[Code of Federal Regulations]
[Title 5, Volume 2]
[Revised as of January 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 5CFR890.204]

[Page 446]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
                     Subpart B_Health Benefits Plans
 
Sec. 890.204  Withdrawal of approval of health benefits plans or carriers.

    (a) The Director may withdraw approval of a health benefits plan or 
carrier if the standards at Sec. 890.201 of this part and 48 CFR 
subpart 1609.70 are not met. Such action carries with it the right to a 
hearing as provided in paragraph (a)(2) of this section.
    (1) Before withdrawing approval, the Director or his or her 
representative shall notify the carrier of the plan, by certified mail, 
that OPM intends to withdraw approval of the health benefits plan and/or 
carrier. The notice shall set forth the reasons why approval is to be 
withdrawn. The carrier is entitled to reply in writing within 15 
calendar days after its receipt of the notice, stating the reasons why 
approval should not be withdrawn.
    (2) On receipt of the reply, or in the absence of a timely reply, 
the Director or representative shall set a date, time, and place for a 
hearing. The carrier shall be notified by certified mail at least 15 
calendar days in advance of the hearing. The hearing officer shall be 
the Director, or a representative designated by the Director, who shall 
not otherwise have been a party to the initial administrative decision 
to issue a letter of intent to withdraw the plan's or carrier's 
approval. The hearing officer shall conduct the hearing unless it is 
waived in writing by the carrier. The carrier is entitled to appear by 
representative and present oral or documentary evidence, including 
rebuttal evidence, in opposition to the proposed action.
    (i) A transcribed record shall be kept of the hearing and shall be 
the exclusive record of the proceeding.
    (ii) After the hearing is held, or after OPM's receipt of the 
carrier's written waiver of the hearing, the Director shall make a 
decision on the record, taking into consideration any recommendation 
submitted by the hearing officer, and send it to the carrier by 
certified mail. A decision of the Director shall be considered a final 
decision for the purposes of this section. The Director, or his or her 
representative, may set a future effective date for withdrawal of 
approval.
    (3) The Director, or his or her representative, may give written 
notice of non-renewal of the contract of a carrier whose plan does not 
meet the minimum enrollee requirement in Sec. 890.201(a)(11). However, 
the Director may defer withdrawing approval of a plan not meeting the 
requirement in Sec. 890.201(a)(11) of this part when, in the judgment 
of OPM, the carrier shows good cause. The Director or representative may 
authorize a plan with fewer than 300 employees or annuitants to remain 
in the FEHB Program when he or she determines, in his or her discretion, 
that it is in the best interest of the Program (e.g., when the plan is 
the only plan available to enrollees in a rural area).
    (b) During a current contract term, the Director, in his or her 
discretion, may reinstate approval of a plan or carrier under this 
section on a finding that the reasons for withdrawing approval no longer 
exist.

[55 FR 9109, Mar. 12, 1990, as amended at 57 FR 14324, Apr. 20, 1992]