Title 5

PART 890

Part 890 - Federal Employees Health Benefits Program

PART 890 - FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Authority:5 U.S.C. 8913; Sec. 890.301 also issued under sec. 311 of Pub. L. 111-03, 123 Stat. 64; Sec. 890.111 also issued under section 1622(b) of Pub. L. 104-106, 110 Stat. 521; Sec. 890.112 also issued under section 1 of Pub. L. 110-279, 122 Stat. 2604; 5 U.S.C. 8913; Sec. 890.803 also issued under 50 U.S.C. 403p, 22 U.S.C. 4069c and 4069c-1; subpart L also issued under sec. 599C of Pub. L. 101-513, 104 Stat. 2064, as amended; Sec. 890.102 also issued under sections 11202(f), 11232(e), 11246(b) and (c) of Pub. L. 105-33, 111 Stat. 251; and section 721 of Pub. L. 105-261, 112 Stat. 2061; Pub. L. 111-148, as amended by Pub. L. 111-152. Source:33 FR 12510, Sept. 4, 1968, unless otherwise noted.

5:2.0.1.1.35.1SUBPART A
Subpart A - Administration and General Provisions
5:2.0.1.1.35.1.161.1SECTION 890.101
   890.101 Definitions; time computations.
5:2.0.1.1.35.1.161.2SECTION 890.102
   890.102 Coverage.
5:2.0.1.1.35.1.161.3SECTION 890.103
   890.103 Correction of errors.
5:2.0.1.1.35.1.161.4SECTION 890.104
   890.104 Initial decision and reconsideration on enrollment.
5:2.0.1.1.35.1.161.5SECTION 890.105
   890.105 Filing claims for payment or service.
5:2.0.1.1.35.1.161.6SECTION 890.106
   890.106 Carrier entitlement to pursue subrogation and reimbursement recoveries.
5:2.0.1.1.35.1.161.7SECTION 890.107
   890.107 Court review.
5:2.0.1.1.35.1.161.8SECTION 890.108
   890.108 Will OPM waive requirements for continued coverage during retirement
5:2.0.1.1.35.1.161.9SECTION 890.109
   890.109 Exclusion of certain periods of eligibility when determining continued coverage during retirement.
5:2.0.1.1.35.1.161.10SECTION 890.110
   890.110 Enrollment reconciliation.
5:2.0.1.1.35.1.161.11SECTION 890.111
   890.111 Continuation of eligibility for former Federal employees of the Civilian Marksmanship Program.
5:2.0.1.1.35.1.161.12SECTION 890.112
   890.112 Continuation of coverage for certain Senate Restaurants employees.
5:2.0.1.1.35.2SUBPART B
Subpart B - Health Benefits Plans
5:2.0.1.1.35.2.161.1SECTION 890.201
   890.201 Minimum standards for health benefits plans.
5:2.0.1.1.35.2.161.2SECTION 890.202
   890.202 Minimum standards for health benefits carriers.
5:2.0.1.1.35.2.161.3SECTION 890.203
   890.203 Application for approval of, and proposal of amendments to, health benefit plans.
5:2.0.1.1.35.2.161.4SECTION 890.204
   890.204 Withdrawal of approval of health benefits plans or carriers.
5:2.0.1.1.35.2.161.5SECTION 890.205
   890.205 Nonrenewal of contracts of health benefits plans.
5:2.0.1.1.35.3SUBPART C
Subpart C - Enrollment
5:2.0.1.1.35.3.161.1SECTION 890.301
   890.301 Opportunities for employees who are not participants in premium conversion to enroll or change enrollment; effective dates.
