|
Home Page > Executive Branch > Code of Federal Regulations > Electronic Code of Federal Regulations
e-CFR Data is current as of November 10, 2009
TITLE 5--Administrative Personnel
CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT
SUBCHAPTER B--CIVIL SERVICE REGULATIONS
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
Subpart A--ADMINISTRATION AND GENERAL PROVISIONS
|
| Definitions; time computations. |
|
|
| Initial decision and reconsideration on enrollment. |
|
|
| Filing claims for payment or service. |
|
|
| Delegation of authority for resolving certain contract disputes. |
|
|
| Will OPM waive requirements for continued coverage during retirement? |
|
|
| Exclusion of certain periods of eligibility when determining continued coverage during retirement. |
|
|
| Enrollment reconciliation. |
|
Subpart B--HEALTH BENEFITS PLANS
|
| Minimum standards for health benefits plans. |
|
|
| Minimum standards for health benefits carriers. |
|
|
| Application for approval of, and proposal of amendments to, health benefit plans. |
|
|
| Withdrawal of approval of health benefits plans or carriers. |
|
|
| Nonrenewal of contracts of health benefits plans. |
|
Subpart C--ENROLLMENT
|
| Opportunities for employees who are not participants in premium conversion to enroll or change enrollment; effective dates. |
|
|
| Coverage of family members. |
|
|
| Continuation of enrollment. |
|
|
| Termination of enrollment. |
|
|
| Reinstatement of enrollment after military service. |
|
|
| When can annuitants or survivor annuitants change enrollment or reenroll and what are the effective dates? |
|
|
| Waiver or suspension of annuity or compensation. |
|
Subpart D--TEMPORARY EXTENSION OF COVERAGE AND CONVERSION
|
| Temporary extension of coverage and conversion. |
|
Subpart E--CONTRIBUTIONS AND WITHHOLDINGS
|
| Government contributions. |
|
|
| Withholdings, contributions, LWOP, premiums, and direct premium payment. |
|
|
| Disposition of contingency reserves upon reorganization or merger of plans. |
|
|
| Recurring premium payments to carriers. |
|
Subpart F--TRANSFERS FROM RETIRED FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
|
| Opportunity to change enrollment. |
|
|
| Persons confined on effective date. |
|
Subpart G--BENEFITS IN MEDICALLY UNDERSERVED AREAS
|
| Payment to any licensed practitioner. |
|
Subpart H--BENEFITS FOR FORMER SPOUSES
|
| Application time limitations. |
|
|
| When can former spouses change enrollment or reenroll and what are the effective dates? |
|
|
| When do enrollments terminate, cancel or suspend? |
|
|
| Employing office responsibilities. |
|
Subpart I--LIMIT ON INPATIENT HOSPITAL CHARGES, PHYSICIAN CHARGES, AND FEHB BENEFIT PAYMENTS
|
| Determination of FEHB benefit payment. |
|
|
| Limits on inpatient hospital and physician charges. |
|
|
| Retired enrolled individuals coinsurance payments. |
|
Subpart J--ADMINISTRATIVE SANCTIONS IMPOSED AGAINST HEALTH CARE PROVIDERS
|
| Bases for mandatory debarments. |
|
|
| Time limits for OPM to initiate mandatory debarments. |
|
|
| Notice of proposed mandatory debarment. |
|
|
| Minimum length of mandatory debarments. |
|
|
| Mandatory debarment for longer than the minimum length. |
|
|
| Contesting proposed mandatory debarments. |
|
|
| Debarring official's decision of contest. |
|
|
| Bases for permissive debarments. |
|
|
| Time limits for OPM to initiate permissive debarments. |
|
|
| Deciding whether to propose a permissive debarment. |
|
|
| Notice of proposed permissive debarment. |
|
|
| Minimum and maximum length of permissive debarments. |
|
|
| Aggravating and mitigating factors used to determine the length of permissive debarments. |
|
|
| Determining length of debarment based on revocation or suspension of a provider's professional licensure. |
|
|
| Determining length of debarment for an entity owned or controlled by a sanctioned provider. |
|
|
| Determining length of debarment based on ownership or control of a sanctioned entity. |
|
|
