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Federal Employees Health Benefits (FEHB) Program Carriers

 

Overview

The Federal Employees Health Benefits (FEHB) Program is the largest employer sponsored health benefits program of its kind. Established by an Act of Congress in 1959, the FEHB Program began covering employees on July 1, 1960. FEHB Program carriers cover most active, full-time civilian employees and retirees of the U.S. government and their families. The Program now provides benefits to nearly 8.3 million federal enrollees and dependents and offers our 180 health plan choices to federal members.

Guiding Principles for Carriers

All carriers must be committed to:

  1. Ensuring enrollees have access to good healthcare benefits;
  2. Striving to keep premiums affordable;
  3. Ensuring enrollees have access to quality provider networks;
  4. Providing competitive healthcare choices for consumers;
  5. Strengthening information for consumers so they can be more involved and responsible for their own healthcare decisions;
  6. Being well managed and financially secure;
  7. Providing efficient and effective contract administration;
  8. Ensuring the timely and accurate submission of actuarial data and financial accounting information;
  9. Maintaining compliance with laws, regulations, contract requirements and administrative guidance at all times; and
  10. Guaranteeing that enrollee and Government resources are protected.

Carrier Letters

2024 Carrier Letters

Letter Date Subject
2024-01 01/23/2024 Experience Rated Carrier Reporting Requirements
2024-02 01/25/2024 Pharmacy Benefits Management (PBM) Transparency Standards
2024-03 01/30/2024 Contraceptive Drugs and Drug-Led Devices; Member and Provider Education
2024-04 02/08/2024 Federal Employees Health Benefits and Postal Service Health Benefits Programs Call Letter
2024-05 02/12/2024 Consolidated Pharmacy Benefits Guidance for the FEHB Program
2024-06 03/07/2024 Technical Guidance and Instructions for 2024 Benefit Proposals
Addendum to Technical Guidance and Instructions for 2025 Benefit Proposal
Attachment A: 2024 FEHB Formulary Template
Attachment B: 2025 FEHB Formulary Template
Attachment C: Formulary Comparison Between 2024 and 2025 Template
Attachment D: 2025 PSHB Drug List Template
Attachment E: FEHB Benefit Difference Comparison Chart
Attachment F: Formulary Comparison Between CMS Base, Enhanced EGWP, and FEHB Template
2024-07 03/11/2024 Update on Aggregate Healthcare Cost and Utilization Data Reporting Requirements
2024-08 03/19/2024 Network Provider Data Reporting Requirements
Provider_PSHB_FEHB JSON file
Provider_PSHB_FEHB Example JSON file
2024-09 04/01/2024 Reconciliation Instructions for 2024 Rates - Community Rated Carriers
Part 3 - 2024 Reconciliation Instructions
2024 Reconciliation Tables Attachments III and IIIA*
2024-10 04/30/2024 2025 Rate Instructions - Community-Rated Carriers
Attachment A: Part 1 - 2025 Community Rating Guidelines
Attachment B: Part 2 - 2025 Proposal Instructions
Attachment C: Proposal Tables Attachments I, IA, II, IIB (QG22-QG28), and IIA
2024-11 05/01/2024 Updated Enrollment Data Reporting Requirements
2024-12 05/10/2024 Carrier Letter for PSHB Carriers Only
2024-13 05/10/2024 Auto-Enrollment Process for Postal Service Employees and Annuitants Transitioning from Federal Employees Health Benefits (FEHB) to Postal Service Health Benefits (PSHB)
2024-14 05/21/2024 2025 Rate Proposal File – Experience-Rated Carriers
2024-15 06/25/2024 Guidance for Audited Financial Statements for Federal Fiscal Year 2024
Attachment A: 2024 FEHBP Financial Reporting and Audit Guide
Attachment B: AUP Survey Form
Attachment C: OPM AUP Reports
2024-16 07/18/2024 Federal Employees Health Benefits (FEHB) Plan Performance Assessment 2026 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
Attachment A: 2026 Clinical Quality, Customer Service and Resource Use Measure Set
2024-17 08/01/2024 OPM Health Reimbursement Arrangement credits for Postal Service enrollees transitioning to PSHB plans for 2025
2024-18 09/18/2024 Coverage for Over-the-Counter Drugs, Products, and Supplies

*This document will be uploaded soon.

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.

2023 | 2022 | 2021 | 2020201920182017201620152014201320122011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001 | 2000 | 1999

