5 C.F.R. § 890.104

Initial decision and reconsideration on enrollment

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(a) Who may file. Except as provided under § 890.1112, an individual may request an agency or retirement system to reconsider an initial decision of its employing office denying coverage or change of enrollment.

(b) Initial employing office decision. An employing office's decision is considered an initial decision as used in paragraph (a) of this section when rendered by the employing office in writing and stating the right to an independent level of review (reconsideration) by the agency or retirement system. However, an initial decision rendered at the highest level of review available within OPM is not subject to reconsideration.

(c) Reconsideration. (1) A request for reconsideration must be made in writing, must include the claimant's name, address, date of birth, Social Security number, name of carrier, reason(s) for the request, and, if applicable, retirement claim number.

(2) The reconsideration review must be an independent review designated at or above the level at which the initial decision was rendered.

(d) Time limit. A request for reconsideration of an initial decision must be filed within 30 calendar days from the date of the written decision stating the right to a reconsideration. The time limit on filing may be extended when the individual shows that he or she was not notified of the time limit and was not otherwise aware of it, or that he or she was prevented by circumstances beyond his or her control from making the request within the time limit. An agency or retirement system decision in response to a request for reconsideration of an employing office's decision is a final decision as described in paragraph (e) of this section.

(e) Final decision. After reconsideration, the agency or retirement system must issue a final decision, which must be in writing and must fully set forth the findings and conclusions.

[59 FR 66437, Dec. 27, 1994]

Notes of Decisions

Cited in 11 cases (1 in the last 5 years), 1977–2021 · leading case: Horvath v. Dodaro, 160 F. Supp. 3d 32 (D.D.C. 2015).

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Horvath v. Dodaro, 160 F. Supp. 3d 32 (D.D.C. 2015). · cites it 3× “” 5 C.F.R. § 890.104 (b). An employee may seek reconsideration within 30 days of the initial decision.”

Lawrence R. Rosano v. Dep't of the Navy, 699 F.2d 1315 (Fed. Cir. 1983). “5 C.F.R. § 890.104 (a). 28 . 5 C.F.R. § 890.”

Pollitt v. Health Care Serv. Corp., 558 F.3d 615 (7th Cir. 2009). “To the extent that HCSC was doing nothing but following the agency’s orders, the case belongs in federal court and must be dismissed — not because of “complete preemption” but because suits related to a federal agency’s health-benefits-coverage decisions must name as the…”

In the Matter of Golinski, 587 F.3d 956 (9th Cir. 2009). “See 5 C.F.R. § 890.104 . The Executive Branch, acting through the Office of Personnel Management (OPM), thought otherwise.”

Dir., Edward J. Meyer Mem'l Hosp. v. Stetz, 433 F. Supp. 323 (W.D.N.Y. 1977). “5 C.F.R. § 890.104 . Although no mention is made in his opposing papers,.”

Arrington v. Grp. Hospitalization & Med. Servs., Inc., 806 F. Supp. 287 (D.D.C. 1992). “That determination was immediately reviewed by the Office of Personnel Management (“OPM”), which considered plaintiff’s request for approval of coverage under the authority of 5 C.F.R. § 890.104 . OPM also denied coverage.”

Alday v. Off. of Pers. Mgmt. (D.D.C. 2021). · cites it 2× “Accord 5 C.F.R. § 890.104 (c). He argued that “OPM should be equitably estopped from retroactively terminating” his FEHB medical coverage.”

Auth. of OPM to Direct Health Insurer Not to Enroll Individual Deemed Eligible by Employing Agency (OLC 2010). · cites it 2× “See 5 C.F.R. § 890.104 (2009). 3 The regulations expressly reserve to OPM, however, the discretion to “order correction of an administrative error upon a showing satisfactory to OPM that it would be against equity and good conscience not to do so.”

Juli Pollitt v. Health Care Serv. Corporatio (7th Cir. 2009). “§8902 (d); 5 C.F.R. §§ 890.104 (a), 890.107(a), (c).”

In the Matter of Karen Golinski (9th Cir. 2009). “See 5 C.F.R. § 890.104 . The Executive Branch, acting through the Office of Person- 1 This court’s EDR plan was adopted at the direction, and with the approval, of the Judicial Conference of the United States, see Judicial Conference of the United States, Model EDR Plan, ch.”

Legal Effect of Fed. Judge's Order as Hearing Officer Under Court's Emp. Dispute Resolution Plan (OLC 2010). “See 5 C.F.R. § 890.104 (2009). The regulations further provide that “[a]fter reconsideration, the [employing] agency .”

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