(a) A suit to compel enrollment under § 890.102 must be brought against the employing office that made the enrollment decision.
(b) A suit to review the legality of OPM's regulations under this part must be brought against the Office of Personnel Management.
(c) Federal Employees Health Benefits (FEHB) carriers resolve FEHB claims under authority of Federal statute (5 U.S.C. chapter 89). A covered individual may seek judicial review of OPM's final action on the denial of a health benefits claim. A legal action to review final action by OPM involving such denial of health benefits must be brought against OPM and not against the carrier or carrier's subcontractors. The recovery in such a suit shall be limited to a court order directing OPM to require the carrier to pay the amount of benefits in dispute.
(d) An action under paragraph (c) of this section to recover on a claim for health benefits:
(1) May not be brought prior to exhaustion of the administrative remedies provided in § 890.105;
(2) May not be brought later than December 31 of the 3rd year after the year in which the care or service was provided; and
(3) Will be limited to the record that was before OPM when it rendered its decision affirming the carrier's denial of benefits.
(e) A suit for equitable relief founded on 5 U.S.C. chapter 89 that is based on 5 U.S.C. 8902(p) and is governed by 5 CFR part 890 must be brought against OPM by December 31 of the 3rd year after the year in which disputed services were rendered.
(f) A suit to compel enrollment or for equitable relief from an adverse enrollment action founded on 5 U.S.C. chapter 89 that is based on information received by OPM pursuant to an agreement with a source agency as defined at § 890.1602, to determine whether Postal Service annuitants or family members of such annuitants satisfy the enrollment requirements set forth in 5 U.S.C. 8903c, may not be brought later than December 31 of the 3rd year after the year in which the enrollment action was effectuated, and will be limited to the record that was before OPM when it effectuated the enrollment action.
[61 FR 15179, Apr. 5, 1996, as amended at 86 FR 36947, July 13, 2021; 89 FR 85028, Oct. 24, 2024]
Notes of Decisions
Empire Healthchoice Assurance, Inc. v. McVeigh, 547 U.S. 677 (2006).
· cites it 6× “" 5 CFR § 890.107 (c) (2005). While this regulation channels *687 disputes over coverage or benefits into federal court by designating a United States agency (OPM) sole defendant, no law opens federal courts to carriers seeking reimbursement from beneficiaries or recovery from…”
Gonzalez v. Blue Cross Blue Shield, 62 F.4th 891 (5th Cir. 2023).
· cites it 7× “”18 Count 2, under the 18 See 5 C.F.R. § 890.107 (authorizing a cause of action “against OPM”).”
Lorita Bryan v. Off. of Pers. Mgmt., 165 F.3d 1315 (10th Cir. 1999).
· cites it 6× “See 5 C.F.R. § 890.107 . Further, Mrs. Bryan asserts she is entitled to the full amount of benefits claimed ($19,744.”
Cedars-Sinai Med. Ctr. v. Nat'l League of Postmasters, 497 F.3d 972 (9th Cir. 2007).
· cites it 2× “See 5 C.F.R. §§ 890.107 (c), 890.107(d)(1). Neither party disputes that Cedars-Sinai failed to exhaust its administrative remedies under FEHBA and its corresponding implementing regulations.”
Bridges v. Blue Cross & Blue Shield Ass'n, 935 F. Supp. 37 (D.D.C. 1996).
· cites it 7× “105 (a) (providing that the OPM, upon the request of the enrollee and after the enrollee appeals the denial of a claim to the carrier, will review disputed claims). The FEHBA also provides that, if an enrollee is not satisfied with the OPM’s resolution of his claim, he may file…”
Virginia Burgin Joseph K. Burgin v. Off. of Pers. Mgmt., & Healthplus, Inc., 120 F.3d 494 (4th Cir. 1997).
· cites it 4× “See 5 C.F.R. § 890.107 (c). On OPM’s motion, the district court entered summary judgment for OPM, ruling that OPM’s action in affirming HealthPlus’ denial of coverage was not “arbitrary and capricious” and that there was no evidence that OPM’s interpretation of the Plan was…”
Hanson v. Blue Cross Blue Shield of Iowa, 953 F. Supp. 270 (N.D. Iowa 1996).
· cites it 8× “5 C.F.R. § 890.107 (d)(1) (providing that judicial review of OPM’s final decision may not be brought prior to exhaustion of the remedies in § 890.”
— 5 C.F.R. § 890.107(b) — 1 case
— 5 C.F.R. § 890.107(c) — 4 cases
Hanson v. Blue Cross Blue Shield of Iowa, 953 F. Supp. 270 (N.D. Iowa 1996).
“5 C.F.R. § 890.107 (d)(1) (providing that judicial review of OPM’s final decision may not be brought prior to exhaustion of the remedies in § 890.”
— 5 C.F.R. § 890.107(d)(1) — 1 case
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.