2023 Carrier Letters

Letter Date Subject
2023-01 01/18/2023 Prevention and Treatment of Obesity
2023-02 01/25/2023 FEHB and Medicare Part D Prescription Drug Coordination
2023-03 02/6/2023 Consolidated Pharmacy Benefits Guidance for the FEHB Program
2023-04 03/1/2023 Federal Employees Health Benefits Program Call Letter
2023-05 03/8/2023 Update on Aggregate Healthcare Cost and Utilization Data Reporting Requirements
2023-06 03/24/2023 Technical Guidance and Instructions for 2024 Benefit Proposals
Attachment A: Brochure Creation Tool 508 Guidance
Attachment B: Instructions for the 2023 and 2024 FEHB Formulary Information Completion and Submission
Attachment C: 2023 FEHB Drug Formulary Template
Attachment D: 2024 FEHB Drug Formulary Template
Attachment E: FEHB Benefit Difference Comparison Chart
2023-07 03/31/23 Reconciliation Instructions for 2023 Rates – Community Rated Carriers
2023 Reconciliation Tables Attachments lll and lllA
2023-08 04/21/23 COVID-19 Public Health Emergency Transition
2023-09 04/28/23 2024 Rate Instructions - Community-Rated Carriers
PART 1 2024 COMMUNITY RATING GUIDELINES
PART 2 2024 PROPOSAL INSTRUCTIONS
Proposal Tables Attachments I, IA, II, IIB (QG21-QG24), and IIA
2023-10 05/17/23 2024 Rate Proposal File – Experience-Rated Carriers
2023-11 04/18/23 Federal Employees Health Benefits Plan Performance Assessment 2025 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
Attachment 1: 2025 Clinical Quality, Customer Service and Resource Use Measure Set
2023-12 05/23/23 Coverage for Gender Affirming Care and Services
2023-13 07/19/23 Methodology for Crediting Postal Service Health Benefits (PSHB) Program Plan Reserves and Earned FEHB Medical Loss Ratio Credits
Attachment A - Crediting the PSHB Reserves Example
2023-14 07/21/23 Taking Action on Social Determinants of Health for FEHB Members
2023-15 07/26/23 Network Adequacy for Behavioral Health Services
2023-16 09/7/23 Initial Guidance on the Federal Employees Health Benefits (FEHB) Program Improper Payments (IPs) and Carrier Reporting Requirements
2023-18a 09/14/2023 Changes to the Standard Contract for Contract Year 2024 - CR-HMO
2023-18b 9/14/2023 Changes to the Standard Contract for Contract Year 2024 - ER-HMO
2023-18c 9/14/2023 Changes to the Standard Contract for Contract Year 2024 - FFS
2023-19 09/19/23 Accreditation Requirements for Federal Employees Health Benefits (FEHB) Carriers
2023-20 12/19/23 Coverage for Immunizations
2023-21 12/21/2023 2024 Plan Performance Assessment Procedure Manual
Attachment A: 2024 FEHB Plan Performance Assessment Procedure Manual
Attachment B: Planned HEDIS and CAHPS Reporting User Guide
Attachment C: 2024 CAHPS Sample Crosswalk
Attachment D: 2024 Quality Improvement Corrective Action Plan Template
Attachment E: 2024 Corrective Action Plan Follow-up Template
2022 Carrier Letters
Letter Date Subject
2022-01 01/10/2022 COVID-19 Over-the-Counter Tests, Vaccines, and Therapeutics
2022-02 01/31/2022 Consolidated Pharmacy Benefits Guidance for the FEHB Program
2022-03 02/17/2022 Federal Employees Health Benefits Program Call Letter
2022-04 03/16/2022 Technical Guidance and Instructions for 2023 Benefit Proposals
Attachment A: Brochure Creation Tool 508 Guidance
Attachment B: Instructions for the 2022 and 2023 FEHB Formulary Information Completion and Submission
Attachment C: 2022 FEHB Drug Formulary Template
Attachment D: 2023 FEHB Drug Formulary Template
Attachment E: FEHB Benefit Difference Comparison Chart
2022-05 03/15/2022 Contraceptive Coverage in the FEHB Program
2022-06 03/31/2022 Reconciliation Instructions for 2022 Rates – Community Rated Carriers
Attachment A: Reconciliation Tables Attachments – III and IIIA
2022-07 03/31/2022 Colonoscopies
2022-08 03/31/2022 COVID-19 Over-the-Counter Tests
2022-09 05/02/2022 2023 Rate Instructions - Community-Rated Carriers
Attachment A: Part 1 – 2023 Community Rated Guidelines
Attachment B: Part 2 – 2023 Proposal Instructions
Attachment C: Proposal Table Attachments – I, II, IIA
2022-10 05/16/2022 2023 Rate Proposal File – Experienced-Rated Carriers
Attachment A: 2023 Experienced Rated Rate Proposal
2022-11 05/24/2022 Coverage of Monoclonal Antibodies Directed Against Amyloid in the FEHB Program
2022-12 07/13/2022 No Surprises Act, Reporting on Pharmacy Benefits and Drug Costs, and Other Provisions of the Consolidated Appropriations Act, 2021
2022-13 07/21/2022 Federal Employees Health Benefits Plan Performance Assessment 2024 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
Attachment 1: 2024 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
2022-14 08/11/2022 Claims Data Requirements for All Community-Rated HMOs – Except State-Mandated Traditional Community-Rated HMOs
Attachment A: 2021 MLR - 2023 ACR Mandatory Claim Layouts
2022-15 08/08/2022 Removing Ineligible Children from Federal Employees Health Benefits (FEHB) Program Coverage
2022-16a 08/15/2022 Changes to the Standard Contract for Contract Year 2023 - CR-HMO
2022-16b 8/15/2022 Changes to the Standard Contract for Contract Year 2023 - ER-HMO
2022-16c 8/15/2022 Changes to the Standard Contract for Contract Year 2023 - FFS
2022-17 08/19/2022 Contraception
2022-18 8/19/2022 Post-Acute Sequelae of COVID (PASC)
2022-19 12/5/2022 Plan Performance Assessment 2023 Procedural Manual
Attachment 1: 2023 FEHB Plan Performance Assessment Procedure Manual
Attachment 2: 2023 Planned HEDIS and CAHPS Reporting User Guide
Attachment 3: 2022 CAHPS Code List
Attachment 4: 2023 CAHPS Sample Crosswalk
Attachment 5: 2023 Quality Improvement Corrective Action Plan Template
Attachment 6: 2023 Corrective Action Plan Follow-up Report
2022-20 12/8/2022 Clarifying the Applicability of the PBM Transparency Standards
2022-21 12/8/2022 COVID-19 Countermeasures

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2021 Carrier Letters
Letter Date Subject
2021-02 02/09/2021 Consolidated Pharmacy Benefits Guidance for the FEHB Program
2021-03 02/17/2021 Federal Employees Health Benefits Program Call Letter
2021-04 03/10/2021 Reconciliation Instructions for 2021 Rates – Community-Rated Carriers
Attachment A: Part 1 – 2022 Community Rated Guidelines
Attachment B: Part 2 – 2022 Proposal Instructions
Attachment C: Proposal Table Attachments – I, II, IIA
2021-05 04/07/2021 Technical Guidance and Instructions for 2022 Benefit Proposals
Attachment A: Instructions for 2021 and 2022 FEHB Formulary Information Completion and Submission
Attachment B: 2021 FEHB Drug Formulary Template
Attachment C: 2022 FEHB Drug Formulary Template
Attachment D: FEHB Benefit Difference Comparison Chart
2021-06 04/15/2021 Family Member Eligibility Verification for Federal Employees Health Benefits (FEHB) Program Coveragee
Attachment 1 – Benefits Administration Letter 21-202: Family Member Eligibility Verification for Federal Employees Health Benefits (FEHB) Program Coverage
Attachment 2 – FEHB Family Member Eligibility Documents
Attachment 3 – Information Provided Does Not Verify Family Member Eligibility
Attachment 4 – Receipt of Eligibility Verification Documents
2021-07 04/27/2021 2022 Rate Instructions -- Community-Rated Carriers
Attachment A: Part 1 – 2022 Community Rated Guidelines
Attachment B: Part 2 – 2022 Proposal Instructions
Attachment C: Proposal Table Attachments – I, II, IIA
2021-08 04/28/2021 2022 RATE PROPOSAL FILE -- Experience-Rated Carriers
Attachment A - 2022 Rate Proposal File
2021-09 05/04/2021 Update on Aggregate Healthcare Cost and Utilization Data Reporting Requirements
Attachment 1 – Pharmacy Cost and Utilization Template and Instructions
2021-10 05/19/2021 Enrollment Reporting Data Requirements (Revised)
2021-11 05/24/2021 Announcement of the 2023 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
Attachment A: QCR Measure Set
2021-12 06/04/2021 Enrollment Transactions and Enrollment Reconciliations for Annuitants
2021-13 07/07/2021 New FEHB Carriers’ FEHB Websites and Mobile Applications Accessibility Requirements
2021-14a 08/13/2021 Changes to the Standard Contract for Contract Year 2022 – CR HMO
2021-14b 08/13/2021 Changes to the Standard Contract for Contract Year 2022 – ER HMO
2021-14c 08/13/2021 Changes to the Standard Contract for Contract Year 2022 – FFS
2021-15 09/13/2021 CL 2021-15 Federal Employees Health Benefits (FEHB) Program - Changes to SF 2809 834 File Format
Attachment A: FEHB Data-Hub SF 2809
2021-16 09/16/2021 Strengthening Parity in Mental Health and Substance Use Disorder Benefits
2021-17 11/22/2021 Claims Data Requirements for All Community-Rated HMOs - except Traditional Community-Rated HMOs
Attachment A: 2020 MLR-2022 ACR Mandatory Claim Layouts
2021-18 11/22/2021 Federal Employees Health Benefits Plan Performance Assessment Postponement of All Lines of Business Benchmark Implementation
2021-19 12/14/2021 2022 Plan Performance Assessment Procedural Manual
Attachment 1: 2022 FEHB Plan Performance Assessment Procedure Manual
Attachment 2: 2022 Planned HEDIS and CAHPS Reporting
Attachment 3: 2022 CAHPS Code List
Attachment 4: 2022 CAHPS Sample Crosswalk
Attachment 5: 2022 Corrective Action Plan Template
Attachment 6: 2022 Corrective Action Plan Follow Up Report

