[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: 5CFR890.906]

[Page 484]
 
                    TITLE 5--ADMINISTRATIVE PERSONNEL
 
          CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED)
 
PART 890_FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents
 
 Subpart I_Limit on Inpatient Hospital Charges, Physician Charges, and 
                          FEHB Benefit Payments
 
Sec. 890.906  Retired enrolled individuals coinsurance payments.

    (a) A retired enrolled individual's coinsurance responsibility for 
inpatient hospital services is calculated in accordance with the plan's 
contractual benefit structure and is based on the amount determined to 
be equivalent to the Medicare part A payment under the DRG-based PPS.
    (b) A retired enrolled individual's coinsurance responsibility for 
physician services is calculated in accordance with the plan's 
contractual benefit structure and is based on the lower of the actual 
charges or the amount determined to be equivalent to the Medicare part B 
payment under the Medicare Participating Physician Fee Schedule for 
Medicare participating physicians and the Medicare Nonparticipating 
Physician Fee Schedule for Medicare nonparticipating physicians.

[60 FR 26668, May 18, 1995]