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Federal Employees Health Benefits Program

Routine Reports and Submissions Required of FEHB Carriers


REPORT

Frequency:

Required of:

Date Due:

For information about this report, contact:

Financial Reports

All reports associated with the Annual Accounting Statement and required by the FEHBP Experienced-Rated Carrier and Service Organization Audit Guide

As directed in Audit Guide

Exp-rated

As directed in Audit Guide

Trust Funds Group/Green (danita.green@opm.gov) AND FEIO/HI Contract Specialist

Community-rated financial reports package (currently, only your annual CPA report is required)

Annual

Comm-rated

90 days after carrier's FY

Trust Funds Group/Green (danita.green@opm.gov) AND FEIO/HI Contract Specialist

Other Financial Reports

C1 - Annual Incurred Report
(12 months increased paid through 18 months)

Annual

FFS

Last business day in July

Ofc of Actuaries actuary@opm.gov) AND FEIO/HI Contract Specialist

C2 - Number of Procedures
and Number Receiving Benefits

Annual

FFS

Last business day in July

Ofc of Actuaries actuary@opm.gov) AND FEIO/HI Contract Specialist

Monthly Incurred

Monthly

FFS and Experienced - Rated HMOS

15 Days after end of month

Ofc of Actuaries actuary@opm.gov) AND FEIO/HI Contract Specialist

LOC System Drawdown

Monthly

FFS and Experienced HMOS

15 days after end of month

Ofc of Actuaries actuary@opm.gov) AND FEIO/HI Contract Specialist

Premium Payment

TFS Form 3881 B Payment Information Form

At approval

All

As directed

Trust Funds Group/Green (danita.green@opm.gov) AND FEIO/HI Contract Specialist

Change of Financial Institution

When applicable

All

As directed

Trust Funds Group/Green (danita.green@opm.gov) AND FEIO/HI Contract Specialist

Enrollment Reporting

Table 1-Summary of FEHBP Enrollment

Annual

All

Apr 15

FEIO/PASS/Figg (eric.figg@opm.gov) AND FEIO/HI Contract Specialist

Rate Related

Rate Proposal (includes several tables and reports)

Annual

All; by Rate type

May 31

Ofc of Actuaries (actuary@opm.gov) AND FEIO/HI Contract Specialist

Rate Reconciliation Request (includes several tables and reports)

Annual

C-rated

April 30

Ofc of Actuaries (actuary@opm.gov) AND FEIO/HI Contract Specialist

Benefit and Brochure Related

Benefit Proposal

Annual

All; by plan type

May 31

ISP/HIG I/Contract Specialist

Brochure Quantity Form

Annual

All; by plan type

As directed

ISP/HIG I/Contract Specialist

Plan Contracting Officials Form

Annual/not less than annual

All

May 31/and when officials change

ISP/HIG I/Contract Specialist

Plan Address Form

As updates are needed

All

As needed

ISP/HIG I/Contract Specialist

Service area statement

With request to expand service area

HMOs

With benefit proposal, when applicable

ISP/HIG I/Contract Specialist

FEHB Quality Assurance

Customer Satisfaction Survey Results (CAHPS)

Annual

All except plans with <500 FEHB enrollees

Jun 17

FEIO/PASS/Calarco (Angela.Calarco@opm.gov) AND FEIO/HI Contract Specialist

HEDIS

Annual

HMOs with > 500 FEHB enrollees

Mid-June

FEIO/PASS/Calarco (Angela.Calarco@opm.gov) AND FEIO/HI Contract Specialist

Quality Assurance Report

Annual

All

Jul 1

FEIO/PASS/Calarco (Angela.Calarco@opm.gov) AND FEIO/HI Contract Specialist

Fraud and abuse cases report

Annual

All

Mar 31

FEIO/PASS/Calarco (Angela.Calarco@opm.gov) AND FEIO/HI Contract Specialist

Fraud and abuse questionnaire

Annual

All

Mar 31

FEIO/PASS/Calarco (Angela.Calarco@opm.gov) AND FEIO/HI Contract Specialist

Debarment/Suspension

FEHB Carrier debarment/suspension actions

Semi-annual

All

Apr 15 and Oct 15

Ofc Of Inspector/Gen/Internet, Debar (debar@opm.gov) AND FEIO/HI Contract Specialist

Pilot Projects

Small Business Subcontracting Plan

Annual

6 pilot project carriers

Jun 15

FEIO/HI Contract Specialist

Subcontracting Report for Individual Contracts (SF 294)

Semi-annual

6 pilot project carriers

Apr 30 and Oct 30

FEIO/HI Contract Specialist

Summary Subcontract Report (SF 295)

Annual

6 pilot project carriers

Oct 30

FEIO/HI Contract Specialist

Agreements and Certifications

Medicare Match Agreement

First year; then when applicable

All

As directed

FEIO/HI

Certification re Disclosure of Lobbying Activities

At approval

All

Before approval

OMB SF LLL, Disclosure of Lobbying Activities (relates to certification)

When applicable

All

As needed

FEIO/HI

Certification re Drug-Free Workplace

At approval

All

Before approval

FEIO/HI

Special Reports

Other Submissions

Service charge request (Plans are not required to request a service charge)

Annual

Exp-rated

As directed

FEIO/HI

Special contingency reserve request

When applicable

Exp-rated

As directed

FEIO/HI

Note: Other reports prepared by this agency are available through our Reports Portal.

This page can be found on the web at the following url: http://www.opm.gov/carrier/reports/index.asp