Click here to skip navigation
An official website of the United States Government.

Healthcare Carriers

 

Overview

Note

We are looking for new Community Rated HMOs.

The U.S. Office of Personnel Management (OPM), administrator of the Federal Employees Health Benefits (FEHB) Program, would like to expand nationwide the number of health maintenance organizations (HMO) available in the Program. With the introduction of the medical loss ratio (MLR) regulations, OPM is hoping that health insurance carriers will be interested in either applying or re-applying for participation under this new pricing method, which replaces the similarly-sized subscriber groups (SSSG) method.

Thank you for visiting the Federal Employees Health Benefits (FEHB) Program's carrier application and information web pages. We created the following pages for health insurance companies interested in participating as a health carrier in our Program. There are three screens:

  • This first screen provides information on the types of health insurers that the Office of Personnel Management (OPM) can approve for participation in the FEHB program.
  • The second screen will ask you to enter specific identifying data such as your name and professional title, your health insurance company and its address. Completing this screen does not constitute submission of your application. We use this information to follow-up with you concerning your interest and your progress in completing the application.
  • The third screen will automatically appear once you complete the data we requested on the second screen. On this screen you will find links to the downloadable application files. To apply for participation in the FEHB Program, you must complete all files. OPM must receive your application by January 31.

What types of health insurers qualify for participation in the FEHB Program?

We will consider applications only from comprehensive, prepaid medical plans. The FEHB Program contracts only with health benefits carriers that offer a complete line of medical services, such as doctor's office visits, hospitalization, emergency care, prescription drug coverage, and treatment of mental conditions and substance abuse. We do not have the authority to contract with companies that offer limited services, such as dental and/or vision plans, prescription drug plans, supplemental insurance and disability insurance. We can not consider applications from fee-for-service carriers.

We especially invite qualified applicants from the states that the Department of Health and Human Services (HHS) has determined to be medically underserved -- Alabama, Arizona, Idaho, Illinois, Louisiana, Mississippi, Missouri, Montana, New Mexico, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming.

We also encourage applicants that HHS, Centers for Medicare and Medicaid Services (CMS), determines to be Federally qualified or that are an approved Competitive Medical Plan (CMP)

We invite you to apply if you believe you qualify to participate in the FEHB Program. Please go to the next screen. If you have a question, please call our HMO contracts office at 202-606-0755 or 202-606-0737 and ask to speak with a contract specialist.

Carrier Letters

2014 Carrier Letters
LetterDateSubject
2014-24 10/15/2014 Measuring Healthcare Quality in the Federal Employees Health Benefits (FEHB) Program
2014-23 10/02/2014 Coverage of Children of Same-Sex Domestic Partners under the FEHB Program
Attachment 1: States that authorize same-sex marriage
2014-22 09/10/2014 Health Benefit Exchange Authority Financial Sustainability Temporary Amendment Act of 2014
2014-21 08/18/14 Change to the Standard Contract (Community-Rated HMO)
Attachment 1: Proposed Changes to Standard 2014 Community-Rated HMO Health Benefits Contract
Attachment 2: Change to the Standard Contract (Experience-Rated HMO)
Attachment 2A: Proposed Changes to Standard 2014 Experience-Rated HMO Health Benefits Contract
Attachment 3: Change to the Standard Contract (Fee-For-Service)
Attachment 3A: Proposed Changes to Standard 2014 Fee-For-Service Health Benefits Contract
2014-20 08/25/2014 2015 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1: CAHPS 5.0H Adult Questionnaire (Commercial)
Attachment 2: 2015 CAHPS Survey Participation Form
Attachment 3: 2014 CAHPS FEHB Sub-Code List
Attachment 4: CAHPS Sample Crosswalk
Attachment 5: Healthcare Organization Questionnaire (HOQ) Screenshot
2014-19 08/07/2014 Initial Guidance on FEHB Plan Performance Assessment
2014-18 07/29/2014 Claims Data Requirements for Non-Traditional Community-Rated Carriers
2014-17 06/13/2014 Gender Identity Disorder/Gender Dysphoria
2014-16 05/07/2014 2015 RATE INSTRUCTIONS -- Community-Rated Carriers
Attachment 1: 2015 Community Rating Guidelines
Attachment 2: 2015 Proposal Instructions
2014-15 05/07/2014 Affordable Care Act (ACA) Medical Loss Ratio (MLR) in the Federal Employees Health Benefits (FEHB)
2014-14 05/02/2014 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2014
Attachment 1: FEHB 2014 Financial Reporting and Audit Guide
Attachment 2: Schedule of Selected Balances (Unaudited)
2014-13 04/22/2014 Update on Coverage for FDA Approved Drugs, Devices and Biological Products
2014-12 04/15/2014 2015 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2015 Technical Guidance and Instructions for Preparing Benefit and Service Area Proposals for New HMOs
2015 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
2015 Automated Data Collection Questions Technical
Technical Guidance Specialty Benchmark File
2014-11 04/14/2014 Federal Employees Health Benefits (FEHB) Program Family Member Audit
2014-10 04/14/2014 Updated FEHB Accreditation Requirements
2014-09 04/07/2014 Reconciliation Instructions for 2014 Rates -- Community-Rated Carriers
2014-08 04/03/2014 Reporting 2014 CAHPS Results
Attachment 1: Sub Code List
Attachment 2: Sample Crosswalk
2014-07 03/26/2014 Information Concerning the Final Rule for the Federal Employees Health Benefits Program Regarding Members of Congress and Congressional Staff
2014-06 03/25/2014 Benefits Plus Testing Group
2014-05 03/24/2014 Federal Employees Health Benefits (FEHB) Program: Self Plus One Enrollment
2014-04 03/20/2014 Supplemental Guidance: Management of Obesity in Adults
2014-03 03/20/2014 Federal Employees Health Benefits Program Call Letter
2014-02 02/06/2014 Calendar Year 2013 Annual Accounting Statement Financial Reporting

Carrier Worksheet

Instructions for the FEHBP Automated Accounting Spreadsheet
Certification of Annual Accounting Statement
2014-01 1/22/2014 Audit Requirements for 2012 MLR Pilot Program Carriers

Carrier Letters Archive

You have reached a collection of archived material.

The content available is no longer being updated and as a result you may encounter hyperlinks which no longer function. You should also bear in mind that this content may contain text and references which are no longer applicable as a result of changes in law, regulation and/or administration.

2013 |2012 |2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001 | 2000 | 1999

