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.

  • 2014-10-17; vol. 79 # 201 - Friday, October 17, 2014
    1. 79 FR 62325 - Federal Employees Health Benefits Program Modification of Eligibility to Certain Employees on Temporary Appointments and Certain Employees on Seasonal and Intermittent Schedules
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      OFFICE OF PERSONNEL MANAGEMENT
      Final rule.
      This final rule is effective November 17, 2014.
      5 CFR Part 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
Public Laws

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.

  • 2014-12-03; vol. 79 # 232 - Wednesday, December 3, 2014
    1. 79 FR 71695 - Federal Employees Health Benefits Program Self Plus One Enrollment Type
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      OFFICE OF PERSONNEL MANAGEMENT
      Proposed rule.
      Comments are due on or before February 2, 2015.
      5 CFR Parts 890 and 892