Code of Federal Regulations (Last Updated: October 10, 2024) |
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 |
§ 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 - XXX |
§ 890.701 - Definitions. |
§ 890.702 - Payment to any licensed practitioner. |
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 |
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. |
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. |
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. |
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. |
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. |
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. |
Effect of Debarment |
§ 890.1042 - Effective dates of debarments. |
§ 890.1043 - Effect of debarment on a provider. |
General Provisions and Definitions |
§ 890.1001 - Scope and purpose. |
§ 890.1002 - Use of terminology. |
§ 890.1003 - Definitions. |
§§ 890.1007--890.1009 - [Reserved] |
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 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. |
§ 890.1608 - 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 - Contributions and withholdings. |
§ 890.1614 - Other administrative provisions. |