B-143846, SEPTEMBER 14, 1960, 40 COMP. GEN. 167

B-143846: Sep 14, 1960

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ARE HOSPITALIZED HAVE THEIR HOSPITALIZATION AND MEDICAL EXPENSE PAID BY THE INSURANCE CARRIER ARE NOT REGARDED AS HAVING RECEIVED HOSPITALIZATION AT GOVERNMENT EXPENSE WITHIN THE MEANING OF SECTION 6.5 (A) OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS EVEN THOUGH THE GOVERNMENT CONTRIBUTES TO THE COST OF THE INSURANCE AND. SUCH EMPLOYEES ARE NOT PRECLUDED FROM RECEIVING PER DIEM FOR THE PERIOD OF HOSPITALIZATION PURSUANT TO SECTION 3 OF THE TRAVEL EXPENSE ACT OF 1949. THE COST OF AMBULANCE SERVICE FROM A TEMPORARY POST OF DUTY TO PERMANENT AND DUTY STATION IS AN ALLOWABLE TRANSPORTATION EXPENSE TION EXPENSE UNDER SECTION 6 (B) OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS. PROVIDED THAT SUCH TRANSPORTATION IS AUTHORIZED OR APPROVED AND THAT APPROVAL IS BASED UPON ADEQUATE MEDICAL EVIDENCE OF NEED.

B-143846, SEPTEMBER 14, 1960, 40 COMP. GEN. 167

CIVILIAN PERSONNEL - TRAVEL STATUS - PER DIEM - HOSPITALIZATION - EMPLOYEES COVERED BY HEALTH INSURANCE - AMBULANCE SERVICE EMPLOYEES ENROLLED UNDER ONE OF THE HEALTH BENEFIT PLANS OFFERED UNDER THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT OF 1959, 5 U.S.C. 3001 NOTE--- 3014, WHO, WHILE IN AN OFFICIAL TRAVEL STATUS, ARE HOSPITALIZED HAVE THEIR HOSPITALIZATION AND MEDICAL EXPENSE PAID BY THE INSURANCE CARRIER ARE NOT REGARDED AS HAVING RECEIVED HOSPITALIZATION AT GOVERNMENT EXPENSE WITHIN THE MEANING OF SECTION 6.5 (A) OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS EVEN THOUGH THE GOVERNMENT CONTRIBUTES TO THE COST OF THE INSURANCE AND, THEREFORE, SUCH EMPLOYEES ARE NOT PRECLUDED FROM RECEIVING PER DIEM FOR THE PERIOD OF HOSPITALIZATION PURSUANT TO SECTION 3 OF THE TRAVEL EXPENSE ACT OF 1949, 5 U.S.C. 836. THE COST OF AMBULANCE SERVICE FROM A TEMPORARY POST OF DUTY TO PERMANENT AND DUTY STATION IS AN ALLOWABLE TRANSPORTATION EXPENSE TION EXPENSE UNDER SECTION 6 (B) OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS, WHICH SPECIFICALLY AUTHORIZES TRANSPORTATION EXPENSE TO AN EMPLOYEE'S DESIGNATED DUTY POST WHENEVER THE EMPLOYEE BECOMES INCAPACITATED DUE TO ILLNESS OR INJURY NOT DUE TO HIS OWN MISCONDUCT WHILE IN AN OFFICIAL TRAVEL STATUS, NOTWITHSTANDING THAT THE COST OF SUCH TRANSPORTATION EXCEEDS THE COST FOR THE RETURN TRIP VIA COMMON CARRIER, PROVIDED THAT SUCH TRANSPORTATION IS AUTHORIZED OR APPROVED AND THAT APPROVAL IS BASED UPON ADEQUATE MEDICAL EVIDENCE OF NEED.

TO M. A. MARCHETTI, DEPARTMENT OF THE INTERIOR, SEPTEMBER 14, 1960:

YOUR LETTER OF AUGUST 26, 1960, REQUESTS OUR DECISION WHETHER A TRAVEL VOUCHER IN FAVOR OF MR. EDWARD THOMAS, MINING ENGINEER, BUREAU OF MINES, HEADQUARTERED AT PITTSBURGH, PENNSYLVANIA, FOR $181.20 COVERING THE PERIOD JULY 7, 1960, TO JULY 13, 1960, MAY BE CERTIFIED FOR PAYMENT.

MR. THOMAS BECAME ILL WHILE IN A TRAVEL STATUS AND WAS HOSPITALIZED AT CLEVELAND, OHIO, FROM JULY 8, 1960, TO JULY 13, 1960. $72 OF THE TOTAL AMOUNT REPRESENTS PER DIEM FOR THE PERIOD OF HOSPITALIZATION AND RETURN TRAVEL TIME TO PITTSBURGH. $99 OF THE REMAINDER REPRESENTS THE COST OF AMBULANCE SERVICE BETWEEN THE HOSPITAL IN CLEVELAND AND A HOSPITAL IN PITTSBURGH PAID BY MR. THOMAS.

MR. THOMAS IS ENROLLED UNDER ENROLLMENT CODE NO. 102 OF THE GOVERNMENT- WIDE SERVICE BENEFIT PLAN, ONE OF THE HEALTH BENEFIT PLANS OFFERED UNDER THE FEDERAL EMPLOYEES HEALTH BENEFIT ACT OF 1959, 73 STAT. 708, 5 U.S.C. 3001 NOTE--- 3014.