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2020 Carrier Letters
Letter Date Subject
2020-01 02/10/2020 Federal Employees Health Benefits Program Call Letter
2020-02 03/11/2020 Information for Carriers on Coronavirus
2020-03 03/24/2020 Technical Guidance and Instructions for 2021 Benefit Proposals
2020 FEHB Drug Formulary Template
2021 FEHB Drug Formulary Template
Attachment VI: FEHB Benefit Difference Comparison Chart
2020-04 03/25/2020 Reconciliation Instructions for 2020 Rates - Community-Rated Carriers
Attachment III & IIIA - Reconciliation Form
2020-05 03/25/2020 Insurance Benefits Processing During Disruption of Normal Agency Operations
Attachment – BAL 20-201 Insurance Benefits Processing During Disruption of Normal Agency Operations
2020-06 03/31/2020 Mid-Year Formulary Changes
2020-07 04/14/2020 2021 RATE PROPOSAL FILE -- Experience-Rated Carriers
2021 Experienced Rated Program All Years
2020-08 04/23/2020 Coverage of Diagnostic Testing, Preventive Services, and Telehealth for COVID-19
2020-09 04/28/2020 2021 Rate Instructions – Community-Rated Carriers
Attachment A: Part 1 – 2021 Community Rated Guidelines
Attachment B: Part 2 – 2021 Proposal Instructions
Attachment C: Proposal Tables Attachments I, II, and IIA
2020-10 05/05/2020 Announcement of the 2022 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
Attachment 1: 2022 Clinical Quality, Customer Service and Resource Use Measure Set 
2020-11 05/05/2020 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2020
Attachment A: Financial Reporting and Audit Guide
Attachment B: Schedule of Selected Balances
2020-12 06/25/2020 Enrollment Data Reporting Requirements
2020-13 06/18/2020 Claims Data Requirements for All Community-Rated HMOs – except Traditional Community-Rated HMOs
OPM-OIG Claim Layout Instructions and Formatting Requirements – except Traditional Community-Rated HMOs
2020-14 10/06/2020 COVID-19 2020 Scoring
2020-15 10/27/2020 Federal Employees Health Benefits (FEHB) Plan Performance Assessment Methodology
2020-16 11/05/2020 Removal of Ineligible Family Members from Enrollments
Attachment 1 – Sample Employing Office /Tribal Employer Letter – Request for Verification of Family Member Eligibility
Attachment 2 – Sample Employing Office/Tribal Employer/Carrier Letter – Receipt of Eligibility Verification Documents
Attachment 3 – Sample Employing Office/Tribal Employer/Carrier Letter – Verification Documents Not Received
Attachment 4 – Sample Employing Office/Tribal Employer Letter – Information Provided Does Not Verify Family Member Eligibility
Attachment 5 – FEHB Family Member Eligibility Documents
BAL 20-203 – Federal Employees Health Benefits Program: Removal of Ineligible Family Members from Enrollments
2020-17 11/19/2020 Aggregate Healthcare Cost and Utilization Data Reporting Requirements
Attachment A: Pharmacy Cost and Utilization Instructions
Attachment B: Pharmacy Cost and Utilization Template
2020-18 11/23/2020 Update on Mid-Year Formulary Changes
Attachment A: Mid-Year Formulary Change OPM Notification Instructions
Attachment B: Mid-Year Formulary Change OPM Notification
2020-19 12/21/2020 COVID-19 Vaccines and Diagnostic Tests
2020-20 12/22/2020 2021 Plan Performance Assessment Procedure Manual
Attachment 1: 2021 Plan Performance Assessment Procedure Manual
Attachment 2: 2021 HEDIS and CAHPS Planned Reporting Document
Attachment 3: 2021 CAHPS Code List

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2019 Carrier Letters
Letter Date Subject
2019-01 03/14/2019 Federal Employees Health Benefits Program Call Letter
2019-02 04/04/2019 Reconciliation Instructions for 2019 Rates - Community-Rated Carriers
Attachment III - Reconciliation Tables
2019-03 04/25/2019 Announcement of the 2021 Clinical Quality, Customer Service, and Resource Use Measure Set and Measures under Consideration for Addition to the 2020 Farm Team
Attachment 1: 2021 Clinical Quality, Customer Service and Resource Use Measure Set
2019-04 05/09/2019 Data-Hub Enhancements to Increase Timeliness of Transactions
2019-05(a) 04/30/2019 2020 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2019-05(b) 04/30/2019 2020 Technical Guidance and Instructions for Preparing Benefit and Service Area Proposals for New HMOs
2019-05(c) 04/30/2019 2020 Technical Guidance and Instructions for Preparing Benefit Proposals for Fee-ForService Carrier
Attachment II (a): FEHB Benefit Difference Comparison Chart
2019-06 05/07/2019 2020 Rate Instructions – Community-Rated Carriers
Attachment A: Part 1 – 2020 Community Rated Guidelines
Attachment B: Part 2 – 2020 Proposal Instructions
Attachment C: Proposal Tables Attachments I, II, and IIA
2019-07 07/15/2019 Claims Data Requirements for All Community-Rated HMOs - except Traditional Community-Rated HMOs
Attachment A: OPM/OIG Claim Layout Instructions and Formatting Requirements
2019-09 09/06/2019 Consumer Assessments of Healthcare Providers and Systems (CAHPS) Surveys Oversampling
2019-10 09/06/2019 Consolidated Pharmacy Benefits Guidance for the FEHB Program
2019-11 09/11/2019 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2019
Attachment A: Financial Reporting and Audit Guide
Attachment B: Schedule of Selected Balances
2019-12 11/26/2019 2020 Plan Performance Assessment Procedure Manual
Attachment I: 2020 Plan Performance Assessment Procedure Manual
Attachment II: 2019 CAHPS Carrier Subcode List

