Title 5: Administrative Personnel
PART 890—FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
Subpart A—Administration and General Provisions
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§ 890.107 Court review.
(a) A suit to compel enrollment under §890.102 must be brought against the employing office that made the enrollment decision.
(b) A suit to review the legality of OPM's regulations under this part must be brought against the Office of Personnel Management.
(c) Federal Employees Health Benefits (FEHB) carriers resolve FEHB claims under authority of Federal statute (5 U.S.C. chapter 89). A covered individual may seek judicial review of OPM's final action on the denial of a health benefits claim. A legal action to review final action by OPM involving such denial of health benefits must be brought against OPM and not against the carrier or carrier's subcontractors. The recovery in such a suit shall be limited to a court order directing OPM to require the carrier to pay the amount of benefits in dispute.
(d) An action under paragraph (c) of this section to recover on a claim for health benefits:
(1) May not be brought prior to exhaustion of the administrative remedies provided in §890.105;
(2) May not be brought later than December 31 of the 3rd year after the year in which the care or service was provided; and
(3) Will be limited to the record that was before OPM when it rendered its decision affirming the carrier's denial of benefits.
[61 FR 15179, Apr. 5, 1996]