5:2.0.1.1.35.3.161.2SECTION 890.302
   890.302 Coverage of family members.
5:2.0.1.1.35.3.161.3SECTION 890.303
   890.303 Continuation of enrollment.
5:2.0.1.1.35.3.161.4SECTION 890.304
   890.304 Termination of enrollment.
5:2.0.1.1.35.3.161.5SECTION 890.305
   890.305 Reinstatement of enrollment after military service.
5:2.0.1.1.35.3.161.6SECTION 890.306
   890.306 When can annuitants or survivor annuitants change enrollment or reenroll and what are the effective dates
5:2.0.1.1.35.3.161.7SECTION 890.307
   890.307 Waiver or suspension of annuity or compensation.
5:2.0.1.1.35.3.161.8SECTION 890.308
   890.308 Disenrollment and removal from enrollment.
5:2.0.1.1.35.4SUBPART D
Subpart D - Temporary Extension of Coverage and Conversion
5:2.0.1.1.35.4.161.1SECTION 890.401
   890.401 Temporary extension of coverage and conversion.
5:2.0.1.1.35.5SUBPART E
Subpart E - Contributions and Withholdings
5:2.0.1.1.35.5.161.1SECTION 890.501
   890.501 Government contributions.
5:2.0.1.1.35.5.161.2SECTION 890.502
   890.502 Withholdings, contributions, LWOP, premiums, and direct premium payment.
5:2.0.1.1.35.5.161.3SECTION 890.503
   890.503 Reserves.
5:2.0.1.1.35.5.161.4SECTION 890.504
   890.504 Disposition of contingency reserves upon reorganization or merger of plans.
5:2.0.1.1.35.5.161.5SECTION 890.505
   890.505 Recurring premium payments to carriers.
5:2.0.1.1.35.6SUBPART F
Subpart F - Transfers From Retired Federal Employees Health Benefits Program
5:2.0.1.1.35.6.161.1SECTION 890.601
   890.601 Coverage.
5:2.0.1.1.35.6.161.2SECTION 890.602
   890.602 Opportunity to change enrollment.
5:2.0.1.1.35.6.161.3SECTION 890.603
   890.603 Effective date.
5:2.0.1.1.35.6.161.4SECTION 890.604
   890.604 [Reserved]
5:2.0.1.1.35.6.161.5SECTION 890.605
   890.605 Persons confined on effective date.
5:2.0.1.1.35.7SUBPART G
Subpart G [Reserved]