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2018 Carrier Letters
Letter Date Subject
2018-01 01/23/2018 Federal Employees Health Benefits Program Call Letter
2018-02 02/12/2018 Technical Correction to Reporting Products and QCR Scoring
2018-03 03/07/2018 FEHB Program Carrier Letter: 2017 Annual Accounting Statement Financial Reporting
Attachment A - AAS Spreadsheet
Attachment B - Instructions for Automated AAS - for CY 2017 Final
Attachment C - AAS Certification 2017
2018-04 03/27/2018 Reconciliation Instructions for 2018 Rates - Community-Rated Carriers
Attachment III - Reconciliation Form
2018-05 04/20/2018 2019 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2019 Technical Guidance and Instructions for Preparing Benefit and Service Area Proposals for New HMOs
2019 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Attachment A - 2018 FEHB Drug Formulary Template v1.8
Attachment B - FEHB Benefit Difference Comparison Chart - In-Network Benefits
2018-06 05/07/2018 2019 Rate Instructions - Community-Rated Carriers
 Part 1 - 2019 Community Rating Guidelines
 Part 2 - 2019 Proposal Instructions
 Attachment I - 2019 Rate Proposal - Small Carriers
2018-07 06/14/2018 2020 Clinical Quality, Customer Service, and Resource Use Measures
 Attachment 1: 2020 Clinical Quality, Customer Service and Resource Use Measure Set
2018-08 06/28/2018 Updated Guidance on OPM’s Letter of Credit System
Attachment A: User Manual for Experience Rated Carriers
Attachment B: Letter of Credit System Guidelines
2018-09A 7/25/2018 Changes to the Standard Contract for Contract Year 2019
Attachment A: Proposed Changes to Standard 2019 Community-Rated Health Benefits Contract
2018-09B 7/25/2018 Changes to the Standard Contract for Contract Year 2019
Attachment A: Proposed Changes to Standard 2019 Experience-Rated Health Benefits Contract
2018-09C 7/25/2018 Changes to the Standard Contract for Contract Year 2019
Attachment A: Proposed Changes to Standard 2019 Fee For Service Health Benefits Contract
2018-10 7/30/2018 Update on Coverage for FDA Approved Drugs, Devices and Biological Products
2018-11 8/3/2018 Federal Employees Health Benefits Program: Removal of Eligible Individuals from Existing Enrollments
2018-12 8/13/2018 Claims Data Requirements for All Community-Rated HMOs - except Traditional Community-Rated HMOs
2018-13 08/22/2018 Accreditation Requirements for FEHB Carriers
2018-14 9/26/2018 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2018
Attachment A: Financial Reporting and Audit Guide
Attachment B: Schedule of Selected Balances
2018-15 10/27/2018 2019 Plan Performance Assessment Procedure Manual
Attachment I: 2019 Plan Performance Assessment Procedure Manual
Attachment II: 2019 CAHPS Carrier Subcode List

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2017 Carrier Letters
Letter Date Subject
2017-15 12/14/2017 Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Consolidated Methodology
2017-14 12/08/2017 Reports to OPM of Information Security Incident and Data Breach
2017-13 11/20/2017 OPM Federal Employees Health Benefits(FEHB) Fraud, Waste and Abuse
Attachment 1: FEHB Fraud and Abuse Definitions
Attachment 2: Mandatory Information Sharing via Written Case Notifications and Referrals to OPM-OIG
Attachment 3: Case Notifications/Status Update Format
Attachment 4: OPM OIG Exposure Request Form
Attachment 5: Fraud and Abuse Annual Report
Attachment 6: Federal Employees Health Benefits Program Statement about Fraud, Waste and Abuse (FWA) Annual Report Certification
2017-12 11/17/2017 2018 Plan Performance Assessment Procedure Manual and Corrective Action Plans for 2017
Attachment I: 2018 Plan Performance Assessment Procedure Manual
Attachment II: 2018 CAHPS Carrier Subcode List
Attachment III: Quality Improvement Corrective Action Plan Template for 2017
2017-11 11/16/2017 2019 Clinical Quality, Customer Service, and Resource Use Measures
Attachment I: 2019 QCR Measure Set
2017-10 10/27/2017 Plan Performance Assessment Best Practices Workgroup
2017-09a 09/05/2017 Change to the Standard Contract
Attachment A: Proposed Changes to Standard 2018 Community Rated Health Benefits Contract
2017-09b 09/05/2017 Change to the Standard Contract
Attachment A: Proposed Changes to Standard 2018 Experience Rated Health Benefits Contract
2017-09c 09/05/2017 Change to the Standard Contract
Attachment A: Proposed Changes to Standard 2018 Fee-For-Service Health Benefits Contract
2017-08 08/02/2017 Summary of Benefits and Coverage (SBC) and Uniform Glossary
Attachment 1 - SBC Template for FEHB Plans
Attachment 2 - Uniform Glossary
Attachment 3 - Instructions for Completing the SBC – Group Health Plan Coverage
Attachment 4 - Frequently Asked Questions about SBCs
2017-07 07/17/2017 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2017
Attachment 1 - Financial Reporting And Audit Guide Federal Fiscal Year 2017
Attachment 2 - Schedule of Selected Balances
2017-06 07/10/2017 Claims Data Requirements for All Community-Rated HMOs - except Traditional Community-Rated HMOs
2017-05 05/12/2017 \2018 Rate Instructions - Cover Letter
Part 1 – 2018 Community Rating Guidelines
Part 2 – 2018 Proposal Instructions
Attachments – Proposal Tables Attachments I, II, and IIA
2017-04 04/18/2017 2017-04(a)  
2018 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
Attachment 2017-04(a2-a)  
FEHB Benefit Difference Comparison Chart In-Network Benefits Spreadsheet
2017-04(b)  
2018 Technical Guidance and Instructions for Preparing Benefit and Service Area Proposals for New HMOs
2017-04(c)  
2018 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Attachment 2017-04(a7)  
2018 FEHB Drug Formulary Template
2017-03 04/12/2017 Reconciliation Instructions for 2017 Rates -- Community-Rated Carriers
Attachment 1: Reconciliation Tables
2017-02 03/16/2017 Plan Performance Assessment Community Rated Adjustment
2017-01 01/11/2017 Federal Employees Health Benefits Program Call Letter

