C.F.R. » Title 48 » CHAPTER 16—OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION › SUBCHAPTER A—GENERAL › PART 1602—DEFINITIONS OF WORDS AND TERMS › Subpart 1602.1—Definitions of FEHBP Terms

48 C.F.R. § 1602.170-2

1602.170-2 Community rate.

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(a) Community rate means a rate of payment based on a per member per month capitation rate or its equivalent that applies to a combination of the subscriber groups for a comprehensive medical plan carrier. References in this subchapter to “a combination of cost and price analysis” relating to the applicability of policy and contract clauses refer to comprehensive medical plan carriers using community rates.

(b) Adjusted community rate means a community rate which has been adjusted for expected use of medical resources of the FEHBP group. An adjusted community rate is a prospective rate and cannot be retroactively revised to reflect actual experience, utilization, or costs of the FEHBP group, except as described in 1615.402(c)(4).

[55 FR 27414, July 2, 1990, as amended at 62 FR 47573, Sept. 10, 1997; 76 FR 38284, June 29, 2011]
Notes of Decisions
Cited in 3 cases, 1995–2016 · leading case: In Re Consol. Hosp. Surcharge Appeals of GILLETTE Child.’S SPECIALTY HEALTHCARE, St. Luke’s Hosp., North Mem'l Health Care, HealthEast Care Sys., Park Nicollet Health Servs., Fairview Health Servs., & Child.’s Hospitals & Clinics of Minnesota, 883 N.W.2d 778 (Minn. 2016).
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In Re Consol. Hosp. Surcharge Appeals of GILLETTE Child.’S SPECIALTY HEALTHCARE, St. Luke’s Hosp., North Mem'l Health Care, HealthEast Care Sys., Park Nicollet Health Servs., Fairview Health Servs., & Child.’s Hospitals & Clinics of Minnesota, 883 N.W.2d 778 (Minn. 2016). “48 C.F.R. § 1602.170-2 . Premiums due to community-rated carriers are paid -on a monthly basis, regardless of actual costs incurred by the carrier.”
Health Ins. Plan of Greater New York, Inc. v. United States, 62 Fed. Cl. 33 (Fed. Cl. 2004). “” 48 C.F.R. § 1602.170-2 (2004). 2 A Federal employee or annuitant selects a health benefits plan and is “enrolled” therein.”
Health Maint. Org. of New Jersey, Inc. v. Whitman, 72 F.3d 1123 (3d Cir. 1995). “” 48 C.F.R. § 1602.170-2 (a). The plans addressed in Travelers were experience-rated plans whose contribution rates “are based on the plan's actual paid claims, administrative expenses, and other allowable 'retentions.”
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