement.
- Civil Monetary Penalties and Financial Assessments
- § 890.1060 Purpose and scope of civil monetary penalties and assessments.
- § 890.1061 Bases for penalties and assessments.
- § 890.1062 Deciding whether to impose penalties and assessments.
- § 890.1063 Maximum amounts of penalties and assessments.
- § 890.1064 Determining the amounts of penalties and assessments to be imposed on a provider.
- § 890.1065 Deciding whether to suspend or debar a provider in a case that also involves penalties and assessments.
- § 890.1066 Notice of proposed penalties and assessments.
- § 890.1067 Provider contests of proposed penalties and assessments.
- § 890.1068 Effect of not contesting proposed penalties and assessments.
- § 890.1069 Information the debarring official must consider in deciding a provider's contest of proposed penalties and assessments.
- § 890.1070 Deciding contests of proposed penalties and assessments.
- § 890.1071 Further appeal rights after final decision to impose penalties and assessments.
- § 890.1072 Collecting penalties and assessments.
- Subpart K—Temporary Continuation of Coverage
- § 890.1101 Purpose.
- § 890.1102 Definitions.
- § 890.1103 Eligibility.
- § 890.1104 Notification by agency.
- § 890.1105 Initial election of temporary continuation of coverage; application time limitations and effective dates.
- § 890.1106 Coverage.
- § 890.1107 Length of temporary continuation of coverage.
- § 890.1108 Opportunities to change enrollment; effective dates.
- § 890.1109 Premium payments.
- § 890.1110 Termination of enrollment or coverage.
- § 890.1111 Employing office responsibilities.
- § 890.1112 Denial of continuation of coverage due to involuntary separation for gross misconduct.
- § 890.1113 The administrative charge.
- Subpart L—Benefits for United States Hostages in Iraq and Kuwait and United States Hostages Captured in Lebanon
- § 890.1201 Purpose.
- § 890.1202 Definitions.
- § 890.1203 Coverage.
- § 890.1204 Effective date of coverage.
- § 890.1205 Change in type of enrollment.
- § 890.1206 Cancellation of coverage.
- § 890.1207 Termination of coverage.
- § 890.1208 Premiums.
- § 890.1209 Responsibilities of the U.S. Department of State.
- § 890.1210 Reconsideration and appeal rights.
- Subpart M—Department of Defense Federal Employees Health Benefits Program Demonstration Project
- § 890.1301 Purpose.
- § 890.1302 Duration.
- § 890.1303 Eligibility.
- § 890.1304 Enrollment.
- § 890.1305 Termination and cancellation.
- § 890.1306 Government premium contributions.
- § 890.1307 Data collection.
- § 890.1308 Carrier participation.
- Subpart N—Federal Employees Health Benefits For Employees of Certain Indian Tribal Employers
- § 890.1401 Purpose.
- § 890.1402 Definitions and deemed references.
- § 890.1403 Tribal employer purchase of FEHB requires current deposit of premium payment and timely payment of administrative fee.
- § 890.1404 Tribal employer election and agreement to purchase FEHB.
- § 890.1405 Tribal employees eligible for enrollment.
- § 890.1406 Correction of enrollment errors.
- § 890.1407 Enrollment process; effective dates.
- § 890.1408 Change in enrollment type, plan, or option.
- § 890.1409 Cancellation of coverage or decreases in enrollment.
- § 890.1410 Termination of enrollment and 31-day temporary extension of coverage; and conversion to individual policy.
- § 890.1411 Temporary Continuation of Coverage (TCC).
- § 890.1412 Non-pay status, insufficient pay, or change to ineligible position.
- § 890.1413 Premiums and administrative fee.
- § 890.1414 Responsibilities of the tribal employer.
- § 890.1415 Reconsideration of enrollment and eligibility decisions and appeal rights.
- § 890.1416 Filing claims for payment or service and court review.
- § 890.1417 No continuation of FEHB enrollment into retirement from employment with a tribal employer.
- § 890.1418 No continuation of FEHB enrollment in compensationer status past 365 days.
- Subpart O [Reserved]
- Subpart P—Postal Service Health Benefits Program
- § 890.1601 Purpose.
- § 890.1602 Definitions and deemed references.
- § 890.1603 Eligibility for the Postal Service Health Benefits Program.
- § 890.1604 Medicare enrollment requirement for certain Postal Service annuitants and eligible family members.
- § 890.1605 Enrollment in the initial contract year.
- § 890.1606 Opportunities to enroll, change enrollment, or reenroll; effective dates.
- § 890.1607 Initial decision and reconsideration.
- § 890.1608 Disenrollment, removal, termination, cancellation, and suspension.
- § 890.1609 Temporary extension of coverage, conversion, or temporary continuation of coverage.
- § 890.1610 Minimum standards for PSHB Program plans and Carriers.
- § 890.1611 Withdrawal of approval of health benefits plan or carrier.
- § 890.1612 Information sharing.
- § 890.1613 Postal Service contract year beginning date, Medicare late enrollment penalty, calculations for the Postal Service Retiree Health Benefits Fund, and clarification of statutory terms.
- § 890.1614 Other administrative provisions.
- § 890.1615 Crediting separate reserves for PSHB.
- § 890.1616 Medicare Part D.
Feedback