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2016 Carrier Letters
Letter Date Subject
2016-15 12/06/2016 Federal Employees Health Benefits (FEHB) Program and Federal Employees Dental and Vision Insurance Program (FEDVIP) Coverage Exception for Children of Same-Sex Domestic Partners
2016-14 11/21/2016 2017 Plan Performance Assessment Carrier Manual and Corrective Action Plan Template for 2016
Attachment 1 – Attachment 1: Attachment 1: 2017 Plan Performance Assessment Carrier Manual
Attachment 2 – Attachment 2: Quality Improvement Corrective Action Plan Template for 2016
Attachment 3 – Attachment 3: 2017 CAHPS Carrier Subcode List
2016-13 10/26/2016 State Tax Preemption
2016-12(c) 08/24/2016 Change(s) to the Standard Contract – All Fee-For-Service Carriers
Attachment A: Proposed Changes to Standard 2017 Fee-For-Service Health Benefits Contract
2016-12(b) 08/24/2016 Change(s) to the Standard Contract – All Experience Rated Health Maintenance Organizations
Attachment A: Proposed Changes to Standard 2017 Experience-Rated HMO Health Benefits Contract
2016-12(a) 08/24/2016 Change(s) to the Standard Contract – All Community Rated Health Maintenance Organization Carriers
Attachment A: Proposed Changes to Standard 2017 Community-Rated HMO Health Benefits Contract
2016-11 08/01/2016 Plan Performance Assessment Improvement Increment
Attachment 1: Example of Improvement Scoring Final
Attachment 2: FAQs for the Improvement Increment Methodology
2016-10 05/18/2016 Claims Data Requirements for Non-State Mandated Community-Rated Carriers
2016-09 05/17/2016 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2016
Attachment 1 – FEHB 2016 Audit Guide
Attachment 2 – SCHEDULE OF SELECTED BALANCES 2016
2016-08 05/05/2016 2017 Rate Instructions — Community-Rated Carriers
Part 1 – 2017 Community Rating Guidlines
Part 2 – 2017 Proposal Instructions
2016-07 04/20/2016 2017 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2017 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Attachment 1: Drug Formulary Worksheet for Non-Discrimination Analysis
2016-06 04/05/2016 Reconciliation Instructions for 2016 Rates -- Community-Rated Carriers
2016-05 03/30/2016 Instructions for Following the 180-day Timeline with Audit Resolution, Preparing Supporting Documentation for Audit Resolution Review and Completing Work Plans
Attachment 1: Experience-Rated Final Audit Timeline
Attachment 2: HMO Audits Final Audit Timeline
Attachment 3: Information System Timeline – Final Audit Report
Attachment 4: Contested Claims Checklist
Attachment 5: Claim Cover Sheet
2016-04 03/04/2016 Updated FEHB Guidance on Population Health and Wellness
2016-03 02/26/2016 Federal Employees Health Benefits Program Call Letter
2016-02 02/16/2016 2018 Clinical Quality, Customer Service, and Resource Use Measures for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment
2016-01 01/12/2016 Federal Employees Health Benefits (FEHB) Program: Enrollment Options Following the Termination of a Plan or Plan Option Final Rule Published
2015 Carrier Letters
Letter Date Subject
2015-19 11/06/2015
Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Measure Collection (Includes HEDIS and CAHPS)
Attachment 1A: HEDIS 2015 Measures Contributing to Exemplary and Most Improved Statuses
Attachment 2A: Carrier Subcode List
Attachment 2B: 2016 CAHPS Survey Participation Form
Attachment 2C: SAMPLE CROSSWALK
2015-18 10/05/2015 FEHB Program coverage for Children of Same-Sex Domestic Partners After Obergefell v. Hodges
2015-17 09/18/2015
Changes to the Standard Contract
Attachment A
Attachment B
Attachment B(2)
Attachment C
Attachment C(2)
2015-16 09/17/2015 Federal Employees Health Benefits (FEHB) Program: Self Plus One Final Rule Released
2015-15 08/16/2015 2017 Clinical Quality, Customer Service, and Resource Use Measures for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment
2015-14 07/28/2015 Updated FEHB Guidance on Preventive Care
2015-13 07/09/2015 Reporting under IRC section 6055 for Federal Employees Health Benefits (FEHB) Program Carriers
2015-12 06/23/2015 Covered Benefits for Gender Transition Services
2015-11 05/12/2015 Claims Data Requirements for Non-Traditional Community-Rated Carriers
2015-10 05/12/2015 Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Methodology
2015-09 5/8/2015 2016 RATE INSTRUCTIONS -- Community-Rated Carriers
Changes for 2016
2016 PROPOSAL INSTRUCTIONS
2015-08 4/29/2015 Federal Employees Health Benefits (FEHB) Program: Self Plus One Enrollment Communication Strategy
Attachment 1: FAQs
Attachment 2: Self Plus One Enrollment Type FastFacts
2015-07 4/24/2015 Guidance for the Preparation of Audited Financial Statements for Federal Fiscal Year 2015
Attachment 1: 2015 Audit Guide
Attachment 2: Schedule of Selected Balances
2015-06 4/24/2015 Reporting 2015 CAHPS Results
Attachment 1: 2015 CAHPS FEHB Sub-Code List
Attachment 2: SAMPLE CROSSWALK
2015-05 3/27/2015 Reconciliation Instructions for 2015 Rates -- Community-Rated Carriers
2015-04 03/23/2015 Notification of Data Breach
2015-03 3/17/2015 2015-03a 2016 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals
2015-03b 2016 Technical Guidance and Instructions for Preparing Benefit and Service Area Proposals for New HMOs
2015-03c 2016 Technical Guidance and Instructions for Preparing Proposals for Fee-For-Service Carriers
Attachment 1: Specialty Benchmark File
2016 Part One ADC Questions
2015-02 3/13/2015 Federal Employees Health Benefits Program Call Letter
2015-01 3/2/2015 Calendar Year 2014 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
2014 Carrier Letters
Letter Date Subject
2014-30 12/30/2014 Federal Employees Health Benefits (FEHB) Program: Self Plus One Enrollment
Attachment 1: SELF PLUS ONE UPDATE STATUS REPORT
2014-29 12/19/2014 Office of Personnel Management (OPM) Federal Employees Health Benefits (FEHB) Fraud, Waste and Abuse
Attachment 1: Definitions
Attachment 2: Mandatory Information Sharing via Written Case Notifications and Referrals to OPM-OIG
Attachment 3: CASE NOTIFICATION / STATUS UPDATE FORMAT
Attachment 4: OPM / OIG EXPOSURE REQUEST FORM
Attachment 5: FWA Report
Attachment 6: Federal Employees Health Benefits Program Statement about Fraud, Waste and Abuse (FWA) Annual Report Certification
2014-28 12/03/2014 Additional Information on the Performance Areas for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment
Attachment 1: Revised Performance Assessment Measure Set
Attachment 2: Contract Oversight Performance Area
2014-26 11/07/2014 Federal Employees Health Benefits (FEHB) Program Carrier Guidance on Ebola Virus
2014-25 10/21/2014

CLER 2.0

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

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2013 Carrier Letters
Letter Date Subject
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

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2012 Carrier Letters
Letter Date Subject
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

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2011 Carrier Letters
Letter Date Subject
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

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2010 Carrier Letters
Letter Date Subject
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

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2009 Carrier Letters
Letter Date Subject
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

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2008 Carrier Letters
Letter Date Subject
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

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2007 Carrier Letters
Letter Date Subject
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

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2006 Carrier Letters
Letter Date Subject
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

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2005 Carrier Letters
Letter Date Subject
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

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2004 Carrier Letters
Letter Date Subject
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

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2003 Carrier Letters
Letter Date Subject
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

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2002 Carrier Letters
Letter Date Subject
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

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2001 Carrier Letters
Letter Date Subject
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

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2000 Carrier Letters
Letter Date Subject
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

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1999 Carrier Letters
Letter Date Subject
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

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Carrier Application

Types of carriers that qualify for participation in FEHB Program

  • The FEHB Program will only consider applications from comprehensive, prepaid medical plans.
  • Carriers must 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 cannot 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).

Note:

We are looking for new Community Rated HMOs.

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.

How to apply

  1. Submit the Carrier Application Information Form on this page.
  2. Complete the following documents and return them to OPM by January 31:

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.

