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Can you summarize 48 CFR 1652.204-71?
Texts of FEHBP Clauses > Coordination of Benefits.
Short Summary
This clause, as prescribed in the Code of Federal Regulations, applies to all FEHBP contracts. It requires the Carrier to coordinate the payment of benefits under the contract with benefits under Medicare, other group health benefits coverages, and automobile insurance that pays benefits without regard to fault. The Carrier is not allowed to pay benefits under the contract until it determines whether it is the primary carrier or unless permitted by the Contracting Officer. The Carrier must follow the order of precedence established by the NAIC Model Guidelines for Coordination of Benefits (COB) as specified by OPM. If the Carrier makes erroneous payments or payments in excess of the contract limitations under COB provisions and is unable to recover such overpayments, the Contracting Officer may allow the amounts to be charged to the contract. COB savings must be reported by experience rated carriers each year. Changes in the order of precedence established by the NAIC Model Guidelines implemented after January 1 of any given year shall be required no earlier than the beginning of the following contract term.
Whom does it apply to?
FEHBP contracts
What does it govern?
Coordination of Benefits
What are exemptions?
No exemptions are mentioned.
What are the Penalties?
No penalties are mentioned.
Jurisdiction
U.S. Federal Government