5:2.0.1.1.35.8SUBPART H
Subpart H - Benefits for Former Spouses
5:2.0.1.1.35.8.161.1SECTION 890.801
   890.801 Introduction.
5:2.0.1.1.35.8.161.2SECTION 890.802
   890.802 Definition.
5:2.0.1.1.35.8.161.3SECTION 890.803
   890.803 Who may enroll.
5:2.0.1.1.35.8.161.4SECTION 890.804
   890.804 Coverage.
5:2.0.1.1.35.8.161.5SECTION 890.805
   890.805 Application time limitations.
5:2.0.1.1.35.8.161.6SECTION 890.806
   890.806 When can former spouses change enrollment or reenroll and what are the effective dates
5:2.0.1.1.35.8.161.7SECTION 890.807
   890.807 When do enrollments terminate, cancel or suspend
5:2.0.1.1.35.8.161.8SECTION 890.808
   890.808 Employing office responsibilities.
5:2.0.1.1.35.9SUBPART I
Subpart I - Limit on Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments
5:2.0.1.1.35.9.161.1SECTION 890.901
   890.901 Purpose.
5:2.0.1.1.35.9.161.2SECTION 890.902
   890.902 Definition.
5:2.0.1.1.35.9.161.3SECTION 890.903
   890.903 Covered services.
5:2.0.1.1.35.9.161.4SECTION 890.904
   890.904 Determination of FEHB benefit payment.
5:2.0.1.1.35.9.161.5SECTION 890.905
   890.905 Limits on inpatient hospital and physician charges.
5:2.0.1.1.35.9.161.6SECTION 890.906
   890.906 Retired enrolled individuals coinsurance payments.
5:2.0.1.1.35.9.161.7SECTION 890.907
   890.907 Effective dates.
5:2.0.1.1.35.9.161.8SECTION 890.908
   890.908 Notification of HHS.
5:2.0.1.1.35.9.161.9SECTION 890.909
   890.909 End-of-year settlements.
5:2.0.1.1.35.9.161.10SECTION 890.910
   890.910 Provider information.
5:2.0.1.1.35.10SUBPART J
Subpart J - Administrative Sanctions Imposed Against Health Care Providers
5:2.0.1.1.35.10.161SUBJGRP 161
   General Provisions and Definitions
5:2.0.1.1.35.10.161.1SECTION 890.1001
   890.1001 Scope and purpose.
5:2.0.1.1.35.10.161.2SECTION 890.1002
   890.1002 Use of terminology.
5:2.0.1.1.35.10.161.3SECTION 890.1003
   890.1003 Definitions.
5:2.0.1.1.35.10.162SUBJGRP 162
   Mandatory Debarments
5:2.0.1.1.35.10.162.4SECTION 890.1004
   890.1004 Bases for mandatory debarments.
5:2.0.1.1.35.10.162.5SECTION 890.1005
   890.1005 Time limits for OPM to initiate mandatory debarments.
5:2.0.1.1.35.10.162.6SECTION 890.1006
   890.1006 Notice of proposed mandatory debarment.
5:2.0.1.1.35.10.162.7SECTION 890.1007
   890.1007 Minimum length of mandatory debarments.
5:2.0.1.1.35.10.162.8SECTION 890.1008
   890.1008 Mandatory debarment for longer than the minimum length.
5:2.0.1.1.35.10.162.9SECTION 890.1009
   890.1009 Contesting proposed mandatory debarments.
5:2.0.1.1.35.10.162.10SECTION 890.1010
   890.1010 Debarring official's decision of contest.
5:2.0.1.1.35.10.163SUBJGRP 163
   Permissive Debarments
5:2.0.1.1.35.10.163.11SECTION 890.1011
   890.1011 Bases for permissive debarments.
5:2.0.1.1.35.10.163.12SECTION 890.1012
   890.1012 Time limits for OPM to initiate permissive debarments.
5:2.0.1.1.35.10.163.13SECTION 890.1013
   890.1013 Deciding whether to propose a permissive debarment.
5:2.0.1.1.35.10.163.14SECTION 890.1014
   890.1014 Notice of proposed permissive debarment.
5:2.0.1.1.35.10.163.15SECTION 890.1015
   890.1015 Minimum and maximum length of permissive debarments.
5:2.0.1.1.35.10.163.16SECTION 890.1016
   890.1016 Aggravating and mitigating factors used to determine the length of permissive debarments.
5:2.0.1.1.35.10.163.17SECTION 890.1017
   890.1017 Determining length of debarment based on revocation or suspension of a provider's professional licensure.
5:2.0.1.1.35.10.163.18SECTION 890.1018
   890.1018 Determining length of debarment for an entity owned or controlled by a sanctioned provider.
