Enclosure to Carrier Letter 2001-02
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ROUTINE REPORTS REQUIRED OF FEHB CARRIERS |
1 |
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REPORT |
Frequency: |
Required of: |
Date Due: |
Reference: |
Guidance: |
For information about this report, contact: |
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Annual Accounting Statement |
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Estimated Summary Statement of FEHBP Operations (see below) |
Annual |
Exp-rated |
Nov 4 |
Contract '1.7 Contract '3.2 |
CL 98-42 |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov) |
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AASAnnual Accounting Statement (Fiscal Year Accounting Statement:) |
Annual |
Exp-rated |
Dec 15 |
Contract '1.7 Contract '3.2 Contract '3.10 |
CL 98-42 |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov)
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Summary Statement of FEHB Operations |
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FEHBP Balance Sheet as of 9/30 |
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Consolidated Statement of FEHBP Cash Flows |
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Schedule 1 -- Health Benefits Charges Paid |
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Financial Reporting Package: |
Annual |
Exp-rated |
Mar 31 |
Contract '1.7, '3.2, and '3.10 |
CL 98-42 |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov)
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Schedule 1BHealth Benefit Charges Paid |
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Schedule 2-Health Benefit Charges Accrued but Unpaid |
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Schedule 3-Administrative Expenses |
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Schedule 3-Addendum-Carrier Cost Containment Expenses |
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ROUTINE REPORTS REQUIRED OF FEHB CARRIERS |
2 |
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REPORT |
Frequency: |
Required of: |
Date Due: |
Reference: |
Guidance: |
For information about this report, contact: |
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Schedule 3A-Supplemental Schedule - Other Expenses |
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Schedule 3B-Vendor Cost Containment Expenses |
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Schedule 3C-Reconciliation of Administrative Expenses |
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Schedule 4-Prior Period Adjustments |
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Schedule 5-Status of Reserves |
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Additional Required Financial and Statistical Information (background) |
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Certified Financial Statements for the Most Current Fiscal Year |
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Audit report on audit of the fiscal year accounting statement |
Annual w/AAC |
Exp-rated plans that elected to provide an audit |
With AAC |
Contract '1.7, '3.2, and '3.10 |
CL 98-42 |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov) |
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Report on compliance with laws, regulations and internal controls |
Annual w/AAC |
Exp-rated plans subject to Aprimary coverage@ |
With AAC |
Contract '1.7, '3.2, and '3.10 |
CL 98-42 and CL 98-30 |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov) |
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ROUTINE REPORTS REQUIRED OF FEHB CARRIERS |
3 |
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REPORT |
Frequency: |
Required of: |
Date Due: |
Reference: |
Guidance: |
For information about this report, contact: |
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Other Financial Reports |
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CPA report (2 copies) -- most recent |
Annual |
All |
90 days after carrier's FY |
Contract '1.7, '3.2, and '3.10 |
CL 98-005 CL 98-042 |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov)) |
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Annual Paid Claims Report |
Annual |
FFS |
Mar 31 |
Contract '1.7 |
Office of Actuary Instructions |
Ofc of Actuary/Simon (SVSimon@opm.gov) |
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Incurred Claims Report |
Annual |
BCBS, MHBP, GEHA, NALC, APWU |
Dec 31 |
Contract '1.7 |
Office of Actuary Instructions |
Ofc of Actuary/Simon (SVSimon@opm.gov) |
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Monthly Incurred Claims |
Monthly |
FFS |
15 days after end of month |
Contract '1.7 |
Office of Actuary Instructions |
Ofc of Actuary/Simon (SVSimon@opm.gov) |
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Premium Payment |
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TFS Form 3881 B Payment Information Form |
At approval |
All |
As directed |
Contract '3.1 |
FMD instructions |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov) |
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Change of Financial Institution |
When applicable |
All |
As directed |
Contract '3.1 |
FMD instructions |
Financial Mgmt Div/Shaffi (ZShaffi@opm.gov) |
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Enrollment Reporting |
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Table 1-Summary of FEHBP Enrollment |
Annual |
All |
Apr 15 |
Contract '1.7 |
CL 98-42 CL 98-005-A CL 98-012 CL 99-013 |