2013 Carrier Letters
LetterDateSubject
2013-25 12/31/13 2014 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1: CAHPS® 5.0H Adult Questionnaire (Commercial)
Attachment 2: 2014 CAHPS Survey Participation Form
Attachment 3: FEHB Subcode List
Attachment 4: CAHPS Sample Crosswalk
2013-24 12/03/2013 Mental Health and Substance Abuse Parity
2013-23 11/15/13 Continuation of FEHB Coverage and Premium Payment Procedures During the Government Shutdown
Attachment 1: Procedures for Requesting Additional Funds
2013-22 10/09/13 Measuring Quality Healthcare in the Federal Employees Health Benefits Program (FEHBP)
Attachment 1: HEDIS Measures Required for 2014
Attachment 2a: Reporting HEDIS Metrics to the National Committee Quality for Assurance (NCQA)
Attachment 2b: HEDIS FEHB Plan Name and Carrier-Code List
Attachment 3: Quality Improvement Corrective Action Plan (CAP)
Attachment 4: Quality in FEHB Healthcare Updates
2013-21 8/23/2013 Immunizations Provided by Government Health Clinics
2013-20 7/03/2013 Coverage of Same-Sex Spouses
2013-19 6/26/2013 Deadlines for Open Season 2013 Deliverables
2013-18 06/26/2013
The Blue Button® Initiative – Updating Guidance
Attachment: Data Elements Available For Members to Download
2013-17 06/25/2013
Change to the Standard Contract (Community-Rated HMO)
Attachment 1: Proposed Changes to Standard 2013 Community-Rated HMO Health Benefits Contract
Attachment 2: Change to the Standard Contract (Experience-Rated HMO)
Attachment 2A: Proposed Changes to Standard 2013 Experience-Rated HMO Health Benefits Contract
Attachment 3: Change to the Standard Contract (Fee-For-Service)
Attachment 3A: Proposed Changes to Standard 2013 Fee-For-Service Health Benefits Contract
2013-16 6/07/2013 Patient-Centered Outcomes Research Institute (PCORI) and HRA Fee
2013-15 5/23/2013 Transitional Reinsurance Program Fee under the Affordable Care Act
2013-14 5/13/2013 Health Insurance Providers Fee under the Affordable Care Act (ACA)
2013-13 5/10/2013 Applications for Premium Remittance Shortfalls
Attachment 1: FEHB Carriers premium remittance shortfall worksheet
2013-12 4/30/2013 Audit Requirements for Adjusted Community-Rating Plans
2013-11 4/29/2013
Rate Instructions - Community-Rated Carriers
Attachment 1: Part 1 - 2014 Community Rating Guidelines
Attachment 2: Part 2 - 2014 Proposal Instructions
2013-10 4/29/2013 Management of Obesity in Adults
2013-09 4/22/2013
2014 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2014 Technical Guidance and Instructions for Preparing Benefit and Service Area Proposals for New HMOs
2014 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
2013-08 4/10/2013 Affordable Care Act (ACA) Medical Loss Ratio (MLR) in the Federal Employees Health Benefits (FEHB) Program
2013-07 4/05/2013
Reporting CAHPS Results
Attachment 1: FEHB Subcode List
Attachment 2: CAHPS Sample Crosswalk
2013-06 3/29/2013 Reconciliation Instructions for 2013 Rates — Community-Rated Carriers
2013-05 03/29/2013
Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2013
2013 Financial Reporting and Audit Guide
Schedule of Selected Balances
2013-04 03/21/2013 Federal Employees Health Benefits Program Call Letter
2013-03 03/11/2013 Patient-Centered Outcomes Research Institute Fee
2013-02 2/12/2013
Calendar Year 2012 Annual Accounting Statement Financial Reporting
Attachment 1: Carrier Worksheet
Attachment 2: Instructions for the FEHBP Automated Accounting Spreadsheet
Attachment 3: Certification of Annual Accounting Statement
2013-01 1/24/2013 Patient Centered Medical Homes (PCMH) within the Federal Employees Health Benefits (FEHB) Program
2012 Carrier Letters
LetterDateSubject
2012-25 12/27/2012 Office of Personnel Management (OPM) Quality Evaluation of Federal Employees Health Benefits (FEHB) Carriers
Attachment 1: HEDIS Measures Required for 2013
Attachment 2: HEDIS FEHB Plan Name and Carrier-Code List 2013
2012-24 12/14/2012 2013 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1 - CAHPS® 5.0H Adult Questionnaire (Commercial)
Attachment 2 - 2013 CAHPS Survey Participation Form
Attachment 3 - FEHB Subcode List
Attachment 4 - 2013 CAHPS Sample Crosswalk
2012-23 9/4/2012 Offshore Contracting
2012-22 8/10/2012 Summary of Benefits and Coverage (SBC) and Uniform Glossary
Attachment 1: ACA FEHB SBC Template
Attachment 2: Uniform Glossary of Health Coverage and Medical Terms
Attachment 3: What This Plan Covers and What it Costs Instruction Guide for Group Coverage
Attachment 4: FAQs
2012-21 8/08/2012 Change to the Standard Contract
Attachment 1: Proposed Changes to Standard 2013 Community-Rated HMO Health Benefits Contract
Attachment 2: Change to the Standard Contract
Attachment 2A: Proposed Changes to Standard 2013 Experience-Rated HMO Health Benefits Contract
Attachment 3: Change to the Standard Contract
Attachment 3A: Proposed Changes to Standard 2013 Fee-For-Service Health Benefits Contract
2012-20 7/12/2012 Change in Federal Employees Health Benefits Program Experience- rated Carrier Reporting
2012-19 7/12/2012 2013 Rate Instruction Update – Community-Rated Carriers
Attachment 1: 2013 Community Rated Guidelines
2012-18 6/18/2012 FEHBA Preemption of State Law re: Subrogation and Reimbursement
2012-17 6/6/2012 Reducing Readmissions, Preventable Complications and Prematurity Background
Attachment 1: Events/Year Health Care Associated Conditions except when properly documented as "Present on Admission"
Attachment 2: Readmission & Prematurity Data
Attachment 3: Readmission & Prematurity Data (Pregnancy)
2012-16 6/5/2012 Implementation of the Electronic CLER 2809, SF 2810 and CLER 2810
Attachment 1: FEHB CLER 2809 Companion Guide
Attachment 2: CLER 2810 Companion Guide
Attachment 3: SF 2810 Companion Guide
2012-15 5/25/2012 Audit Requirements for Adjusted Community-Rating Plans
2012-14 5/09/2012 Update on Tribal Employer Participation in the Federal Employees Health Benefits Program
Attachment 1: Carrier Questions
Attachment 2: Sample POI
Attachment 3: When FEHB Coverage Ends for Tribal Employee(s)
2012-13 4/19/2012 2013 Rate Instructions - Community-Rated Carriers
Attachment 1: 2013 Community Rating Guidelines
Attachment 2: 2013 Proposal Instructions
2012-12 4/19/2012 2013 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
Attachment 1: 2013 Technical Guidance and Instructions for Preparing Benefit and Service Area Proposals for New HMOs
Attachment 2: 2013 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service
2012-11 4/09/2012 Reporting 2012 CAHPS Results
Attachment 1: Financial Reporting and Audit Guide
Attachment 2: Schedule of Selected Balances
2012-10 4/05/2012 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2012
Attachment 1: Financial Reporting and Audit Guide
Attachment 2: Schedule of Selected Balances
2012-09 3/29/2012 Federal Employees Health Benefits Program Call Letter
2012-08 3/26/2012 Rate Reconciliation Instructions for Community Rated HMOs
2012-07 3/23/2012 Enrollment Transactions and Enrollment Reconciliation for Annuitants
2012-06 3/20/2012 Tennessee High Risk Assessment Tax (AccessTN Program)
Attachment 1: Preemption-Tennessee Letter 2809
2012-05 3/15/2012 Paperless Reimbursement Guidance for FEHB and FEDVIP Carriers
2012-04 2/16/2012 Indian Tribe Participation in the FEHB Program
Attachment 1: Questions and Answers from the Carrier Workgroup
Attachment 2: Timeline for Initial Enrollment Opportunity
2012-03 2/3/2012 Guidance to Reduce Enrollment Reconciliation Discrepancies
Attachment 1: Notice Of Issue With Family Enrollment
Attachment 2: Notice Of Intent To Disenroll
Attachment 3: Notice Of Assistance Letter
2012-02 1/25/2012 HEDIS® 2012 Data Collection for all FEHB Carriers
Attachment 1: HEDIS® Measures Required for 2012
Attachment 2: HEDIS® FEHB Plan Name and Carrier-Code List
2012-01 1/4/2012 Guidance on Testing and Implementation of the SF2809 Electronic File in the HIPAA 5010 format
Attachment: HIPAA Transaction Standard Companion Guide for SF 2809

Back to Top

2011 Carrier Letters
LetterDateSubject
2011-22 12/28/2011 2012 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment A: CAHPS Health Plan Survey 4.0H Adult Questionnaire (Commercial)
Attachment B: Survey Participation Form
Attachment C: FEHB Subcode List
Attachment D: Sample Crosswalk
2011-21 12/19/2011 Blue Button Initiative
Attachment 1: Blue Button Icon
Attachment 2: Blue Button Overview Presentation
Attachment 3: "How Blue Button Works" Presentation
Attachment 4: Sample data dictionary
2011-19 10/13/11 Criteria for Demonstrating Compliance with Contractual Requirement for Enrollment Reconciliation
2011-18 9/23/11 Additional Information on the One Percent Loading for Community-Rated HMO Carriers
2011-17a 9/23/11 Change to the Standard Contract
Attachment 1: Proposed Changes to Standard 2012 Community-Rated HMO Health Benefits Contract
2011-17b 9/23/11 Change to the Standard Contract
Attachment 1: Proposed Changes to Standard 2012 Experience-Rated HMO Health Benefits Contract
2011-17c 9/23/11 Change to the Standard Contract
Attachment 1: Proposed Changes to Standard 2012 Fee-For-Service Health Benefits Contract
2011-16 7/13/11 Measuring Performance of Healthcare Delivery
Attachment 1
Attachment 2
2011-15 7/8/11 New Premium Rating Methodology for Most Community Rated Carriers
Attachment: MLR Regulations
2011-14 6/23/11 Additional Information on Contract Security Clauses
Attachment 1: 2011 Security Clause Amendments
Attachment 2: Contractor Staffing Change Report
2011-13 6/17/11 Fraud and Abuse: Mandatory Information Sharing via Written Case Notifications to OPM's Office of the Inspector General
Attachment 1: Case Notification/Status Update Format
Attachment 2: OPM/OIG Exposure Request Form
2011-12 5/28/11 Gender Reassignment
2011-11 5/13/11 Audit Requirements for Adjusted Community-Rating Plans
2011-10a 5/4/11 2012 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2011-10b 5/4/11 2012 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
2011-10c 5/4/11 2012 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
2011-09 4/27/11 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2011
Attachment 1: Financial Reporting and Audit Guide
Attachment 2: Schedule of Selected Balances
2011-08 4/26/11 2012 RATE INSTRUCTIONS -- Community-Rated Carriers
Attachment 1: Part 1 - 2012 Community rating Guidelines
Attachment 2: Part 2 - Proposal Instructions
2011-07 4/8/11 Reporting 2011 CAHPS Results
Attachment 1: 2011 CAHPS FEHB Sub-Code List
Attachment 2: Sample Crosswalk
2011-06 4/4/11 Reconciliation Instructions for 2011 Rates -- Community-Rated Carriers
Attachment: Rate Recconciliation Instructions
2011-05 2/10/11 Federal Employees Health Benefits Program Call Letter
2011-04 3/23/11 Calendar Year 2010 Annual Accounting Statement Financial Reporting
Attachment A: AAS Spreadsheet
Attachment B: Patient-Centered Medical Homes (PCMH)
Attachment C: Certification of Annual Accounting Statement
2011-03 2/10/11 Change in Federal Employees Health Benefits Program Experience- rated Carrier Reporting Requirements and Submission Process
2011-02 2/3/11 Demonstrating Value through Clinical and Financial Integration
Attachment A: Payment Bundling
Attachment B: Patient-Centered Medical Homes (PCMH)
Attachment C: Accountable Care Organizations (ACOs)
2011-01 1/20/11 Survey and Administration of 2011 Plan Tobacco Cessation Benefits
Attachment A: Smoking Cessation Benefits Report
Attachment B: 2011 Smoking Cessation Benefit Report
Attachment C: Smoking Cessation Benefit Flyer