Routine Reports

Report Frequency Required of Date Due Contact
Agreements and Certifications
Certification re Disclosure of Lobbying Activities At approval All Before approval Health Insurance Specialist
OMB SF LLL, Disclosure of Lobbying Activities (relates to certification) When applicable All As needed Health Insurance Specialist
Certification re Drug-Free Workplace At approval All Before approval Health Insurance Specialist
Benefit and Brochure Related
Benefit Proposal Annual All; by plan type May 31 Health Insurance Specialist
Brochure Quantity Form Annual All; by plan type As directed Health Insurance Specialist
Plan Contracting Officials Form Annual/not less than annual All May 31/and when officials change Health Insurance Specialist
Plan Address Form As updates are needed All As needed Health Insurance Specialist
Service area statement With request to expand service area HMOs With benefit proposal, when applicable Health Insurance Specialist
Debarment/Suspension
FEHB Carrier debarment/suspension actions Semi-annual All Apr 15 and Oct 15 debar@opm.gov
Enrollment Reporting
Table 1-Summary of FEHBP Enrollment Annual All Apr 30 FEIO/OPS
FEHB Quality Assurance
Customer Satisfaction Survey Results (CAHPS) Annual Feb 1 cahps@opm.gov
HEDIS Annual As directed by NCQA auditor hedis@opm.gov
Quality Assurance Report Annual All Jul 1 fehbqareport@opm.gov
Fraud and abuse cases report Annual All Mar 31 Health Insurance Specialist
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 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 melanese.wynn@opm.gov
Other Financial Reports
C1 - Annual Incurred Report
(12 months incurred paid through 18 months)
Annual FFS July 31 actuary@opm.gov
C2 - Number of Procedures and Number Receiving Benefits Annual FFS July 31 actuary@opm.gov
Triangle Table Quarterly FFS and Experience Rated HMOs 15 days after end of quarter actuary@opm.gov
Loca Draw down Quarterly FFS and Experience Rated HMOs 15 days after end of quarter actuary@opm.gov
Other Submissions
Service charge request (Plans are not required to request a service charge) Annual Exp-rated As directed Health Insurance Specialist
Special contingency reserve request When applicable Exp-rated As directed Health Insurance Specialist
Pilot Projects
Small Business Subcontracting Plan Annual 6 pilot project carriers Jun 15 Health Insurance Specialist
Subcontracting Report for Individual Contracts (SF 294) Semi-annual 6 pilot project carriers Apr 30 and Oct 30 Health Insurance Specialist
Summary Subcontract Report (SF 295) Annual 6 pilot project carriers Oct 30 Health Insurance Specialist
Premium Payment
TFS Form 3881 B Payment Information Form At approval All As directed melanese.wynn@opm.gov
Change of Financial Institution When applicable All As directed melanese.wynn@opm.gov
Rate Related
Rate Proposal (includes several tables and reports) Annual All; by Rate type May 31 actuary@opm.gov
Rate Reconciliation Request (includes several tables and reports) Annual C-rated April 30 actuary@opm.gov

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Reference Materials

Performance Assessment

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

Newsletters

Performance Assessment

Federal Employees Health Benefit (FEHB) Program Plan Performance Assessment

The Office of Personnel Management’s (OPM) goal is to improve the health of the populations we serve, ensure the delivery of high quality consumer focused health care, and provide Federal employees and retirees with affordable insurance benefits. We evaluate FEHB Carriers on key parameters of clinical quality, customer service, resource use, and contract oversight.

Many aspects of our performance assessment framework rely on measures from the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Scoring measures against national benchmarks help OPM recognize top performing health insurance carriers in the program, inform enrollee choice, and link objective performance to profit.

FEHB Carriers are encouraged to join the National Committee for Quality Assurance's Digital Measurement Community to learn about the implementation of digital performance measures. FEHB Carriers may also find the Health Care Payment Learning and Action Network, managed by the Department of Health and Human Services, as a source of proven value-based payment models utilized among commercial carriers. OPM also encourages FEHB Carriers to join the PPA Best Practices Workgroup. Details can be found in Carrier Letter 2017-10, "Plan Performance Assessment Best Practices Workgroup." Carriers interested in joining the FEHB Program should carefully review materials listed under the subject areas on this page.

Below are links to more FEHB Plan Performance Assessment Information:

The table below is a list of the FEHB Carrier Letters related to the Plan Performance Assessment.