5:2.0.1.1.35.10.163.19SECTION 890.1019
   890.1019 Determining length of debarment based on ownership or control of a sanctioned entity.
5:2.0.1.1.35.10.163.20SECTION 890.1020
   890.1020 Determining length of debarment based on false, wrongful, or deceptive claims.
5:2.0.1.1.35.10.163.21SECTION 890.1021
   890.1021 Determining length of debarment based on failure to furnish information needed to resolve claims.
5:2.0.1.1.35.10.163.22SECTION 890.1022
   890.1022 Contesting proposed permissive debarments.
5:2.0.1.1.35.10.163.23SECTION 890.1023
   890.1023 Information considered in deciding a contest.
5:2.0.1.1.35.10.163.24SECTION 890.1024
   890.1024 Standard and burden of proof for deciding contests.
5:2.0.1.1.35.10.163.25SECTION 890.1025
   890.1025 Cases where additional fact-finding is not required.
5:2.0.1.1.35.10.163.26SECTION 890.1026
   890.1026 Procedures if a fact-finding proceeding is not required.
5:2.0.1.1.35.10.163.27SECTION 890.1027
   890.1027 Cases where an additional fact-finding proceeding is required.
5:2.0.1.1.35.10.163.28SECTION 890.1028
   890.1028 Conducting a fact-finding proceeding.
5:2.0.1.1.35.10.163.29SECTION 890.1029
   890.1029 Deciding a contest after a fact-finding proceeding.
5:2.0.1.1.35.10.164SUBJGRP 164
   Suspension
5:2.0.1.1.35.10.164.30SECTION 890.1030
   890.1030 Effect of a suspension.
5:2.0.1.1.35.10.164.31SECTION 890.1031
   890.1031 Grounds for suspension.
5:2.0.1.1.35.10.164.32SECTION 890.1032
   890.1032 Length of suspension.
5:2.0.1.1.35.10.164.33SECTION 890.1033
   890.1033 Notice of suspension.
5:2.0.1.1.35.10.164.34SECTION 890.1034
   890.1034 Counting a period of suspension as part of a subsequent debarment.
5:2.0.1.1.35.10.164.35SECTION 890.1035
   890.1035 Provider contests of suspensions.
5:2.0.1.1.35.10.164.36SECTION 890.1036
   890.1036 Information considered in deciding a contest.
5:2.0.1.1.35.10.164.37SECTION 890.1037
   890.1037 Cases where additional fact-finding is not required.
5:2.0.1.1.35.10.164.38SECTION 890.1038
   890.1038 Deciding a contest without additional fact-finding.
5:2.0.1.1.35.10.164.39SECTION 890.1039
   890.1039 Cases where additional fact-finding is required.
5:2.0.1.1.35.10.164.40SECTION 890.1040
   890.1040 Conducting a fact-finding proceeding.
5:2.0.1.1.35.10.164.41SECTION 890.1041
   890.1041 Deciding a contest after a fact-finding proceeding.
5:2.0.1.1.35.10.165SUBJGRP 165
   Effect of Debarment
5:2.0.1.1.35.10.165.42SECTION 890.1042
   890.1042 Effective dates of debarments.
5:2.0.1.1.35.10.165.43SECTION 890.1043
   890.1043 Effect of debarment on a provider.
5:2.0.1.1.35.10.166SUBJGRP 166
   Notifying Outside Parties About Debarment and Suspension Actions
5:2.0.1.1.35.10.166.44SECTION 890.1044
   890.1044 Entities notified of OPM-issued debarments and suspensions.
5:2.0.1.1.35.10.166.45SECTION 890.1045
   890.1045 Informing persons covered by FEHBP about debarment or suspension of their provider.
5:2.0.1.1.35.10.167SUBJGRP 167
   Exceptions to the Effect of Debarments
5:2.0.1.1.35.10.167.46SECTION 890.1046
   890.1046 Effect of debarment or suspension on payments for services furnished in emergency situations.
5:2.0.1.1.35.10.167.47SECTION 890.1047
   890.1047 Special rules for institutional providers.
5:2.0.1.1.35.10.167.48SECTION 890.1048
   890.1048 Waiver of debarment for a provider that is the sole source of health care services in a community.
5:2.0.1.1.35.10.168SUBJGRP 168
   Special Exceptions To Protect Covered Persons
5:2.0.1.1.35.10.168.49SECTION 890.1049
   890.1049 Claims for non-emergency items or services furnished by a debarred or suspended provider.
