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
Subpart E — Contributions and Withholdings
Subpart F — Transfers From Retired Federal Employees Health Benefits Program
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
- § 890.1001— Scope and purpose.
- § 890.1002— Use of terminology.
- § 890.1003— Definitions.
- § 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.
- § 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.
- § 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.
- § 890.1042— Effective dates of debarments.
- § 890.1043— Effect of debarment on a provider.
- § 890.1044— Entities notified of OPM-issued debarments and suspensions.
- § 890.1045— Informing persons covered by FEHBP about debarment or suspension of their provider.
- § 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.
- § 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.
- § 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.
- § 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
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.
- § 890.1607— 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.