About FEHBA Liens
The Federal Employees Health Benefits Act (FEHBA) of 1959 (5 U.S.C. 8901 et seq.) 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. FEHBA Plans are contracts between the insurance carrier and the United States Office of Personnel Management (OPM). Most federal employees are eligible to enroll in FEHBA Plans.
FEHBA contains a preemption provision which provides that certain contract terms in health insurance plans “shall” preempt state or local law. The language of a FEHBA Plan preempts state law, whether consistent or inconsistent with federal plan provisions, on matters of “coverage or benefits” (5 U.S.C. 8902(m)(1)).
On April 18, 2017 in Coventry Health Care Of Mo., Inc. V. Nevils the United States Supreme Court held that the subrogation/reimbursement plan language contained in the health insurance contracts of Federal Employee Health Benefit plans (FEHBA) preempted state law.
“We conclude, however, that the statute, not a contract, strips state law of its force. … FEHBA contract terms have preemptive force”
The review of the FEHBA Payment Summary to ensure there are no errors, duplicates or unrelated treatment is included.
When a lien has been established by the FEHBA Plan a compromise can be proposed as an attempt to reduce the lien.
The Federal Employees Health Benefits Act (FEHBA) of 1959 (5 U.S.C. 8901 et seq.)
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 notifying, verifying, and negotiating a lien until final resolution is reached. This may include the pursuit of compromises, appeals or waivers until the lien holder produces their final offer for recovery.
The process of determining if the FEHBA Plan has a repayment obligation and confirmation that such obligation has been fully and finally satisfied.
FEHBA Plan FAQ
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.
How long does FEHBA Plan lien resolution usually take?
Lien resolution process is handled by private industry which is not subject to arbitrary response times. As a result the resolution process is typically faster than can be expected in dealing with governmental agencies.