Back to top

2010 Carrier Letters
LetterDateSubject
2010-23 12/20/10 2011 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1: CAHPS Health Plan Survey 4.0H Adult Questionnaire (Commercial)
Attachment 2: Survey Participation Form
Attachment 3: FEHB Subcode List
Attachment 4: Survey Participation Form
2010-22 12/10/10 New 2011 FEHB Contract Security Clauses
Attachment A: New 2011 FEHB Contract Security Clauses
Attachment B: Contractor Staffing Change Report
2010-21a 12/08/10 HEDIS® Data Collection
2010-21b 12/08/10 HEDIS® Data Collection for Fee-for-Service Carriers
2010-20 10/19/2010 Internal Claims and Appeals and External Reviews under the Affordable Care Act
2010-19 09/10/2010 Tobacco Litigation Records Retention
2010-18 08/31/2010 Patient Protection and Affordable Care Act
2010-17 07/15/2010 Disputed Claims and the Carriers' Reconsideration Files
2010-16 06/17/2010 Medicare Secondary Payer Recovery Requirements
Part 1: 2011 Community Rating Guidelines
2010-15a 06/16/2010 Change to the Standard Contract for Community-Rated HMOs
Attachment A: Proposed Changes to Standard 2010 Community-Rated HMO Health Benefits Contract
2010-15b 06/16/2010 Change to the Standard Contract for Experience-Rated HMO Carriers
Attachment A: Proposed Changes to Standard 2010 Experience-Rated HMO Health Benefits Contract
2010-15c 06/16/2010 Change to the Standard Contract for Fee-For-Service Carriers
Attachment A: Proposed Changes to Standard 2010 Fee-For-Service Health Benefits Contract
2010-14 05/25/2010 Clarification of Data Breach Notification Requirements
2010-13 05/18/2010 Audit Requirements for Adjusted Community-Rating Plans
2010-12a 05/17/2010 Additional Information and Instructions on the Technical Guidance for the 2011 Contract Year for HMO carriers
2010-12b 05/17/2010 Additional Information and Instructions on the Technical Guidance for the 2011 Contract Year for NEW HMO carriers
2010-12c 05/17/2010 Additional Information and Instructions on the Technical Guidance for the 2011 Contract Year for FFS carriers
2010-11a 05/17/2010 2011 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals for HMO carriers
2010-11b 05/17/2010 2010 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
2010-11c 05/17/2010 2011 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
2010-10 05/04/2010 2011 RATE INSTRUCTIONS -- Community-Rated Carriers
Part 1: 2011 Community Rating Guidelines
Part 2: Proposal Instructions
2010-09 04/26/2010 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2010
Attachment 1: Financial reporting and Audit Guide
Attachment 2: Schedule of Selected Balances
2010-08 04/09/2010 The Health Data Warehouse
2010-07 04/08/2010 Reporting 2010 CAHPS Results
Attachment 1: FEHB Subcode list
Attachment 2: Sample Crosswalk
2010-06 04/07/2010 Federal Employees Health Benefits Program Call Letter
2010-05 03/18/2010 Reconciliation Instructions for 2010 Rates -- Community-Rated Carriers
2010-04 02/22/2010 Pharmacy Benefits Management (PBM)
2010-03 01/28/2010 Calendar 2010 Annual Accounting Statement Financial Reporting
Attachment 1: Carrier worksheet
Attachment 2: Annual Reporting Instructions for Experienced Rated Plans
Attachment 3: Annual Accounting Statement
2010-02 01/20/2010 Guidelines on HEDIS® Measures for Fee-for-Service Carriers
2010-01 01/20/2010 HEDIS® Data Collection

Back to top

2009 Carrier Letters
LetterDateSubject
2009-17 11/9/2009 2010 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1: Survey Instructions
Attachment 2: Survey Participation Form
Attachment 3: FEHB Subcode List
Attachment 4: Sample Crosswalk
2009-16 10/5/2009 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2009
Attachment 1: Requirements for Federal Fiscal Year 2009 Audited Financial Statements
Attachment 2: Federal Employees Health Benefits Program (FEHBP) Experience-Rated Carriers Schedule of Selected Balances
Attachment 3: Schedule of Selected Balances
2009-15c 9/2/2009 Change to the Standard Contract
Attachment: Proposed Changes to Standard 2010 Experience-Rated HMO Health Benefits Contract
2009-15b 9/2/2009 Change to the Standard Contract
Attachment: Proposed Changes to Standard 2010 Experience-Rated HMO Health Benefits Contract
2009-15a 9/2/2009 Change to the Standard Contract
Attachment: Proposed Changes to Standard 2010 Community-Rated HMO Health Benefits Contract
2009-14 9/2/2009 OPM's Letter of Credit System
Attachment 1: User Manual for Experienced-Rated Carriers
Attachment 2: Letter of Credit (LOC) System Guidelines
2009-13 7/9/2009 Federal Funding Accountability and Transparency Act
2009-12 5/21/2009 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2009
Attachment 1: Financial Reporting and Audit Guide
Attachment 2: Schedule of Selected Balances
2009-11(a) 5/1/2009 2010 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2009-11(b) 5/1/2009 2010 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
2009-11(c) 5/1/2009 2010 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
2009-10 4/22/2009 Inspector General Reform Act of 2008
2009-09 4/22/2009 2010 Rate Instructions -- Community-Rated Carriers
Attachment 1:   Part A: Community Rating Guidelines 2010
Attachment 2:   Part B: Proposal Instructions 2010
2009-08 4/20/2009 Federal Employees Health Benefits Program Call Letter
2009-07 4/10/2009 Reporting 2009 CAHPS Results
Attachment 1: FEHB Plan Sub code List
Attachment 2: CAHPS Sample Crosswalk
2009-06 4/10/2009 Audit Requirements for Adjusted Community-Rating Plans
2009-05 2/27/2009 Reconciliation Instructions for 2009 Rates -- Community-Rated Carriers
2009-04 2/20/2009 Health Information Technology and Transparency
2009-03 2/13/2009 Calendar 2008 Annual Accounting Statement Financial Reporting
Attachment 1: Carrier worksheet
Attachment 2: Annual Reporting Instructions for Experienced Rated Plans
Attachment 3: Annual Accounting Statement
2009-02 1/27/2009 HEDIS® Measures for Fee-for-Service Carriers
2009-01 1/27/2009 HEDIS® Data Collection

back to top

2008 Carrier Letters
LetterDateSubject
2008-19 12/19/2008 2009 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment: CAHPS® 4.0H Adult Questionnaire (Commercial) Survey Instructions
Attachment: Survey Participation Form
Attachment: 2009 FEHB Plan Report
Attachment: Sample Crosswalk
2008-18 12/05/2008 Federal Employees Health Benefits Program
2008-17 11/10/2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 - Federal Employees Health Benefits Program Carrier Guidance
2008-16 10/09/2008 HIT and Transparency Report for 2008
Attachment: Federal Employees Health Benefits (FEHB) ProgramReport on Health Information Technology (HIT) and Transparency
2008-15 09/10/2008 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2008
Attachment 1: Requirements for Federal Fiscal Year 2008 Audited Financial Statements
Attachment 2: Schedule of Selected Balances
2008-13c 06/12/2008 Change to the Standard Contract
Attachment: Proposed Changes to Standard 2009 FFS Health Benefits Contract
2008-13b 06/12/2008 Change to the Standard Contract
Attachment: Proposed Changes to Standard 2009 Experience-Rated HMO Health Benefits Contract
2008-13a 06/12/2008 Change to the Standard Contract
Attachment: Proposed Changes to Standard 2009 Community-Rated HMO Health Benefits Contract
2008-12 05/20/2008 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2008
Attachment 1: Financial Reporting and Audit Guide
Attachment 2: Schedule of Selected Balances
2008-11 05/13/2008 2009 RATE INSTRUCTIONS-Revision -- Community-Rated Carriers
2008-10 04/21/2008 Reporting 2008 CAHPS Results
Attachment 1: 2008 Plan Subcodes
Attachment 2: Sample Crosswalk
2008-09 04/15/2008 Audit Requirements for Adjusted Community-Rating Plans
2008-08 04/14/2008 2009 RATE INSTRUCTIONS -- Community-Rated Carriers
Attachment
2008-07c 04/11/2008 2009 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
2008-07b 04/11/2008 2009 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
2008-07 04/11/2008 2009 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2008-06 03/11/2008 March 11, 2008 Federal Employees Health Benefits Program Call Letter
2008-05 02/27/2008 February 27, Reconciliation Instructions for 2008 Rates -- Community-Rated Carriers
2008-04 01/31/2008 Guidelines on HEDIS ® Measures for Fee-for-Service Carriers
2008-03 01/25/2008 Calendar 2007 Annual Accounting Statement Financial Reporting
Attachment 1: Statement of Cash Flows for Calendar year 2007
Attachment 2: Annual Reporting Instructions for Experienced-Rated Carriers
Attachment 3: Certification of Contract Year 2007 Annual Accounting Statement

