5 CFR 890.904 - Determination of FEHB benefit payment.

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§ 890.904 Determination of FEHB benefit payment.
(a) The FEHB plan's benefit payment for inpatient hospital services under this subpart is the amount calculated by the FEHB plan, using information and instructions provided by the Department of Health and Human Services (HHS) and guidelines specified by OPM, as equivalent to the Medicare Part A payment under the DRG-based PPS (this is, the amount payable before the Medicare deductible, coinsurance and lifetime limits are applied), reduced by any FEHB plan deductible, coinsurance, copayment, or preadmission certification penalty that is the responsibility of the retired enrolled individual.
(b) The FEHB plan's benefit payment for physician services under this subpart is determined by taking the lower of the following amounts:
(1) The amount determined by the FEHB plan, which is equivalent to the Medicare part B payment under the Medicare Participating Physician Fee Schedule for Medicare participating physicians and the Medicare Nonparticipating Physician Fee Schedule for Medicare nonparticipating physicians (the amount payable before the Medicare deductible and coinsurance are applied); or
(2) The actual billed charges; and
(3) Reducing the lower amount by any FEHB plan deductible, coinsurance, or copayment that is the responsibility of the retired enrolled individual.
[58 FR 38663, July 20, 1993, as amended at 60 FR 26668, May 18, 1995]

Title 5 published on 2014-01-01

The following are only the Rules published in the Federal Register after the published date of Title 5.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2014-08-08; vol. 79 # 153 - Friday, August 8, 2014
    1. 79 FR 46608 - Phased Retirement
      GPO FDSys XML | Text
      OFFICE OF PERSONNEL MANAGEMENT
      Final rule.
      Effective November 6, 2014.
      5 CFR Parts 581, 582, 831, 838, 841, 842, 843, 848, 870, and 890

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United States Code
U.S. Code: Title 5 - GOVERNMENT ORGANIZATION AND EMPLOYEES
U.S. Code: Title 22 - FOREIGN RELATIONS AND INTERCOURSE
U.S. Code: Title 50 - WAR AND NATIONAL DEFENSE
Statutes at Large

Title 5 published on 2014-01-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 5 CFR 890 after this date.

  • 2014-08-08; vol. 79 # 153 - Friday, August 8, 2014
    1. 79 FR 46608 - Phased Retirement
      GPO FDSys XML | Text
      OFFICE OF PERSONNEL MANAGEMENT
      Final rule.
      Effective November 6, 2014.
      5 CFR Parts 581, 582, 831, 838, 841, 842, 843, 848, 870, and 890