| Determining length of debarment based on false, wrongful, or deceptive claims. |
|
|
| Determining length of debarment based on failure to furnish information needed to resolve claims. |
|
|
| Contesting proposed permissive debarments. |
|
|
| Information considered in deciding a contest. |
|
|
| Standard and burden of proof for deciding contests. |
|
|
| Cases where additional fact-finding is not required. |
|
|
| Procedures if a fact-finding proceeding is not required. |
|
|
| Cases where an additional fact-finding proceeding is required. |
|
|
| Conducting a fact-finding proceeding. |
|
|
| Deciding a contest after a fact-finding proceeding. |
|
|
| Counting a period of suspension as part of a subsequent debarment. |
|
|
| Provider contests of suspensions. |
|
|
| Information considered in deciding a contest. |
|
|
| Cases where additional fact-finding is not required. |
|
|
| Deciding a contest without additional fact-finding. |
|
|
| Cases where additional fact-finding is required. |
|
|
| Conducting a fact-finding proceeding. |
|
|
| Deciding a contest after a fact-finding proceeding. |
|
|
| Effective dates of debarments. |
|
|
| Effect of debarment on a provider. |
|
|
| Entities notified of OPM-issued debarments and suspensions. |
|
|
| Informing persons covered by FEHBP about debarment or suspension of their provider. |
|
|
| Effect of debarment or suspension on payments for services furnished in emergency situations. |
|
|
| Special rules for institutional providers. |
|
|
| Waiver of debarment for a provider that is the sole source of health care services in a community. |
|
|
| Claims for non-emergency items or services furnished by a debarred or suspended provider. |
|
|
| Exception to a provider's debarment for an individual enrollee. |
|
|
| Applying for reinstatement when period of debarment expires. |
|
|
| Reinstatements without application. |
|
|
| Table of procedures and effective dates for reinstatements. |
|
|
| Agencies and entities to be notified of reinstatements. |
|
|
| Contesting a denial of reinstatement. |
|
|
| Purpose and scope of civil monetary penalties and assessments. |
|
|
| Bases for penalties and assessments. |
|
|
| Deciding whether to impose penalties and assessments. |
|
|
| Maximum amounts of penalties and assessments. |
|
|
| Determining the amounts of penalties and assessments to be imposed on a provider. |
|
|
| Deciding whether to suspend or debar a provider in a case that also involves penalties and assessments. |
|
|
| Notice of proposed penalties and assessments. |
|
|
| Provider contests of proposed penalties and assessments. |
|
|
| Effect of not contesting proposed penalties and assessments. |
|
|
| Information the debarring official must consider in deciding a provider's contest of proposed penalties and assessments. |
|
|
| Deciding contests of proposed penalties and assessments. |
|
|
| Further appeal rights after final decision to impose penalties and assessments. |
|
|
| Collecting penalties and assessments. |
|
Subpart K--TEMPORARY CONTINUATION OF COVERAGE
|
| Initial election of temporary continuation of coverage; application time limitations and effective dates. |
|
|
| Length of temporary continuation of coverage. |
|
|
| Opportunities to change enrollment; effective dates. |
|
|
| Termination of enrollment or coverage. |
|
|
| Employing office responsibilities. |
|
|
| Denial of continuation of coverage due to involuntary separation for gross misconduct. |
|
|
| The administrative charge. |
|
Subpart L--BENEFITS FOR UNITED STATES HOSTAGES IN IRAQ AND KUWAIT AND UNITED STATES HOSTAGES CAPTURED IN LEBANON
|
| Effective date of coverage. |
|
|
| Change in type of enrollment. |
|
|
| Cancellation of coverage. |
|
|
| Responsibilities of the U.S. Department of State. |
|
|
| Reconsideration and appeal rights. |
|
Subpart M--DEPARTMENT OF DEFENSE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM DEMONSTRATION PROJECT
|
| Termination and cancellation. |
|
|
| Government premium contributions. |
|
|