2008-02

01/24/2008

HEDIS® Data Collection

2008-01

01/11/2008

The Massachusetts Health Care Reform Act

Attachment 1:Massachusetts Schedule HC

Attachment 2: Massachusetts Schedule HC

back to top

2007 Carrier Letters
LetterDateSubject
2007-27UPDATED 02/21/2008 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1: CAHPS® 4.0H Adult Questionnaire (Commercial) Survey Instructions
Attachment 2: Survey Participation Form
Attachment 3: FEHB Plan Report
Attachment 4: Sample Crosswalk
2007-27 01/07/2008 2008 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1: CAHPS® 4.0H Adult Questionnaire (Commercial) Survey Instructions
Attachment 2: Survey Participation Form
Attachment 3: FEHB Plan Report
Attachment 4: Sample Crosswalk
2007-26 10/16/2007 Preventative Care for Adults
2007-25 10/15/2007 Health Information Technology (HIT) and Transparency Report
Attachment: Report on Health Information Technology (HIT) and Transparency
2007-24 08/28/2007 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2007
Attachment 1: Requirements for Federal Fiscal Year 2007 Audited Financial Statements
Attachment 2: Federal Employees Health Benefits Program Experience-Rated Carriers Schedule of Selected Balances (UNAUDITED)
2007-23 08/27/2007 Federal Employees Health Benefits Program Procedures for Provider Overpayment Recoveries
2007-22 06/25/2007 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2007
Attachment: Financial Reporting and Audit Guide
2007-21 06/22/2007 Notification of Data Breach
2007-20 06/07/2007 2008 Health Savings Accounts Contribution Limits
Attachment: HSA Index Amounts for 2008
2007-19 06/07/2007 Civilian Board of Contract Appeals
2007-18 05/16/2007 FEHB Carrier Letter Listserv
2007-17c 04/23/2007 Change to the Standard Contract
Attachment : Proposed Changes to Standard 2008 Fee-For-Service Health Benefits Contract
2007-17b 04/26/2007 Change to the Standard Contract
Attachment : Proposed Changes to Standard 2008 Experience-Rated HMO Health Benefits Contract
2007-17a 04/23/2007 Change to the Standard Contract
Attachment : Proposed Changes to Standard 2008 Community-Rated HMO Health Benefits Contract
2007-16 04/25/2007 Waiver of Requirements for Continued Coverage During Retirement
2007-15 04/24/2007 Debarred Providers in the Federal Employees Health Benefits Program
Attachment 1: FEHBP Carrier letter 1993-01 - Debarred Providers in the Federal Employees Health Benefits Program
Attachment 2: FEHBP Carrier letter 1993-20 - Debarred Providers in the Federal Employees Health Benefits Program
2007-14 04/23/2007 Reporting 2007 CAHPS Results
Attachment 1: FEHB Plan Sub-codes
Attachment 2: Sample Crosswalk
2007-13c 04/12/2007 2008 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
2007-13b 04/12/2007 2008 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
2007-13a 04/12/2007 2008 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2007-12 03/30/2007 Notifying OPM's Office of the Inspector General Concerning Fraud and Abuse Cases in the FEHB Program
Attachment 1: FEHBP Data Exposure Request Form
2007-11 03/28/2007 Implications of Medicare Anti-Kickback Statute for Coordination of Benefits
2007-10 03/27/2007 2008 RATE INSTRUCTIONS -- Community-Rated Carriers
Attachment 1: 2008 FEHB RATE INSTRUCTIONS - COMMUNITY-RATED PLANS
2007-09 03/22/2007 Audit Requirements for Adjusted Community-Rating Plans
Attachment 1: Medical Claim Field Requirements
Attachment 2: Pharmaceutical Claim Field Requirements
Attachment 3: US OPM, Office of The Inspector General, Office of Audits Media Specifications Form
2007-08 03/13/2007 High Deductible Health Plan Options
2007-07 03/07/2007 Federal Employees Health Benefits Program Call Letter
2007-06 02/28/2007 Omnibus Budget Reconciliation Act of 1990 (OBRA '90) IPPS Pricer Program Usage
2007-05 02/28/2007 Medicare Part B Adjustments to the Omnibus Budget Reconciliation Act of 1990 (OBRA'90) Pricing
2007-04 02/26/2007 Calendar 2006 Financial Reporting
Attachment 1: Federal Employees Health Benefits Program Annual Reporting Instructions for Experience-Rated Carrier
Attachment 2: Supplemental Schedule of Health Benefit Charges Paid for Calendar Year 2006
Attachment 3: Certification of Annual Accounting Statement (Carrier)
2007-03 02/21/2007 Reconciliation Instructions for 2007 Rates-- Community-Rated Carriers
Attachment: OPM Reconciliation Guidelines – 2007
2007-02 02/16/2007 2008 Standard Contract Changes
2007-01 02/12/2007 HEDIS® Data Collection

back to top

2006 Carrier Letters
LetterDateSubject
2006-32 12/28/2006 Standard Contract Amendments
Attachment: Standard Contract Amendments
2006-31 12/27/2006 2007 Consumer Assessment of Healthcare Providers and Systems Program Requirements
Attachment 1: CAHPS® 4.0H Adult Questionnaire
Attachment 2: Survey Participation Form
Attachment 3: CAHPS Plan codes
Attachment 4: Sample Crosswalk
2006-29 12/21/2006 The Tax Relief and Health Care Act of 2006
Attachment: The Tax Relief and Health Care Act of 2006
2006-28 11/28/2006 Federal Acquisition Regulation (FAR) Changes that Impact Federal Employees Health Benefit Program (FEHBP) Carrier Contracts
2006-27 11/02/2006 HealthierFeds Physical Activity Challenge
2006-26 10/26/2006 Federal Employees Dental and Vision Insurance Program (FEDVIP) and Non-FEHB Supplementary Dental and Vision Coverage under the Federal Employees Health Benefits (FEHB) Program
2006-25 09/14/2006 The Office of Personnel Management's Strategy for Pandemic Influenza
2006-24 09/14/2006 The President's Executive Order Promoting Quality and Efficient Health Care in Federal Government Health Care Programs
2006-23 07/14/2006 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2006
Attachment: Requirements for Federal Fiscal Year 2006 Audited Financial Statements
2006-22 07/24/2006 Federal Employees Health Benefits Program Fee-For-Service Plan and Experience-rated HMO Reports
Attachment to Carrier Letter 2006-22
2006-21 07/17/2006 Guidance on HEDIS® Measures for Fee-for-Service Plans
2006-20 06/13/2006 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2006
Attachment 1: FINANCIAL REPORTING AND AUDIT GUIDE Federal Fiscal Year 2006
2006-19 06/08/2006 Raffles Conducted by Federal Employees Health Benefits Program Health Plans
2006-18 06/08/2006 Raising the Level of Transparency in the FEHB Program
2006-17 05/17/2006 Delivering Plan Brochures Electronically
2006-16c 05/15/2006 Change to the Standard Contract
Attachment 1: Changes to Standard 2007 Fee-For-Service Health Benefits Contract
2006-16b 05/15/2006 Change to the Standard Contract
Changes to Standard 2007 Experience-Rated HMO Health Benefits Contract
2006-16a 05/15/2006 Change to the Standard Contract
Changes to Standard 2007 Community-Rated HMO Health Benefits Contract
2006-15 05/09/2006 Organ/Tissue Transplant Benefits
2007 Organ/Tissue Transplants and Diagnoses
2006-14 05/08/2006 Audit Requirements for Adjusted Community-Rating Plans
2006-13(c) 05/01/2006 2007 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Attachment 1: 2007 FEHB Proposal Instructions
2006-13(b) 05/01/2006 2007 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
Attachment 1: 2007 FEHB Proposal Instructions
2006-13(a) 05/01/2006 2007 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
Attachment 1: 2007 FEHB Proposal Instructions
2006-12 05/01/2006 CL 2006-12 of May 1, 2006, 2007 RATE INSTRUCTIONS -- Community-Rated Carriers
Attachment 1: 2007 FEHB Rate Instructions - Community-Rated Plans
2006-11 04/21/2006 CL 2006-11 of April 21, 2006, Reporting Requirement of HEDIS Measures for Fee-for-Service Plans
2006-10 04/21/2006 CL 2006-10 of April 21, 2006, Reporting 2006 CAHPS Results
Attachment 1: FEHB Subcode ID Crosswalk
Attachment 2: Sample Crosswalk
2006-09 04/04/2006 Federal Employees Health Benefits Program Call Letter
2006-08 03/30/2006 Checklists for Large Provider Agreements
Attachment 1: General Checklist for Large Provider Agreements
Attachment 2: Specific Checklist for Pharmacy Benefit Management (PBM)LPA's Providing a Retail Pharmacy Network and/or Mail Order Pharmacy
2006-07 03/30/2006 CL 2006-07 of March 30, 2006, 2006 FEHB Carrier Conference
2006-06 03/15/2006 Disclosure of Creditable Prescription Drug Coverage to the Centers for Medicare & Medicaid Services (CMS)
2006-05 03/15/2006 Reconciliation Instructions for 2006 Rates -- Community-Rated Carriers
Table of Contents
Attachment 1: OPM Reconciliation Guidelines-2006
Attachment 2: Reconciliation Instructions
Attachment 3: Reconciliation
Attachment 3A: Reconciliation Backup Forms
Attachment 3B: Section 1 ?General Questionnaire
Attachment 4: Documentation of 2006 Community Rates and Riders
Attachment 5: Certificate of Accurate Pricing
Attachment 6: Carrier Contacts
2006-04 02/01/2006 Extended Coverage for Employees Called to Active Military Duty
Attachment 1: BAL 06-401: Extended Coverage for Employees Called to Active Military Duty
Attachment 2: P.L. 108-375 Processing Table
2006-03 UPDATED 02/21/2006 2006-03 Updated of February 21, 2006, HEDIS® Data Collection Letter 2006-03
2006-03 02/01/2006 HEDIS® Data Collection
2006-02 02/01/2006 Meeting with OPM Personnel
2006-01 01/24/2006 2006 Consumer Assessment of Health Plans Survey Requirements
Attachment 1: CAHPS® 3.0H Adult Questionnaire (Commercial) SURVEY INSTRUCTIONS
Attachment 2: Survey Participation Form
Attachment 3: FEHB Plan List
Attachment 4: Sample Crosswalk

