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