Letter Date Subject Note
2024-16 7/18/2024 Federal Employees Health Benefits Plan Performance Assessment 2026 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will be scored under the 2026 Plan Performance Assessment (PPA).
Attachment 1: 2026 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
2023-21 12/21/2023 2024 Plan Performance Assessment Procedural Manual The purpose of this Carrier Letter is to transmit the attachments described below to all Carriers in the Federal Employees Health Benefits (FEHB) Program:
  • Attachment 1: 2024 Plan Performance Assessment Procedure Manual
  • Attachment 2: 2024 Planned HEDIS and CAHPS Reporting User Guide
  • Attachment 3: 2024 CAHPS Sample Crosswalk
  • Attachment 5: Quality Improvement Corrective Action Plan Template
  • Attachment 6: 2024 Corrective Action Plan Follow-up Report
Attachment 1: 2024 FEHB Plan Performance Assessment Procedure Manual
Attachment 2: 2024 Planned HEDIS and CAHPS Reporting User Guide
Attachment 3: 2024 CAHPS Sample Crosswalk
Attachment 4: 2024 Quality Improvement Corrective Action Plan Template
Attachment 5: 2024 Corrective Action Plan Follow Up Report
2023-11 4/18/2023 Federal Employees Health Benefits Plan Performance Assessment 2025 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will be scored under the 2025 Plan Performance Assessment (PPA).
Attachment 1: 2025 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
2022-19 12/5/2022 2023 Plan Performance Assessment Procedural Manual The purpose of this Carrier Letter is to transmit the attachments described below to all Carriers in the Federal Employees Health Benefits (FEHB) Program:
  • Attachment 1: 2023 Plan Performance Assessment Procedure Manual
  • Attachment 2: 2023 Planned HEDIS and CAHPS Reporting
  • Attachment 3: 2023 CAHPS Code List
  • Attachment 4: 2023 CAHPS Sample Crosswalk
  • Attachment 5: 2023 Corrective Action Plan Template
  • Attachment 6: 2023 Corrective Action Plan Follow-up Report
Attachment 1: 2023 FEHB Plan Performance Assessment Procedure Manual
Attachment 2: 2023 Planned HEDIS and CAHPS Reporting
Attachment 3: 2023 CAHPS Code List
Attachment 4: 2023 CAHPS Sample Crosswalk
Attachment 5: 2023 Corrective Action Plan Template
Attachment 6: 2023 Corrective Action Plan Follow Up Report
2022-13 7/21/2022 Federal Employees Health Benefits Plan Performance Assessment 2024 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will be scored under the 2024 Plan Performance Assessment (PPA).
Attachment 1: 2024 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set
2021-19 12/14/2021 2022 Plan Performance Assessment Procedural Manual The purpose of this Carrier Letter is to transmit the attachments described below to all Carriers in the Federal Employees Health Benefits (FEHB) Program:
  • Attachment 1: 2022 Plan Performance Assessment Procedure Manual
  • Attachment 2: 2022 Planned HEDIS and CAHPS Reporting
  • Attachment 3: 2022 CAHPS Code List
  • Attachment 4: 2022 CAHPS Sample Crosswalk
  • Attachment 5: 2022 Corrective Action Plan Template
  • Attachment 6: 2022 Corrective Action Plan Follow-up Report
Attachment 1: 2022 FEHB Plan Performance Assessment Procedure Manual
Attachment 2: 2022 Planned HEDIS and CAHPS Reporting
Attachment 3: 2022 CAHPS Code List
Attachment 4: 2022 CAHPS Sample Crosswalk
Attachment 5: 2022 Corrective Action Plan Template
Attachment 6: 2022 Corrective Action Plan Follow Up Report
2021-18 11/22/2021 Federal Employees Health Benefits Plan Performance Assessment Postponement of All Lines of Business Benchmark Implementation This Carrier Letter supersedes Carrier Letters 2020-15 and 2020-20 in part, by updating the Federal Employees Health Benefits (FEHB) Plan Performance Assessment (PPA) methodology guidance to postpone All Lines of Business (ALOB) benchmark implementation until the 2022 plan year (measurement year 2021).
2021-11 5/24/2021 Announcement of the 2023 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will score under the 2023 Plan Performance Assessment (PPA).
Attachment 1: 2023 Clinical Quality, Customer Service and Resource Use Measure Set
2020-20 12/22/2020 2021 Plan Performance Assessment Procedure Manual This Carrier Letter is to transmit the attachments described below to all Carriers in the Federal Employees Health Benefits (FEHB) Program:
  • Attachment 1: 2021 Plan Performance Assessment Procedure Manual
  • Attachment 2: Planned HEDIS and CAHPS Reporting Template
  • Attachment 3: 2021 CAHPS Code List
Attachment 1: 2021 Plan Performance Assessment Procedure Manual
Attachment 2: Planned HEDIS and CAHPS Reporting Template
Attachment 3: 2021 CAHPS Code List
2020-15 10/27/2020 Federal Employees Health Benefits (FEHB) Plan Performance Assessment Methodology The purpose of this Carrier Letter is to update the FEHB Plan Performance Assessment (PPA) methodology guidance. Carriers must reference the annual PPA Procedure Manual for operational instructions and specific measures that must be reported to OPM.
2020-14 10/6/2020 Update on Plan Performance Assessment Scoring Due To COVID-19 Pandemic This Carrier Letter outlines OPM’s FEHB Plan Performance Assessment (PPA) response to the national emergency caused by the COVID-19 pandemic.
2020-10 5/5/2020 Announcement of the 2022 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will score under the 2022 Plan Performance Assessment (PPA).
Attachment 1: 2022 Clinical Quality, Customer Service and Resource Use Measure Set
2019-12 11/26/2019 2020 Plan Performance Assessment Procedure Manual The purpose of this Carrier Letter is to transmit the attachments described below to all carriers in the Federal Employees Health Benefits (FEHB) Program:
  • Attachment 1: 2020 Plan Performance Assessment Procedure Manual
  • Attachment 2: 2020 CAHPS Carrier Subcode List
Attachment 1: 2020 Plan Performance Assessment Procedure Manual
Attachment 2: 2020 CAHPS Carrier Subcode List
2019-09 9/06/2019 Consumer Assessments of Healthcare Providers and Systems (CAHPS) Surveys Oversampling OPM’s goal is to have enough CAHPS survey data reported so that FEHB Carrier contracts have performance indicators displayed on the OPM website for both quality and customer service measures. Performance data is valuable to FEHB enrollees, Agency Benefit Officers and others. Therefore, OPM is providing additional guidance to FEHB Carriers.
2019-03 4/25/2019 Announcement of the 2021 Clinical Quality, Customer Service, and Resource Use Measure Set and Measures under Consideration for Addition to the 2020 Farm Team This Carrier Letter announces changes to the Clinical Quality, Customer Service, and Resource Use (QCR) measures and priority weights that will be scored under the 2021 Plan Performance Assessment. In addition, measures for potential inclusion in the 2020 Farm Team are presented. The full 2021 QCR measure set is shown in Attachment 1 of the Carrier Letter.
Attachment 1: 2021 Clinical Quality, Customer Service and Resource Use Measure Set
2018-15 10/25/2018 2019 Plan Performance Assessment Procedure Manual The purpose of this Carrier Letter is to transmit the attachments to all carriers in the Federal Employees Health Benefits (FEHB) Program.
Attachment 1: 2019 Plan Performance Assessment Procedure Manual
Attachment 2: 2019 CAHPS Carrier Subcode List
2018-13 8/22/2018 Accreditation Requirements for FEHB Carriers This letter updates Federal Employees Health Benefits (FEHB) Program accreditation requirements pursuant to the FEHB Standard Contract, Section 1.9, which states "the Carrier shall continue to pursue and maintain accreditation according to the steps and timeframes outlined by OPM."
2018-07 6/14/2018 2020 Clinical Quality, Customer Service, and Resource Use Measures This Carrier Letter announces changes to the Clinical Quality, Customer Service, and Resource Use (QCR) measures and priority weights that will be scored under the 2020 Plan Performance Assessment.  The full 2020 QCR measure set is shown in Attachment 1 of the Carrier Letter.
Attachment 1: 2020 Clinical Quality Customer Service and Resource Use Measure Set
2018-02 2/12/2018 Technical Correction to Reporting Products and QCR Scoring Over the first two cycles of the Federal Employees Health Benefits Program (FEHB) Plan Performance Assessment scoring, the Office of Personnel Management (OPM) has encountered occasional situations that could affect the accurate choice of QCR benchmarks. After consulting with NCQA, OPM issued this Carrier Letter with the clarification, effective for benchmark comparison beginning in 2018 and going forward
2017-15 12/14/2017 Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Consolidated Methodology The purpose of this Carrier Letter is to simplify administration of the FEHB Plan Performance Assessment (PPA) by consolidating methodology guidance. The PPA was announced in 2014. Carrier payment based on PPA scoring began in 2016. This letter compiles all current guidance regarding the methodology. Carriers must reference the annual PPA Procedure Manual for operational instructions and specific measures that must be reported to OPM.
2017-12 11/17/2017 2018 Plan Performance Assessment Procedure Manual and Corrective Action Plans for 2017 The purpose of this Carrier Letter is to transmit the following attachments to all carriers in the Federal Employees Health Benefits (FEHB) Program:
Attachment 1: 2018 Plan Performance Assessment Procedure Manual
Attachment 2: 2018 CAHPS Carrier Subcode List
Attachment 3: Quality Improvement Corrective Action Plan Template for 2017
2017-11 11/16/2017 2019 Clinical Quality, Customer Service, and Resource Use Measures The purpose of this Carrier Letter is to announce the Clinical Quality, Customer Service, and Resource Use (QCR) measures to be utilized in the 2019 Plan Performance Assessment. A list of the 2019 QCR Measure Set is included in Attachment 1.
Attachment 1: 2019 Clinical Quality, Customer Service and Resource Use Measure Set
2017-10 10/27/2017 Plan Performance Assessment Best Practices Workgroup This carrier letter details policies and procedures pertaining to the Federal Employees Health Benefits (FEHB) Plan Performance Assessment Best Practices Workgroup. In this notice, it is hereafter referred as the "Best Practices Workgroup" or the "workgroup."
2017-02 03/16/2017 Plan Performance Assessment Community Rated Adjustment Announced a proposed update to the Federal Employees Health Benefits (FEHB) Program Plan Performance Assessment for Community Rated Carriers. Beginning with the 2017 performance assessment period and for future rating periods a Community-Rated Adjustment (CRA) would be applied to the overall performance score (OPS) of community-rated carriers in the FEHB Program to incentivize high performance.
2016-14 11/21/2016 2017 Plan Performance Assessment Carrier Manual and Corrective Action Plan Template for 2016 Released the 2017 Plan Performance Assessment Carrier Manual, Quality Improvement Corrective Action Plan Template for 2016, and the 2017 CAHPS Carrier Subcode List. The Carrier Letter provides specific guidance for the 2017 plan year on reporting HEDIS and CAHPS, Clinical Quality, Customer Service, and Resource Use (QCR) measures, Corrective Action Plans, QCR calculations and scoring policies, and other information Carriers need on FEHB Plan Performance Assessment.
Attachment 1 – Attachment 1: Attachment 1: 2017 Plan Performance Assessment Carrier Manual
Attachment 2 – Attachment 2: Quality Improvement Corrective Action Plan Template for 2016
Attachment 3 – Attachment 3: 2017 CAHPS Carrier Subcode List
2016-11 08/01/2016 Plan Performance Assessment Improvement Increment Released the methodology for the FEHB Plan Performance Assessment Improvement Increment that OPM will implement as part of the Fall 2017 Clinical Quality, Customer Service, and Resource Use (QCR) calculation.
Attachment 1: Example of Improvement Scoring Final
Attachment 2: FAQs for the Improvement Increment Methodology
2016-02 02/16/2016 2018 Clinical Quality, Customer Service, and Resource Use Measures for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment These are the 2018 measures. Office of Personnel Management (OPM) gives two years notice on the measures scored. OPM has greater flexibility to delete a measure.
2015-19 11/06/2015
Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Measure Collection (Includes HEDIS and CAHPS) Outlines the process for collection and submission of measures to the OPM for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment This combines HEDIS and CAHPS reporting info, and includes the data correction procedures.
Attachment 1A: HEDIS 2015 Measures Contributing to Exemplary and Most Improved Statuses
Attachment 2A: Carrier Subcode List
Attachment 2B: 2016 CAHPS Survey Participation Form
Attachment 2C: SAMPLE CROSSWALK
2015-15 08/16/2015 2017 Clinical Quality, Customer Service, and Resource Use Measures for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment Provide the FEHB Plan Performance Assessment Clinical Quality, Customer Service, and Resource Use (QCR) measures to be scored for 2017 evaluation.
2015-10 06/05/2015 Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Methodology Provide details on the OPM methodology for the FEHB Plan Performance Assessment (Performance Assessment). The Performance Assessment evaluation will begin in 2016.
2014-28 12/03/2014 Additional Information on the Performance Areas for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment Provides the full set of domains and components for the four proposed performance areas, including updates to the previously published measures and details of the Contract Oversight performance area, for 2016.
Attachment 1: Revised Performance Assessment Measure Set
Attachment 2: Contract Oversight Performance Area
2014-19 08/07/2014 Initial Guidance on FEHB Plan Performance Assessment Provides information on the Federal Employees Health Benefits (FEHB) Health Plan Performance Assessment and to request carrier feedback on the proposed measures and timeline.