back to top

2005 Carrier Letters
LetterDateSubject
2005-14c UPDATED 09/22/2005 (UPDATED) Change to the Standard Contract
Attachment A UPDATED - Changes to Standard 2006 Fee-For-Service Health Benefits Contract
Attachment B UPDATED - Amendments to Standard 2005 Fee-For-Service Health Benefits Contract
2005-14b UPDATED 09/22/2005 (UPDATED) Change to the Standard Contract
Attachment A UPDATED - Changes to Standard 2006 Experience-Rated HMO Health Benefits Contract
Attachment B UPDATED - Amendments to Standard 2005 Experience-Rated HMO Health Benefits Contract
2005-14a UPDATED 09/22/2005 (UPDATED) Change to the Standard Contract
Attachment A UPDATED - Changes to Standard 2006 Community-Rated HMO Health Benefits Contract
Attachment B UPDATED - Amendments to Standard 2005 Community-Rated HMO Health Benefits Contract
2005-14c 08/30/2005 Change to the Standard Contract
Attachment A - Changes to Standard 2006 Experience-Rated HMO Health Benefits Contract
Attachment B - Amendments to Standard 2005 Experience-Rated HMO Health Benefits Contract
2005-14b 08/30/2005 Change to the Standard Contract
Attachment A - Changes to Standard 2006 Experience-Rated HMO Health Benefits Contract
Attachment B - Amendments to Standard 2005 Experience-Rated HMO Health Benefits Contract
2005-14a 08/30/2005 Change to the Standard Contract
Attachment A - Changes to Standard 2006 Community-Rated HMO Health Benefits Contract
Attachment B - Amendments to Standard 2005 Community-Rated HMO Health Benefits Contract
2005-13a 05/25/2005 2006 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
Attachment - 2006 PROPOSAL INSTRUCTIONS
2005-13b 05/25/2005 2006 Technical Guidance and Instructions for Preparing benefits and Service Area Proposals for New HMOs
Attachment - 2006 PROPOSAL INSTRUCTIONS
2005-13c 05/25/2005 2006 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Attachment - 2006 PROPOSAL INSTRUCTIONS
2005-12 05/17/2005 2006 RATE INSTRUCTIONS -- Community-Rated Carriers
Attachment - 2006 FEHB RATE INSTRUCTIONS
2005-11 05/17/2005 Rating Process for Community-Rated Plans
Attachment - Community Rating Instructions
2005-10 04/19/2005 Federal Employees Health Benefits Program Annual Call Letter
Appendix A - Federal Employees Health Benefits Program Annual Call Letter Checklist
Appendix B - FEHB High Deductible Health Plans
2005-09 03/30/2005 Reconciliation Instructions for 2005 Rates -- Community-Rated Carriers
Attachment - Table of contents
2005-08 03/30/2005 Carrier Responsibilities - Reconsideration Process and Medical Necessity Determinations
Attachment 1- Carrier Responsibilities in Disputed Claims Process
Attachment 2 - Disputed Claims and the Carriers' Reconsideration Files
2005-07 03/23/2005 Office of Personnel Management's (OPM) Requirement to Provide Section 508 Web Accessible Compliant Health Plan Brochures for the Visual Impaired
Attachment 1- File Manager Instructions
Attachment 2 - Proposed 2006 Brochure Language Changes
Attachment 3 - Brochure Template Design and Layout Revisions
Attachment 4 - Supplemental Pages
2005-06 03/16/2005 FEHB Carrier Conference
Attachment - Carrier Conference Agenda
2005-05 02/23/2005 Additional Payroll Office Changes under e-Payroll
Attachment 1 - Attachment - State Memo
2005-04 02/10/2005 HEDIS® Data
2005-03 02/09/2005 Calendar 2004 Financial Reporting
Attachment 1 - Instructions for Automated AAS
Attachment 2 - AAS Spreadsheet
Attachment 3 - Certification of Annual Accounting Statement
2005-02 01/18/2005 Prescription Drug Availability
Attachment - Director's letter concerning prescription drug availability for emergency relief workers
2005-01 01/14/2005 2005 Consumer Assessment of Health Plans Survey Requirements
Appendix A - CAHPS Questionnaire
Appendix B - Survey Participation Form
Appendix C - FEHB Sub-code list
Appendix D - Sample Crosswalk

back to top

2004 Carrier Letters
LetterDateSubject
2004-13 11/03/2004 Updated SF 2809
2004-12 10/04/2004 The West Virginia Health Care Provider Tax Act of 1993
2004-11 09/27/2004 Brochure Development, Production, and Distribution for 2005
2004-10 09/14/2004 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year
2004-09 (a) 09/08/2004 Standard Contract Changes
2004-09 (b) 09/08/2004 Standard Contract Changes
2004-09 (c) 09/08/2004 Standard Contract Changes
2004-08 07/07/2004 Payroll Office Changes
Attachment - National Aeronautics and Space Administration (NASA)
2004-07 (a) 06/30/2004 2005 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
Attachment - 2005 FEHB Proposal Instructions
2004-07 (b) 06/30/2004 2005 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
Attachment - 2005 FEHB Proposal Instructions
2004-07 (c) 06/30/2004 2005 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Attachment - 2005 FEHB Proposal Instructions
2004-06 05/07/2004 2005 RATE INSTRUCTIONS -- Community-Rated Carriers
Attachment 1 OPM Community Rating Guidelines
2004-05 05/05/2004 Reconciliation Instructions for 2004 Rates. Community-Rated Carriers
Attachment 1 OPM Reconciliation Guidelines
Attachment 2 Reconciliation Instructions
Attachment 4
Attachment 5 Certificate of Accurate Pricing
Attachment 6
2004-04 04/19/2004 Federal Employees Health Benefits Program Annual Call Letter
Attachment 1 Federal Employees Health Benefits Program Annual Call Letter --- Checklist
Attachment 2 FEHB High Deductible Health Plans Criteria
2004-03 03/22/2004 The Colorado High Risk Health Insurance Act
Attachment 1
2004-02 03/15/2004 Calendar 2003 Financial Reporting
Attachment 1 - Summary statement spreadsheet
Attachment 2 - Financial reporting instructions
Attachment 3 - Certification of Annual Accounting Statement
2004-01 03/04/2004 HEDIS Data Collection

back to top

2003 Carrier Letters
LetterDateSubject
2003-35 12/17/2003 2004 Consumer Assessment of Health Plans Survey Requirements
Appendix A - Adult Questionnaire
Appendix B- Survey Participation Form
Appendix C- FEHB Plan and Subcode
Appendex D- Sample Crosswalk
2003-34 12/10/2003 Using the FEHB Disenrollment Regulations on CLER Discrepancies; Pseudo Social Security Numbers
Attachment 1 - Notice of Intent to Disenroll
Attachment 2 - Summary of Requirements and Recommendations for CLER for Both FEHB Carriers and Government Agencies
2003-33 11/03/2003 HIPAA compliant enrollment transactions
Enclosure - HIPAA Transaction Standard Companion Guide
2003-32 10/30/2003 Continuing Health Care for Federal Workers in the World Trade Center and the Pentagon
2003-31 10/08/2003 Financial Reporting Instructions for Federal Fiscal Year 2003 (Experience-rated Carriers)
Enclosure B1 - Guidelines and Table of Contents
Enclosure B2 - Preliminary Reporting Package Requirements
Enclosure B3 - Final Reporting Package Requirements
2003-30-A 10/02/2003 Changes to the Standard Contract- Community-rated HMOs
Enclosure
2003-30-B 10/02/2003 Changes to the Standard Contract- Experience-rated HMOs
Enclosure
2003-30-C 10/02/2003 Changes to the Standard Contract- Fee-for-Service
Enclosure
2003-28 09/05/2003 Avoiding Potential Misuse of Social Security Numbers in the Federal Employees Health Benefits Program
2003-27 08/18/2003 Financial Reporting and Auditing Requirements for Federal Fiscal Year 2003
2003-26 08/13/2003 Brochure Development, Production and Distribution for 2003 (letter only)
Enclosure 1 - Sample Rate Sheet
Enclosure 2A - Fee-for-service Brochure Examples
Enclosure 2B - HMO Brochure Examples
Enclosure 3 - Additional Guidance for Typesetting Brochure Cover
Enclosure 4 - Printing, Distribution, and Shipping Specification for FEHB Brochure
Enclosure 5 - Brochure Quantity Forms for Fee for Service and HMO Plans
Enclosure 6 - Shipping Labels
Enclosure 7 - Instructions for Creating PDF Versions of your FEHB Brochure
2003-25 08/13/2003 Revised FEHB Quality Assurance and Fraud and Abuse Reports
Attachment 1 - 2004 Quality Assurance Report
Attachment 2 - 2004 Fraud and Abuse Report
2003-24 08/12/2003 Accuracy of Health Plan Web Site Information
2003-23 06/18/2003 Industry Standards for Fraud & Abuse (F&A) Programs
2003-22 05/16/2003 Director Kay Coles James' HealthierFeds Campaign
Attachment - April is National Donate Life Organ and Tissue Donor Awareness Month
Attachment - May is High Blood Pressure Awareness Month
2003-21 05/136/2003 CAHPS Survey Data & Crosswalk Reminder
Appendix C - Plan Subcode List
Appendix D - Sample Crosswalk
2003-20 05/09/2003 Patient Safety Information on the FEHB Web Site
2003-19 05/06/2003 2004 Rate Instructions for Experience-Rated Plans
2003-18(a) 05/06/2003 2004 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
Enclosure
2003-18(b) 05/06/2003 2004 Technical Guidance and Instructions for Preparing Benefits and Service Area Proposals for New HMOs
Enclosure
2003-18(c) 05/06/2003 2004 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Enclosure
2003-17 04/30/2003 The State of Missouri Pharmacy Assessment
Enclosure
2003-16 04/30/2003 Surcharges and Assessments Under the New York Health Care Reform Act of 2000
Enclosure
2003-15 04/18/2003 Federal Employees Health Benefits Program Annual Call Letter
Enclosure - Checklist
2003-14 04/18/2003 2004 RATE INSTRUCTIONS - Community-Rated Carriers
Enclosure
2003-13 04/16/2003 Administrative Changes
2003-12 03/25/2003 Reconciliation Instructions for 2003 Rates—Community-Rated Carriers
Enclosure
2003-11 03/18/2003 LEVEL ORANGE ALERT
2003-10 03/10/2003 Emergency Prescription Drug Availability
2003-09 03/04/2003 Calendar 2002 Financial Reporting
Enclosure B - Automated AAS (for electronic submissions)
Enclosure C - Instructions for Automated AAS (for electronic submissions)
Enclosure D - Certification of Annual Accounting Statement (for both electronic and paper submissions)
Enclosure E - Annual Reporting Package (for paper submissions)
Enclosure F - Summary Statement Form (for paper submissions)
2003-08 03/04/2003 Brochure changes for 2004
2003-07 02/21/2003 Proposed Regulations
Enclosure
2003-06 02/19/2003 2003 Medicare Match
Enclosures
2003-05 02/04/2003 MHSA Parity Implementation Report
Attachment
2003-04 01/24/2003 Processing FEHB Enrollments
2003-03 01/24/2003 FEHB Carrier Conference
2003-02 01/21/2003 HEDIS® Data and QA and Fraud and Abuse Reporting
Attachment 1 — Fraud & Abuse Report
Attachment 2 — FFS Quality Assurance Report
Attachment 3 — HMO Quality Assurance Report
2003-01 01/13/2003 The State of Massachusetts Assessment on Pharmacies
Enclosure

