Federal Employees Health Benefits Program

Table of Contents

1. OPM Reconciliation Guidelines - 2004
   The guidelines discuss our 2004 reconciliation policy. Note: Attachments I and II were part of your 2004 rate proposal.

2. Reconciliation Instructions
   Line-by-line instructions for completing Attachment III and the Backup Forms.

3. Attachment III (The Reconciliation)
   This sheet determines the difference between your estimated proposed 2004 rates and the actual 2004 Federal rates.

4. Attachment IIIA (The Reconciliation Backup Forms)
   These forms backup calculations for the rates and loadings on Attachment III.

5. Attachment IIIB (The Reconciliation Questionnaire)
   Complete as many as apply to your plan.
   Section 1 - General Questions
   Section 2 - Similary Sized Subscriber Groups (SSSGs) Questions
   Section 3 - Traditional Community Rating (TCR) Questions
   Section 4 - Community Rating by Class (CRC) Questions
   Section 5 - Adjusted Community Rating (ACR) Questions

6. Attachment IV
   This is an instruction sheet for submitting documentation of the community rates for groups renewing on January 1, 2004.

7. Attachment V
   This is the Certificate of Accurate Pricing.

8. Attachment VI
   This form gives us the names, telephone numbers, email addresses, and fax numbers of two persons we can contact about your reconciliation.