Why does OPM utilize the Plan Performance Assessment?

The Plan Performance Assessment (PPA) was created through a rulemaking notice published in the Federal Register on June 30, 2015 to "establish a consistent assessment system, create a more objective performance standard and provide more transparency for enrollees, OPM is developing a framework that will utilize a discrete set of quantifiable measures examining key aspects of contract performance and specific criteria for performance factors which will then be linked to health plan premium disbursements." Under the FEHBAR at 48 CFR 1615.404-70(b): "The sum of the maximum scores for the profit analysis factors will be 1 percent.

OPM is committed to assuring that Federal employees, annuitants and their family members have a robust selection of demonstrably high-quality health plans in the FEHB. The PPA Methodology Carrier Letter is contained under the PPA Methodology section. Performance metrics utilized in the PPA reflect important aspects of health insurance coverage.

The PPA results are then utilized in two different manners. First, each FEHB Carrier’s profit factors are tied to their PPA results. Secondly, individual measure results are posted to the OPM website on the page "Ensuring Quality Healthcare" and in the results for the FEHB Plan Comparison Tool. In this way, quality and customer service information is available for Federal employees and annuitants as they review their health care insurance options.

How are clinical quality, customer service, and resource use measures utilized in the Plan Performance Assessment?

OPM has selected measures that have been shown to be valid, auditable, comparable across different types of health plans, and actionable by health insurance carriers. Currently measures that assess clinical quality and resource use have come from the National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness and Information Data Set (HEDIS). HEDIS measures are designed to measure the quality of healthcare delivered through a health insurer carriers’ network of providers or system of care. OPM has utilized the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to assess consumer experience and service within the PPA.

How is Contract Oversight evaluated under the Plan Performance Assessment?

OPM Contracting Officers evaluate FEHB carriers within the Contract Oversight performance area using information from the following domains: contract performance, responsiveness to OPM, contract compliance, technology management and data security. The components under each domain are essential aspects of effective contract performance oversight. They are used to assess carrier performance and negotiate profit. The information considered is detailed in the PPA Methodology Carrier Letter. The most recent version is contained under the PPA Methodology section of the Performance Assessment webpage.

How is health plan value assessed in the FEHB?

Consistent with OPM’s strategic goals, OPM is committed to improving healthcare quality and affordability in the FEHB Program. OPM measures quality under the FEHB PPA. Measuring affordability is challenging because affordability varies based on the individual members’ circumstances. We intend to assess the value of FEHB benefits by calculating and comparing measures of relative cost to complement the PPA quality results. As previously announced, OPM intends to identify risk-adjusted cost measure(s) for this purpose.

Where are Plan Performance Assessment materials available?

OPM maintains a specific PPA webpage for the reference of FEHB Carriers. It can be found under the tab titled, "Performance Assessment," within the carrier portion of the OPM Insurance section of the website. All relevant materials are contained in the following categories: FEHB Carrier Letters; FEHB Publications; Educational Videos; Methodology Letter; Annual Procedure Manual; FAQs and Contact Information. Questions concerning the PPA can always be sent to: FEHBPerformance@opm.gov.

Carriers may submit comments and questions with a copy to their Health Insurance Specialist to:

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