OIP/IPED/Figg (EDFigg@opm.gov) |
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ROUTINE REPORTS REQUIRED OF FEHB CARRIERS |
4 |
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REPORT |
Frequency: |
Required of: |
Date Due: |
Reference: |
Guidance: |
For information about this report, contact: |
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Rate Related |
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Rate Proposal (includes several tables and reports) |
Annual |
All; by Rate type |
May 31 |
Contract '3.2
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CL 98-16
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Ofc of Actuary/Simon (SVSimon@opm.gov) |
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Rate Reconciliation Request (includes several tables and reports) |
Annual |
C-rated |
April 30 |
Contract '3.2 |
CL 98-10 |
Ofc of Actuary/Simon (SVSimon@opm.gov) |
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Utilization Data per 1,000 Members |
Annual |
C-rated |
May 31 |
Contract '1.7 |
Call Letter |
Ofc of Actuary/Simon (SVSimon@opm.gov)
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Benefit Proposals and Brochure Production |
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Plan Contracting Officials Form |
Annual/not less than annual |
All |
May 31/as needed |
Contract '1.7 |
Call letter |
OIP/ICD/contract rep
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FEHB Plan Address Form |
As updates are needed |
All |
As needed |
Contract '1.7 |
Contract rep |
OIP/ICD/contract rep
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ROUTINE REPORTS REQUIRED OF FEHB CARRIERS |
5 |
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REPORT |
Frequency: |
Required of: |
Date Due: |
Reference: |
Guidance: |
For information about this report, contact: |
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Satisfaction/Quality Assessment |
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Customer Satisfaction Survey Results (CAHPS) |
Annual |
All except plans with <500 FEHB enrollees) |
Jun 15 |
Contract '1.9 |
CL 98-45 CL 98-45A |
OIP/IPED/Pierce (TMMorrow@opm.gov) |
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HEDIS (pilot) |
Annual |
HMOs with > 500 FEHB |
June 15 |
Contract '1.9 |
CL 99-016 CL 00-03 |
OIP/IPID/Pfleeger (jpfleege@opm.gov)
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Quality assurance performance standards |
Annual |
All |
Jan 31
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Contract '1.9 |
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OIP/IPID/Pfleeger (jpfleege@opm.gov) |
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Other Reports |
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FEHB Carrier Debarment ActionsB (reported to OIG on providers excluded after 1/29/92) |
Semi-annual |
All |
Apr 15 Oct 15 |
Contract '2.7 |
OIG Instructions |
Ofc of Inspector Gen/Smith (JLSmith@opm.gov)
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FEHB Carrier Debarment ActionsB (reported to OIP on providers excluded before 1/29/92) |
Annual |
FFS (not HMO)
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Mar 31 |
Annual appropriations |
CL 93-01 CL 93-20 |
OIP/IPED/Kalland (AMKallan@opm.gov) |
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Fraud and abuse cases report |
Semi-annual |
All |
Jan 31 Jul 31 |
Contract '1.9 |
CL 91-10 CL 93-32 CL 94-02 |
OIP/IPED/Morrow (TMMorrow@opm.gov) |
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ROUTINE REPORTS REQUIRED OF FEHB CARRIERS |
6 |
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REPORT |
Frequency: |
Required of: |
Date Due: |
Reference: |
Guidance: |
For information about this report, contact: |
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Pilot Project |
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Small Business Subcontracting Plan |
Annual |
6 pilot project carriers |
Jun 15 |
Contract Appendix F |
OPM Instructions 4/9/96 |
OIP/IPID/Bodenheimer (LR Bodenheimer @opm.gov) |
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Subcontracting Report for Individual Contracts (SF 294) |
Semi-annual |
6 pilot project carriers |
Apr 30 Oct 30 |
Same |
OPM Instructions 4/9/96 |
OIP/IPID/Bodenheimer (LR Bodenheimer @opm.gov) |
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Summary Subcontract Report (SF 295) |
Annual |
6 pilot project carriers |
Oct 30 |
Same |
OPM Instructions 4/9/96 |
OIP/IPID/Bodenheimer (LR Bodenheimer @opm.gov) |
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Agreements and Certifications |
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Agreement re Release of Medicare Data |
First year; then when applicable |
All |
As directed |
OPM-HHS Agreement |
Annual Letter |
OIP/IPED/Kalland (AMKallan@opm.gov) |
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Certification re Disclosure of Lobbying Activities |
At approval |
All |
Before approval |
Contract '5.45 |
Contract rep |
OIP/ICD/contract rep
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OMB SF LLL, Disclosure of Lobbying Activities (relates to certification) |
When applicable |
All |
As needed |
Contract '5.45 |
Contract rep |
OIP/ICD/contract rep
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Certification re Drug-Free Workplace |
At approval |
All |
Before approval |
Contract '5.25 |
Contract rep |
OIP/ICD/contract rep
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