back to top

2002 Carrier Letters
LetterDateSubject
2002-39 12/16/2002 2003 Consumer Assessment of Health Plans Survey Requirements
Enclosure A - CAHPS® 3.0H Adult Commercial Questionnaire
Enclosure B - Survey Participation Form
Enclosure C -FEHB Sub-codes
Enclosure D - Sample Crosswalk
2002-38 11/14/2002 FEHB Enrollments from the Transportation Security Administration
2002-37 10/09/2002 Electronic Enrollment Changes for 2003
Enclosure 1, Individual File Layout
Enclosure 2, Participating Federal Agencies
2002-36 10/04/2002 Federal Employees Health Benefits (FEHB) Program Study on the Cost of Mandated Benefits
Enclosure
2002-35 09/25/2002 Financial Reporting Requirements for Federal Fiscal Year 2002
Enclosure B1
Enclosure B2
Enclosure B3
Enclosure B4
2002-34 09/25/2002 Federal Employees Health Benefits (FEHB) Program Study on the Cost of Mandated Benefits
Enclosure
2002-33 09/25/2002 Federal Employees Health Benefits (FEHB) Program Waiver
Enclosure
2002-32 09/24/2002 Federal Employees Health Benefits Program Proposed Regulation
Attachment
2002-31 09/23/2002 FEHB/DOD Demonstration Project
Attachment
2002-30 09/11/2002 Accelerated Timeframes for Financial Statement Reporting
2002-29 09/05/2002 Unsigned SF 2809s
2002-28 08/29/2002 Additional Brochure Changes for 2003
2002-27 08/22/2002 Additional Brochure Changes for 2003
2002-26 08/08/2002 Brochure Development, Production and Distribution for 2002 (letter only)
Enclosure 1 - Sample Rate Sheet
Enclosure 2A - FFS Brochure Examples
Enclosure 2B - HMO Brochure Examples
Enclosure 3 - Additional Guidance for Typesetting Brochure Cover
Enclosure 4 - Printing, Distribution, and Shipping Specification for FEHB Brochure
Enclosure 5 - Brochure Quantity Forms for Fee for Service and HMO Plans
Enclosure 6 - Shipping Labels
Enclosure 7 - Instructions for Creating PDF Versions of your FEHB Brochure
2002-25 07/30/2002 Audit Guide
Summary of Audit Guide Changes
FEHBP Experience-Rated Carrier and Service Organization Audit Guide
2002-24-A 07/30/2002 Changes to the Standard Contract — Community-rated HMOs
Enclosure
2002-24-B 07/30/2002 Changes to the Standard Contract — Experience-rated HMOs
Enclosure
2002-24-C 07/30/2002 Changes to the Standard Contract — Fee-for-Service
Enclosure
2002-23 07/12/2002 Placement of ID Numbers in CLER
2002-22 07/02/2002 Brochure Changes for 2003
2002-21 06/28/2002 Amendment to 2003 RATE INSTRUCTIONS -- Community-Rated Carriers
2002-20 05/28/2002 ORP Payroll Office Number and CLER Update
2002-19 05/15/2002 CAHPS Survey Data & Crosswalk Reminder
Sample Completed Crosswalk
List of FEHB Codes and Plan Names
2002-18 05/05/2002 Postponement of January 1 Effective Date for Open Season Elections
2002-17 04/23/2002 Brochure Changes for 2003
2002-16(a) 04/18/2002 Technical Guidance and Instructions for Submitting 2003 HMO Benefit and Service Area Proposals
Enclosure
2002-16(b) 04/18/2002 Technical Guidance and Instructions for Submitting 2003 HMO Benefit and Service Area Proposals for New HMOs
Enclosure
2002-16(c) 04/18/2002 Technical Guidance for 2003 Benefit Proposals - Fee-For-Service Carriers
Enclosure
2002-15 04/18/2002 2003 Rate Instructions -- Community-Rated Carriers
Enclosure
2002-14 04/16/2002 Federal Employees Health Benefits Program Annual Call Letter
2002-13 04/12/2002 2003 Rate Instructions for Experience-Rated Plans
Enclosure
2002-12 03/22/2002 Reconciliation Instructions for 2002 Rates— Community-Rated Carriers
Enclosure
2002-11 03/22/2002 2002 Medicare Match
Enclosure A — Medicare Data Release Agreement
Enclosure B — Report Description — Annuitant Medicare Match Lists
Enclosure C — Annuitant Medicare Match
2002-10 03/01/2002 Accelerated Timeframes for Financial Statement Reporting
March 20 Meeting Agenda
Schedule of Reporting Requirements
2002-09 02/28/2002 Training for the FEHB Clearinghouse Project
2002-08 02/19/2002 FEHB Carrier Conference
Attachment
2002-07 02/12/2002 MHSA Parity Implementation Report
Attachment
2002-06 02/05/2002 Payroll Office Numbers and Processing Electronic Enrollment
Attachment
2002-05 02/01/2002 Calendar 2001 Financial Reporting (Experience-Based Carriers)
Enclosure A — Certification of Annual Accounting Statement
Enclosure B — Annual Reporting Package
Enclosure C — Summary Statement of FEHHBP Financial Operations
2002-04 01/30/2002 Department of Defense enrollment transfers
2002-03 01/29/2002 FEHB Routine Reporting Requirements for 2002
2002-02 01/28/2002 Health Insurance Portability and Accountability Act
2002-01 01/11/2002 FEHB Quality Assurance Requirements
Enclosure A — Fraud and Abuse Report spreadsheet
Enclosure B — FFS - FEHB 2001 QA Report spreadsheet
Enclosure C — HMO - FEHB 2001 QA Report spreadsheet

back to top

2001 Carrier Letters
LetterDateSubject
2001-41 12/03/2001 2002 Consumer Assessment of Health Plans Survey Requirements
Appendix A - Survey Instructions
Appendix B - Vendor Selection Form
Appendix C - FEHB Plan Names, Carrier Codes and Subcodes
Appendix D - Sample Crosswalk
2001-40 11/29/2001 Federal Employees Health Benefits Program (FEHB): Suspension of FEHB Coverage to use TRICARE
Attachment
2001-39 11/08/2001 Clearinghouse: Electronic File Layout of SF 2809 and SF 2810
Enclosure 1 — CLER 2809 Corrective Action File Layout
Enclosure 2 — CLER 2810 Corrective Action File Layout
2001-38 10/29/2001 Guidance to Carriers on Services Related to Anthrax
2001-37 10/18/2001 Connecting Agency HR Offices to the FEHB Clearinghouse Project
2001-36 10/16/2001 FEHB Fall Carrier Conference
2001-35 10/108/2001 Correct Payroll Office Numbers for the Department of Defense
2001-34 10/01/2001 2001 Fiscal Year Financial Reporting
Enclosure: Encl B Table of Contents
Enclosure: Est Summary Statement
Enclosure: FY Statements
Enclosure: Summary Instructions
Enclosure: Summary Statement
2001-33 09/21/2001 Revised Electronic Enrollment Changes for 2002
Enclosure — Individual File Layout
2001-32 09/21/2001 Revised Encryption Instructions for Sending Data to the FEHB Clearinghouse
Enclosure — Encryption Instruction for Sending Data to CLER
2001-31 09/12/2001 Compassionate Response to the National Disaster
2001-30 09/12/2001 Encryption Instructions for Sending Data to the FEHB Clearinghouse
Enclosure
Replaced by the enclosure to CL 2001-32.
2001-29 09/07/2001 Electronic Enrollment Changes for 2002
Enclosure 1 — Individual File Layout
Replaced by the enclosure to CL 2001-33.
Enclosure 2 — Participating Federal Agencies
2001-28 09/05/2001 FEHB Fall Carrier Conference
2001-27 08/27/2001 Coverage for FDA-Approved Drugs, Devices, and Biological Products
2001-26 08/08/2001 Audit Guide (fee-for-service plans and experience-rated HMOs only)
Enclosure — Audit Guide
Summary of 2001 Audit Guide Changes
2001-25 08/06/2001 Brochure Development, Production and Distribution for 2002 (full version, with all attachments — 47 pages, 1.4 Meg file)
2001-25 08/06/2001 Brochure Development, Production and Distribution for 2002 (letter only)
Enclosure 1 - Sample Rate Sheet
Enclosure 2A - FFS Brochure Examples
Enclosure 2B - HMO Brochure Examples
Enclosure 3 - Additional Guidance for Typesetting Brochure Cover
Enclosure 4 - Printing, Distribution, and Shipping Specification for FEHB Brochure
Enclosure 5 - Brochure Quantity Forms for Fee for Service and HMO Plans
Enclosure 6 - Shipping Labels
Enclosure 7 - Instructions for Creating PDF Versions of your FEHB Brochure
2001-24 08/02/2001 Amendments to the Standard Contract
Enclosure — Fee-for-service Plans
Enclosure — Experience-Rated HMOs
Enclosure — Community-Rated HMOs
2001-23 07/31/2001 Revised patient safety standards
2001-22 07/18/2001 Postponement of January 1 Effective Date for all Open Season Elections
2001-21 06/22/2001 Input File Layout for the FEHB Clearinghouse
Enclosure A, Enrollment File Layout
Enclosure B, CLER Requirements Document
2001-20 06/21/2001 HIPAA Workgroup
2001-19 05/30/2001 Accreditation
2001-18-NEW 05/22/2001 Contract Year 2002 Brochure Language and Format -- Carriers of New FEHB Plans
Enclosure -- Patterns
2001-18 05/22/2001 Contract Year 2002 Brochure Language and Format -- All Carriers
Enclosure FFS 1 - FFS Pattern
Enclosure FFS 2 - FFS Edit List
Enclosure HMO 1 - HMO Pattern
Enclosure HMO 2 - HMO Edit List
2001-17 05/08/2001 Reminder to Provide CAHPS Survey Data & Crosswalk
Enclosure A, Crosswalk
Enclosure B, FEHB Subcode Plan Name List
2001-16 05/07/2001 Verification of accreditation status (for HMO plans)
2001-15 05/01/2001 2002 Rate Instructions - DoD Demonstration Project - Community Rated Carriers
Enclosure
Enclosure 2, Plan Participation in DoD/FEHB Demonstration Project
2001-14 05/01/2001 Federal Employees Health Benefits (FEHB) Program: January 1 Effective Date for all Open Season Enrollments and Changes
2001-13 04/25/2001 FEHB Clearinghouse Update
Enclosure
2001-12 04/24/2001 Health Insurance Portability and Accountability Act: Privacy Regulations
2001-11(a) 04/18/2001 Technical Guidance for 2002 Benefit and Service Area Proposals - HMOs
Enclosure
2001-11(b) 04/18/2001 Technical Guidance for 2002 Benefit and Service Area Proposals -- New HMOs
Enclosure
2001-11(c) 04/19/2001 Technical Guidance for 2002 Benefit Proposals - FFS
Enclosure
2001-10 04/10/2001 2002 Rate Instructions - Community Rated Carriers
Enclosure
2001-09 04/10/2001 Call Letter for Contract Year 2002
2001-08 04/04/2001 2002 Rate Instructions for Experience-Rated Plans
2001-07 03/22/2001 Reconciliation Instructions for 2001 Rates--Community-Rated Carriers
Enclosure
2001-06 03/20/2001 2001 Medicare Match
Enclosure
2001-05 03/14/2001 Brochure edits for 2002
Enclosure
2001-04 02/13/2001 HEDIS® Data (HMO Carriers Only)
2001-3A 02/06/2001 2000 Financial Reporting (Experience-Rated Carriers) (the enclosures are linked from the web version of the letter)
2001-3B 02/06/2001 2000 Financial Reporting (Community-Rated Carriers)
2001-02 02/06/2001 FEHB Routine Requirements
Attachment
2001-1 02/02/2001 Administrative Changes

