Information on the Appeals Process for Disputed Claims under the Federal Employees Health Benefits Program

The Federal Employees Health Benefits program provides health insurance coverage for about 3.3 million enrollees (Government employees and annuitants) and over 6.4 million dependents. The health insurance plans review health benefits claims to determine if they are payable under their contracts with the Civil Service Commission (CSC). Federal regulations require the CSC to notify the enrollee and the health insurance plan of its finding within 30 days after it receives all information it requested to aid in reviewing the case.