TWO QUESTIONS ARE PRESENTED: (1), WHETHER IN VIEW OF SECTION 6.5A OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS MR. THOMAS IS ENTITLED TO PER DIEM FOR THIS PERIOD OF OSPITALIZATION; AND, (2), WHETHER REIMBURSEMENT FOR THE COST OF AMBULANCE SERVICE MAY BE PAID IN FULL OR MUST BE LIMITED NOT TO EXCEED THE COST OF COMMON CARRIER.

SECTION 3 OF THE TRAVEL EXPENSE ACT OF 1949, 63 STAT. 166, AS AMENDED, 5 U.S.C. 836, AUTHORIZES PAYMENT OF PER DIEM TO CIVILIAN OFFICERS AND EMPLOYEES WHO BECOME INCAPACITATED BECAUSE OF ILLNESS OR INJURY, NOT DUE TO THEIR OWN MISCONDUCT, WHILE TRAVELING ON OFFICIAL BUSINESS AWAY FROM THEIR DESIGNATED POSTS OF DUTY.

SECTION 6.5A AND B OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS ISSUED PURSUANT THERETO READS AS FOLLOWS:

(A) * * * REFUND OF THE PER DIEM ALLOWANCE SHALL BE REQUIRED FROM THE EMPLOYEE IN ANY CASE WHERE HE RECEIVES HOSPITALIZATION UNDER ANY FEDERAL STATUTE OR RECEIVES REIMBURSEMENT UNDER SUCH STATUTE FOR HOSPITAL EXPENSES PAID BY HIM.

(B) TRANSPORTATION EXPENSES TO EMPLOYEE'S DESIGNATED POST OF DUTY AND PER DIEM EN ROUTE SHALL BE ALLOWED WHENEVER THE EMPLOYEE BECOMES INCAPACITATED DUE TO ILLNESS OR INJURY, NOT DUE TO HIS OWN MISCONDUCT, WHILE EN ROUTE TO OR WHILE AT TEMPORARY DUTY STATION PRIOR TO COMPLETION OF TEMPORARY DUTY ASSIGNMENT WHEN AUTHORIZED OR APPROVED.

THE PURPOSE OF SECTION 6.5A OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS IS TO PROHIBIT PAYMENT OF PER DIEM WHEN AN EMPLOYEE IS ENTITLED BY LAW TO RECEIVE HOSPITALIZATION AT GOVERNMENT EXPENSE OR REIMBURSEMENT BY THE GOVERNMENT FOR HOSPITAL EXPENSES PAID BY HIM, AS, FOR EXAMPLE, UNDER THE FEDERAL EMPLOYEES COMPENSATION ACT OF 1916, AS AMENDED, 5 U.S.C. 751-793. SEE 32 COMP. GEN. 113.

THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT OF 1959 ESTABLISHED A GOVERNMENT-WIDE PROGRAM OF INSURANCE FOR FEDERAL EMPLOYEES AND THEIR DEPENDENTS, THE COSTS OF WHICH ARE SHARED BY THE GOVERNMENT, AS EMPLOYER, AND ITS EMPLOYEES. THE ACT DOES NOT ENTITLE FEDERAL EMPLOYEES TO HOSPITALIZATION AT GOVERNMENT EXPENSE BUT GIVES FEDERAL EMPLOYEES THE OPPORTUNITY TO OBTAIN HEALTH INSURANCE BY ENROLLING IN ONE OF THE HEALTH BENEFIT PLANS OFFERED UNDER THIS PROGRAM.

THE ACT AUTHORIZES THE CIVIL SERVICE COMMISSION TO ENTER INTO CONTRACTS WITH QUALIFIED CARRIERS OFFERING HEALTH BENEFIT PLANS DESCRIBED IN SECTION 4 OF THE ACT. REIMBURSEMENT FOR HOSPITALIZATION AND OTHER MEDICAL EXPENSES IS PAID BY THE CARRIER ACCORDING TO THE TERMS OF ITS INSURANCE CONTRACT.

CONSEQUENTLY, THE FACT THAT THE GOVERNMENT CONTRIBUTES TO THE COST OF THE EMPLOYEE'S HEALTH INSURANCE DOES NOT AFFECT HIS RIGHT TO RECEIVE PER DIEM DURING THE PERIOD OF HOSPITALIZATION.

THE EXPENSE OF AMBULANCE SERVICE TO AN EMPLOYEE'S DESIGNATED POST OF DUTY IS AN ALLOWABLE TRANSPORTATION EXPENSE UNDER SECTION 6.5B OF THE STANDARDIZED GOVERNMENT TRAVEL REGULATIONS AND MAY BE PAID IN FULL WHEN AUTHORIZED OR APPROVED. B-127109, APRIL 6, 1956, COPY ENCLOSED. WE NOTE THAT THE VOUCHER IS ADMINISTRATIVELY APPROVED AND WE ASSUME THAT SUCH APPROVAL IS BASED UPON ADEQUATE MEDICAL EVIDENCE OF NEED.

THE VOUCHER, THEREFORE, MAY BE CERTIFIED FOR PAYMENT IF OTHERWISE CORRECT.