back to top

2000 Carrier Letters
LetterDateSubject
2000-55 12/20/2000 Federal Employees Health Benefits Children's Equity Act of 2000
2000-54 12/07/2000 Reminder of Reporting Requirements for Carriers Participating in the Department of Defense and Federal Employees Health Benefits Program Demonstration Project in 2000
Enclosure 1
2000-53 12/07/2000 LIVE WEBCAST: At 9:30 a.m. EST on Monday, December 11, 2000
2000-52 11/29/2000 Federal Employee Assistance Program Headquarters Contacts
2000-51 11/27/2000 2001 Consumer Assessment of Health Plans Survey (letter only)
Enclosure 1 - CAPHS® Adult Questionnaire (Commercial)
Enclosure 2 - Vendor Selection Form
Enclosure 3 - Crosswalk
Enclosure 3 - 2001 FEHB Sub-Code Plan List
2000-50 11/15/2000 Compliance With The Americans With Disabilities Act (ADA)
2000-49 10/26/2000 Health Insurance Portability and Accountability Act: Standards for Electronic Transactions and Standards for Privacy of Individually Identifiable Health Information
2000-48 10/11/2000 2000 Fiscal Year Financial Reporting
Enclosures
2000-47 10/11/2000 Open Season Enrollment Issues
2000-46 09/29/2000 How do you like the carrier web page?
2000-45 09/12/2000 Coverage for Pastoral Counselors in Medically Underserved Areas
2000-44 09/12/2000 Updating Plan Information
2000-43A 09/08/2000 Amendments to the Standard Contract for Fee-for-Service Carriers
Enclosure
2000-43B 09/08/2000 Amendments to the Standard Contract for Experience-Rated HMO's
Enclosure
2000-43C 09/12/2000 Amendments to the Standard Contract for Community-Rated Carriers
Enclosure
2000-42 09/01/2000 Electronic Enrollment Changes
NOTE: The information in this letter has been modified by CL 2001-29 of Sept. 7, 2001.
Enclosure 1 - Individual File Layout
Enclosure 2 - Agencies Participating in Employee Express
2000-41 09/01/2000

Brochure Development, Production and Distribution for 2001

2000-41 09/01/2000 Brochure Development, Production and Distribution for 2001 (letter only)
Enclosure 1 - 2001 Rate Information Page
Enclosure 2A - FFS Brochure Examples
Enclosure 2B - HMO Brochure Examples
Enclosure 3 - Additional Guidance for Typesetting Brochure Cover
Enclosure 4 - Printing, Distribution, and Shipping Specification for FEHB Brochure
Enclosure 5 - Sample Brochure Quantity Forms
Enclosure 6A - Agencies Shipping Label
Enclosure 6B - DoD Project Shipping Label
Enclosure 6C - National Computer Systems Shipping Label
2000-40 08/25/2000 Fall Conference Registration and Synopsis
2000-39 08/25/2000 MinnesotaCare Tax
2000-38 07/28/2000 Five Steps to Safer Health Care
2000-37 07/25/2000 FEHB Fall Plan Conference CORRECTION and ADDITION
2000-36 07/25/2000 Verification of accreditation status (for HMO plans)
2000-35 07/21/2000 Audit Guide for Experience-rated Carriers
Attachment — FEHBP Experienced-rated Carrier and Service Organization Audit Guide
2000-34 07/21/2000 New Public Health Service Smoking Cessation Guideline
2000-33 07/21/2000 New Survey Contractor Selected
2000-32A 07/17/2000 FEHB Clearinghouse (Experience-rated Carriers)
2000-32B 07/17/2000 FEHB Clearinghouse (Community-rated Carriers)
2000-31 07/07/2000 Contract Year 2001 Brochure Language and Format
FFS Attachment Part 1
FFS Attachment Part 2
FFS Attachment Part 3
HMO Attachment Part 1
HMO Attachment Part 2
HMO Attachment Part 3
2000-30 07/07/2000 FEHB Fall Plan Conference
2000-29 06/21/2000 The Department of Defense (DoD) and Federal Employees Health Benefits (FEHB) Program Demonstration Project
2000-28 06/21/2000 Correction to Letter 2000-25
2000-27 06/06/2000 New Vendor for Medicare Part B Claims Adjudication
2000-26 05/31/2000 Electronic Enrollment
2000-25 05/31/2000 PlanSmartChoice and the FEHB Website
2000-24 05/15/2000 FEHB Carrier Web Page
2000-23 05/08/2000 Plain language for your 2001 brochure
Plain language for your 2001 brochure - FFS
Part I of 3
Plain language for your 2001 brochure - FFS
Part II of 3
Plain language for your 2001 brochure - FFS
Part III of 3
Plain language for your 2001 brochure - HMO
Part I of 3
Plain language for your 2001 brochure - HMO
Part II of 3
Plain language for your 2001 brochure - HMO
Part III of 3
2000-22 05/05/2000

Open Season Material & Reimbursement of Printing Costs

2000-21A 05/05/2000 Technical Guidance for Benefit Proposals
2000-21B 05/05/2000 Technical Guidance for Benefit and Service Area Proposals
2000-21C 05/05/2000 Technical Guidance for Benefit and Service Area Proposals
2000-20 05/05/2000 Updated Participation in the DoD/FEHB Demonstration Project
2000-19 05/01/2000 2001 RATE INSTRUCTIONS - DoD Demonstration Project — Community Rated Carriers
2000-18A 04/19/2000 2001 Rate Instructions for Experience-Rated Plans
2000-18B 04/19/2000 2001 RATE INSTRUCTIONS — Community-Rated Carriers
2000-17 04/11/2000 Call Letter for Contract Year 2001 — Policy Guidance
2000-16 04/04/2000 2001 ADDITIONAL RECONCILIATION INSTRUCTIONS Community-Rated Carriers Only
2000-15 03/27/2000 Corrections to FEHB Program Carrier Letters
2000-14 03/22/2000 Reconciliation Instructions for 2000 Rates — Community-Rated Carriers
2000-13 03/21/2000 Request for Feedback on Disenrollment Regulations
2000-12 03/06/2000 2000 Medicare Match
2000-11 03/01/2000 Mental Health and Substance Abuse Parity Evaluation
2000-10 03/01/2000 Premium conversion
2000-09 02/28/2000 FEHB Routine Reporting Requirements
2000-08 02/28/2000 Reporting Requirements for Carriers Participating in the Department of Defense and Federal Employees Health Benefits Program Demonstration Project.
2000-07 02/28/2000 Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact.
2000-06 02/09/2000 HEDIS® Data
2000-05C 02/09/2000 1999 Financial Reporting
2000-05E 02/09/2000 1999 Financial Reporting
2000-04 01/27/2000 Processing Annuitant Enrollments
2000-03 01/19/2000 Consumer Assessment of Health Plans Survey
2000-02 Family Centered Activities by FEHB Health Carriers
2000-01 01/04/2000 Department of Defense and Federal Employees Health Benefits Program Demonstration Project

