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Electronic Code of Federal Regulations

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e-CFR Data is current as of December 18, 2014

Title 5Chapter ISubchapter BPart 890


TITLE 5—Administrative Personnel

CHAPTER I—OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)

SUBCHAPTER B—CIVIL SERVICE REGULATIONS (CONTINUED)

PART 890—FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM

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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
Delegation of authority for resolving certain contract disputes.
§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.
rule

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.
rule

Subpart C—ENROLLMENT

§890.301
Opportunities for employees who are not participants in premium conversion 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.
rule

Subpart D—TEMPORARY EXTENSION OF COVERAGE AND CONVERSION

§890.401
Temporary extension of coverage and conversion.
rule

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.
rule

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.
rule

Subpart G—BENEFITS IN MEDICALLY UNDERSERVED AREAS

§890.701
Definitions.
§890.702
Payment to any licensed practitioner.
rule

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.
rule

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.
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Subpart J—ADMINISTRATIVE SANCTIONS IMPOSED AGAINST HEALTH CARE PROVIDERS

General Provisions and Definitions

§890.1001
Scope and purpose.
§890.1002
Use of terminology.
§890.1003
Definitions.

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.

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.

Effect of Debarment

§890.1042
Effective dates of debarments.
§890.1043
Effect of debarment on a provider.

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.

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.

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.

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.
rule

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.
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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.
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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.


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