5:2.0.1.1.35.10.168.50SECTION 890.1050
   890.1050 Exception to a provider's debarment for an individual enrollee.
5:2.0.1.1.35.10.169SUBJGRP 169
   Reinstatement
5:2.0.1.1.35.10.169.51SECTION 890.1051
   890.1051 Applying for reinstatement when period of debarment expires.
5:2.0.1.1.35.10.169.52SECTION 890.1052
   890.1052 Reinstatements without application.
5:2.0.1.1.35.10.169.53SECTION 890.1053
   890.1053 Table of procedures and effective dates for reinstatements.
5:2.0.1.1.35.10.169.54SECTION 890.1054
   890.1054 Agencies and entities to be notified of reinstatements.
5:2.0.1.1.35.10.169.55SECTION 890.1055
   890.1055 Contesting a denial of reinstatement.
5:2.0.1.1.35.10.170SUBJGRP 170
   Civil Monetary Penalties and Financial Assessments
5:2.0.1.1.35.10.170.56SECTION 890.1060
   890.1060 Purpose and scope of civil monetary penalties and assessments.
5:2.0.1.1.35.10.170.57SECTION 890.1061
   890.1061 Bases for penalties and assessments.
5:2.0.1.1.35.10.170.58SECTION 890.1062
   890.1062 Deciding whether to impose penalties and assessments.
5:2.0.1.1.35.10.170.59SECTION 890.1063
   890.1063 Maximum amounts of penalties and assessments.
5:2.0.1.1.35.10.170.60SECTION 890.1064
   890.1064 Determining the amounts of penalties and assessments to be imposed on a provider.
5:2.0.1.1.35.10.170.61SECTION 890.1065
   890.1065 Deciding whether to suspend or debar a provider in a case that also involves penalties and assessments.
5:2.0.1.1.35.10.170.62SECTION 890.1066
   890.1066 Notice of proposed penalties and assessments.
5:2.0.1.1.35.10.170.63SECTION 890.1067
   890.1067 Provider contests of proposed penalties and assessments.
5:2.0.1.1.35.10.170.64SECTION 890.1068
   890.1068 Effect of not contesting proposed penalties and assessments.
5:2.0.1.1.35.10.170.65SECTION 890.1069
   890.1069 Information the debarring official must consider in deciding a provider's contest of proposed penalties and assessments.
5:2.0.1.1.35.10.170.66SECTION 890.1070
   890.1070 Deciding contests of proposed penalties and assessments.
5:2.0.1.1.35.10.170.67SECTION 890.1071
   890.1071 Further appeal rights after final decision to impose penalties and assessments.
5:2.0.1.1.35.10.170.68SECTION 890.1072
   890.1072 Collecting penalties and assessments.
5:2.0.1.1.35.11SUBPART K
Subpart K - Temporary Continuation of Coverage
5:2.0.1.1.35.11.171.1SECTION 890.1101
   890.1101 Purpose.
5:2.0.1.1.35.11.171.2SECTION 890.1102
   890.1102 Definitions.
5:2.0.1.1.35.11.171.3SECTION 890.1103
   890.1103 Eligibility.
5:2.0.1.1.35.11.171.4SECTION 890.1104
   890.1104 Notification by agency.
5:2.0.1.1.35.11.171.5SECTION 890.1105
   890.1105 Initial election of temporary continuation of coverage; application time limitations and effective dates.
5:2.0.1.1.35.11.171.6SECTION 890.1106
   890.1106 Coverage.
5:2.0.1.1.35.11.171.7SECTION 890.1107
   890.1107 Length of temporary continuation of coverage.
5:2.0.1.1.35.11.171.8SECTION 890.1108
   890.1108 Opportunities to change enrollment; effective dates.
5:2.0.1.1.35.11.171.9SECTION 890.1109
   890.1109 Premium payments.
5:2.0.1.1.35.11.171.10SECTION 890.1110
   890.1110 Termination of enrollment or coverage.
5:2.0.1.1.35.11.171.11SECTION 890.1111
   890.1111 Employing office responsibilities.
5:2.0.1.1.35.11.171.12SECTION 890.1112
   890.1112 Denial of continuation of coverage due to involuntary separation for gross misconduct.
5:2.0.1.1.35.11.171.13SECTION 890.1113
   890.1113 The administrative charge.
5:2.0.1.1.35.12SUBPART L
Subpart L - Benefits for United States Hostages in Iraq and Kuwait and United States Hostages Captured in Lebanon