Back to top

1999 Carrier Letters
LetterDateSubject
1999   Year 2000 Compliance
1999-62 12/21/1999 FEHB Clearinghouse
1999-61 12/21/1999 Y2K Service Interruptions
1999-60 12/16/1999 Tobacco Litigation
1999-59 12/13/1999 Payroll Office Changes
1999-58 full CR contract 11/23/1999 Federal Employees Health Benefits Program Standard Contract
1999-58
CR amend
11/23/1999 Year 2000 Amendments to the Standard Contract for Community-Rated Carriers
1999-58 11/23/1999 Amendments to the Standard Contract for Community-Rated Carriers
1999-57 11/02/1999 Department of Defense and Federal Employees Health Benefits Program Demonstration Project
1999-56 10/28/1999 New FEHB Election Forms
1999-55 10/28/1999 Plan Performance Data Collection
1999-54 10/27/1999 Open Season Enrollment Issues
1999-53A 10/21/1999 1999 Fiscal Year Financial Reporting
1999-52 10/20/1999 Mental Health and Substance Abuse Parity
1999-51 10/19/1999 The 2000 FEHB Web Site
1999-50 10/05/1999 Implications of Medicare Anti-Kickback Statute for Coordination of Benefits
1999-49 09/28/1999 DoD/FEHB Demonstration Project and Health Fairs 
DoD/FEHB Demonstration Project and Health Fairs - Enclosure
1999-48 09/22/1999 Correction to Carrier Letter 1999-046
1999-47 09/20/1999 FEHB Press Release and Rates for 2000
1999-46 09/08/1999 2000 Plan Brochure Development, Production and Distribution
1999-45 09/15/1999 Fall Conference
1999-44 09/07/1999 Electronic Enrollment Correction
1999-43 09/07/1999 Transitional Care under the Patients' Bill of Rights
1999-42 09/02/1999 The Guide to Federal Employees Health Benefits Plans for Year 2000 and the FEHB web site.
1999-41 08/30/1999 Electronic Enrollment
NOTE: The information in this letter has been modified by CL 2001-29 of Sept. 7, 2001.
1999-40 08/27/1999 Greenbrier Clinic, Inc., Compliance Plan
1999-39 08/27/1999 Class Deviation from Federal Acquisition Regulation (FAR) 31.205-46(a)(2)(i), Maximum Per Diem Rates Under the Federal Travel Regulations (FTR)
1999-38A 08/18/1999 Amendments to the Standard Contracts for Fee-for-Service Carriers
1999-38B 08/18/1999 Amendments to the Standard Contracts for Community-Rated Carriers
1999-38C 08/18/1999 Amendments to the Standard Contracts for Experience-Rated HMOs
1999-37 08/17/1999 Revisions to the original fee-for-service brochure language
1999-36A 08/13/1999 1999 Contract Amendments
1999-36B 08/13/1999 1999 Contract Amendments
1999-36C 08/13/1999 1999 Contract Amendment
1999-35 08/13/1999 The Debt Collection Improvement Act of 1996 (DCIA)
1999-34 08/06/1999 Notification of certain enrollment changes
1999-33 07/22/1999 Verification of accreditation status
1999-32 07/19/1999 Brochure language concerning Breast Reconstruction
1999-31 07/19/1999 Revisions to the original HMO brochure language
1999-30 07/16/1999 The Department of Defense (DoD) and Federal Employees Health Benefits (FEHB) Program Demonstration Project
1999-29 07/14/1999 Contract Year 2000 Brochure Language and Format
1999-28 06/18/1999 Results of IPA Audits of Experience-Rated Carriers
1999-27 06/07/1999 Mental Health and Substance Abuse Parity
1999-26 06/18/1999 OIP Plain Language Style and Usage Guide
1999-25 05/25/1999 Contract Year 2000 Brochure Language and Format
1999-24 05/18/1999 Request for Feedback on the Carrier Information System
1999-23 05/17/1999 Cryosurgery for Localized Prostate Cancer
1999-22 05/06/1999 1999 FEHB Customer Satisfaction/CAHPS Survey
1999-21 04/28/1999 Participation in the DoD/FEHB Demonstration Project
1999-21DoD 05/06/1999 2000 RATE INSTRUCTIONS DOD Demonstration Project Community Rated Carriers
1999-20 04/28/1999 Delayed Annuitant Medicare Match Data
1999-19 04/19/1999 United States of America and State of Florida, ex rel. Louis H. Mueller v. Eckerd Corporation, Case Number 95-2030-Civ-T-17C (M.D. Fla.)
1999-18A 04/13/1999 Year 2000 Compliance
1999-18B 04/13/1999 Year 2000 Compliance
1999-17A 04/16/1999 2000 RATE INSTRUCTIONS Community Rated Carriers
1999-17B 04/28/1999 2000 Rate Instructions for Experience-Rated Plans
1999-16 04/09/1999 Annual Call Letter for Contract Year 2000
Call Letter Enclosure - FFS
Call Letter Enclosure - HMO
Call Letter New Enclosure - HMO
1999-15 03/26/1999 Correction to Reconciliation Instructions For 1999 Rates Community-Rated Carriers
1999-14 03/19/1999 Reconciliation Instructions For 1999 Rates - Community-Rated Carriers
1999-13 03/16/1999 Table 1 -- Reporting Under The FEHB Program
1999-12 03/05/1999 1998 and 1999 Contract Amendments on Cost Accounting Standards
1999-09 02/18/1999 Correction to Disenrollment and Reconciliation Carrier Letter
1999-08 02/09/1999 FEHB Reporting Requirements
1999-07 02/09/1999 Disenrollment and Reconciliation
1999-06 02/05/1999 1999 Medicare Match
1999-05 02/01/1999 Military Retirees FEHB Coverage Demonstration Project
1999-04 01/22/1999 Surcharges and Taxes on Connecticut Hospital Services
1999-03 01/21/1999 Revision of the Guide to Federal Employees Health Benefits Plans
1999-02 01/15/1999 Employee Express Evaluation
1999-01 01/15/1999 FEHB Plain Language Initiative

Back to top

Carrier Application

If you want to apply to participate in the FEHB Program, please do the following:

Carrier Application Information Form











Routine Reports

ReportFrequencyRequired ofDate DueContact
Agreements and Certifications
Medicare Match Agreement First year; then when applicable All As directed ISP/HIG/Contract Specialist
Certification re Disclosure of Lobbying Activities At approval All Before approval ISP/HIG/Contract Specialist
OMB SF LLL, Disclosure of Lobbying Activities (relates to certification) When applicable All As needed ISP/HIG/Contract Representative
Certification re Drug-Free Workplace At approval All Before approval ISP/HIG/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
Debarment/Suspension
FEHB Carrier debarment/suspension actions Semi-annual All Apr 15 and Oct 15 Ofc Of Inspector/Gen/Internet, Debar (debar@opm.gov)
Enrollment Reporting
Table 1-Summary of FEHBP Enrollment Annual All Apr 15 ISP/PPEG/Figg (eric.figg@opm.gov)
FEHB Quality Assurance
Customer Satisfaction Survey Results (CAHPS) Annual All except plans with <500 FEHB enrollees Jun 17 cahps@opm.gov)
HEDIS Annual HMOs with > 500 FEHB enrollees Mid-June hedis@opm.gov)
Quality Assurance Report Annual All Jul 1 Amber.Hudson@opm.gov)
Fraud and abuse cases report Annual All Mar 31 fraudandabuse@opm.gov)
Fraud and abuse questionnaire Annual All Mar 31 fraudandabuse@opm.gov)
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/ Wynn (melanese.wynn@opm.gov)
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/ Wynn (melanese.wynn@opm.gov)
Other Financial Reports
C1 - Annual Incurred Report
(12 months increased paid through 18 months)
Annual FFS Last business day in July Ofc of Actuaries/Cook bryant.cook@opm.gov)
C2 - Number of Procedures and Number Receiving Benefits Annual FFS Last business day in July Ofc of Actuaries/Cook bryant.cook@opm.gov)
Monthly Incurred Monthly FFS and Experienced - Rated HMOS 15 Days after end of month Ofc of Actuaries/Cook bryant.cook@opm.gov)
Loca Draw down Monthly FFS and Experienced HMOS 15 days after end of month Ofc of Actuaries/Cook bryant.cook@opm.gov)
Other Submissions
Service charge request (Plans are not required to request a service charge) Annual Exp-rated As directed ISP/HIG/Contract Specialist
Special contingency reserve request When applicable Exp-rated As directed ISP/HIG/Contract Specialist
Pilot Projects
Small Business Subcontracting Plan Annual 6 pilot project carriers Jun 15 ISP/HIG/Contract Specialist
Subcontracting Report for Individual Contracts (SF 294) Semi-annual 6 pilot project carriers Apr 30 and Oct 30 ISP/HIG/Contract Specialist
Summary Subcontract Report (SF 295) Annual 6 pilot project carriers Oct 30 ISP/HIG/Contract Specialist
Premium Payment
TFS Form 3881 B Payment Information Form At approval All As directed Trust Funds Group/Wynn (melanese.wynn@opm.gov)
Change of Financial Institution When applicable All As directed Trust Funds Group/Wynn (melanese.wynn@opm.gov)
Rate Related
Rate Proposal (includes several tables and reports) Annual All; by Rate type May 31 Ofc of Actuaries/Simon (sherry.simon@opm.gov)
Rate Reconciliation Request (includes several tables and reports) Annual C-rated April 30 Ofc of Actuaries/Simon (sherry.simon@opm.gov)

Back to Top

Reference Materials

Health Information Technology References

Health & Human Services

Executive Branch/Congressionally Appointed Commission

Regional Health Organizations (focusing on the States with which HHS-AHRQ has contracts on HIT demos)

Technology Groups

Control Panel