B-203551,(MRV),L/M, JUN 22, 1981, OFFICE OF GENERAL COUNSEL

B-203551,(MRV),L/M: Jun 22, 1981

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DREYER: THIS IS IN RESPONSE TO YOUR LETTER OF MAY 29. CONCERNING PROBLEMS YOU HAVE ENCOUNTERED WITH THE HEALTH INSURANCE PLAN SPONSORED BY THE AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES. SECS. 8901 13 (1976) THE OFFICE OF PERSONNEL MANAGEMENT (OPM) IS VESTED WITH THE AUTHORITY TO CONTRACT WITH QUALIFIED CARRIERS FOR HEALTH BENEFIT PLANS AND TO PRESCRIBE NECESSARY REGULATIONS TO ADMINISTER THIS STATUTORY AUTHORITY. IT WILL. REVIEW A HEALTH BENEFITS PLAN DECISION TO DETERMINE WHETHER THE DECISION IS IN ACCORDANCE WITH THE TERMS OF OPM'S CONTRACT WITH THE CARRIER OF THE PLAN. THE UNITED STATES DISTRICT COURTS AND THE UNITED STATES COURT OF CLAIMS ARE VESTED WITH JURISDICTION TO HEAR CLAIMS UNDER THE HEALTH INSURANCE STATUTE.

B-203551,(MRV),L/M, JUN 22, 1981, OFFICE OF GENERAL COUNSEL

PRECIS-UNAVAILABLE

MR. VICTOR L. DREYER:

THIS IS IN RESPONSE TO YOUR LETTER OF MAY 29, 1981, CONCERNING PROBLEMS YOU HAVE ENCOUNTERED WITH THE HEALTH INSURANCE PLAN SPONSORED BY THE AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES.

THE GENERAL ACCOUNTING OFFICE HAS NO JURISDICTION TO RESOLVE INDIVIDUAL PROBLEMS OR COMPLAINTS ASSOCIATED WITH THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM. UNDER THE PROVISIONS OF 5 U.S.C. SECS. 8901 13 (1976) THE OFFICE OF PERSONNEL MANAGEMENT (OPM) IS VESTED WITH THE AUTHORITY TO CONTRACT WITH QUALIFIED CARRIERS FOR HEALTH BENEFIT PLANS AND TO PRESCRIBE NECESSARY REGULATIONS TO ADMINISTER THIS STATUTORY AUTHORITY. UNDER THE PROVISIONS OF 5 C.F.R. SEC. 890.106 (1980) (COPY ENCLOSED), OPM STATES THAT WHILE IT DOES NOT ADJUDICATE INDIVIDUAL CLAIMS FOR PAYMENT OR SERVICE, IT WILL, UPON WRITTEN REQUEST BY THE EMPLOYEE OR ANNUITANT, REVIEW A HEALTH BENEFITS PLAN DECISION TO DETERMINE WHETHER THE DECISION IS IN ACCORDANCE WITH THE TERMS OF OPM'S CONTRACT WITH THE CARRIER OF THE PLAN. FINALLY, THE UNITED STATES DISTRICT COURTS AND THE UNITED STATES COURT OF CLAIMS ARE VESTED WITH JURISDICTION TO HEAR CLAIMS UNDER THE HEALTH INSURANCE STATUTE. SEE 5 U.S.C. SEC. 8912 (1976).

WE TRUST THAT THIS INFORMATION IS HELPFUL TO YOU.

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