The Federal Employees Health Benefits Act (FEHBA) of 1959 created the Federal Employees Health Benefits Program, which became effective in 1960. It is the largest employer-sponsored group health insurance program in the world, covering more than 8 million Federal employees, retirees, former employees, and family members. The current law governing the Program is Chapter 89 of Title 5, United States Code. It authorizes the Office of Personnel Management to write any regulations necessary to carry out the Act. These regulations are in Part 890 of Title 5 and Chapter 16 of Title 48, Code of Federal Regulations.
The Office of Personnel Management. This federal agency manages, and directs the FEHBA program including the approval of Plan language, and the negotiation of contract rates.
The governing document outlining the coverage as well as the rights and responsibilities agreed to by the plan holder and the beneficiary. All FEHBA Plans can be found here https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/.
The process of negotiating a lien until final resolution is reached. This may include the pursuit of reductions or assertions of invalidity pursuant to applicable laws until the lien holder produces their final offer for recovery.
Do I need to notify my FEHBA Plan when I make a claim for personal injuries against a third party?
The terms of your FEHBA Plan will articulate the responsibilities of the parties. Typically the Plan requires cooperation and notification in circumstances where another party may become responsible for the medical benefits the Plan has already paid.
Are the recovery rights of the FEHBA Plan controlled by state or federal law?
The language of a FEHBA Plan preempts state law on matters of “coverage or benefits” (5 U.S.C. 8902(m)(1)). However, the United States Supreme Court rendered an important decision limiting preemption under FEHBA in the case of Empire HealthChoice Assurance, Inc. v. McVeigh, 547 U.S. 677, 126 S. Ct. 2121 (2006). The Supreme Court declined to exercise subject matter jurisdiction, holding that Section 8902(m)(1) does not raise a federal question to support federal jurisdiction.
This issue has been hotly litigated and there is no clear ruling at this point. The argument for application of state law is best articulated in Nevils v. Group Health Plan, Inc., (Mo. en banc 2016); whereas, the argument for federal preemption is articulated in Helfrich v. Blue Cross & Blue Shield Ass’n, 804 F.3d 1090 (10th Cir. 2015).