5:2.0.1.1.35.12.171.1SECTION 890.1201
   890.1201 Purpose.
5:2.0.1.1.35.12.171.2SECTION 890.1202
   890.1202 Definitions.
5:2.0.1.1.35.12.171.3SECTION 890.1203
   890.1203 Coverage.
5:2.0.1.1.35.12.171.4SECTION 890.1204
   890.1204 Effective date of coverage.
5:2.0.1.1.35.12.171.5SECTION 890.1205
   890.1205 Change in type of enrollment.
5:2.0.1.1.35.12.171.6SECTION 890.1206
   890.1206 Cancellation of coverage.
5:2.0.1.1.35.12.171.7SECTION 890.1207
   890.1207 Termination of coverage.
5:2.0.1.1.35.12.171.8SECTION 890.1208
   890.1208 Premiums.
5:2.0.1.1.35.12.171.9SECTION 890.1209
   890.1209 Responsibilities of the U.S. Department of State.
5:2.0.1.1.35.12.171.10SECTION 890.1210
   890.1210 Reconsideration and appeal rights.
5:2.0.1.1.35.13SUBPART M
Subpart M - Department of Defense Federal Employees Health Benefits Program Demonstration Project
5:2.0.1.1.35.13.171.1SECTION 890.1301
   890.1301 Purpose.
5:2.0.1.1.35.13.171.2SECTION 890.1302
   890.1302 Duration.
5:2.0.1.1.35.13.171.3SECTION 890.1303
   890.1303 Eligibility.
5:2.0.1.1.35.13.171.4SECTION 890.1304
   890.1304 Enrollment.
5:2.0.1.1.35.13.171.5SECTION 890.1305
   890.1305 Termination and cancellation.
5:2.0.1.1.35.13.171.6SECTION 890.1306
   890.1306 Government premium contributions.
5:2.0.1.1.35.13.171.7SECTION 890.1307
   890.1307 Data collection.
5:2.0.1.1.35.13.171.8SECTION 890.1308
   890.1308 Carrier participation.
5:2.0.1.1.35.14SUBPART N
Subpart N - Federal Employees Health Benefits For Employees of Certain Indian Tribal Employers
5:2.0.1.1.35.14.171.1SECTION 890.1401
   890.1401 Purpose.
5:2.0.1.1.35.14.171.2SECTION 890.1402
   890.1402 Definitions and deemed references.
5:2.0.1.1.35.14.171.3SECTION 890.1403
   890.1403 Tribal employer purchase of FEHB requires current deposit of premium payment and timely payment of administrative fee.
5:2.0.1.1.35.14.171.4SECTION 890.1404
   890.1404 Tribal employer election and agreement to purchase FEHB.
5:2.0.1.1.35.14.171.5SECTION 890.1405
   890.1405 Tribal employees eligible for enrollment.
5:2.0.1.1.35.14.171.6SECTION 890.1406
   890.1406 Correction of enrollment errors.
5:2.0.1.1.35.14.171.7SECTION 890.1407
   890.1407 Enrollment process; effective dates.
5:2.0.1.1.35.14.171.8SECTION 890.1408
   890.1408 Change in enrollment type, plan, or option.
5:2.0.1.1.35.14.171.9SECTION 890.1409
   890.1409 Cancellation of coverage or decreases in enrollment.
5:2.0.1.1.35.14.171.10SECTION 890.1410
   890.1410 Termination of enrollment and 31-day temporary extension of coverage; and conversion to individual policy.
5:2.0.1.1.35.14.171.11SECTION 890.1411
   890.1411 Temporary Continuation of Coverage (TCC).
5:2.0.1.1.35.14.171.12SECTION 890.1412
   890.1412 Non-pay status, insufficient pay, or change to ineligible position.
5:2.0.1.1.35.14.171.13SECTION 890.1413
   890.1413 Premiums and administrative fee.
5:2.0.1.1.35.14.171.14SECTION 890.1414
   890.1414 Responsibilities of the tribal employer.
5:2.0.1.1.35.14.171.15SECTION 890.1415
   890.1415 Reconsideration of enrollment and eligibility decisions and appeal rights.
5:2.0.1.1.35.14.171.16SECTION 890.1416
   890.1416 Filing claims for payment or service and court review.
5:2.0.1.1.35.14.171.17SECTION 890.1417
   890.1417 No continuation of FEHB enrollment into retirement from employment with a tribal employer.
5:2.0.1.1.35.14.171.18SECTION 890.1418
   890.1418 No continuation of FEHB enrollment in compensationer status past 365 days.