Covered services
Primary source
Verbatim text below is from the Electronic Code of Federal Regulations (eCFR), a public-domain U.S. government work. Always verify the current version with the eCFR before relying on it for any legal matter.
Full Text
(a) The limitation on the charges and FEHB benefit payments for inpatient hospital services apply to inpatient hospital services which are:
(1) Covered under both Medicare part A and the retired enrolled individual's FEHB plan; and
(2) Supplied to a retired enrolled individual who does not have Medicare part A; and
(3) Provided by hospital providers who have in force participation agreements with the Secretary of Health and Human Services (HHS) consistent with sections 1814(a) and 1866 of the Social Security Act, and receive Medicare part A payments in accordance with the diagnosis related group (DRG) based prospective payment system (PPS).
(b) The limitation on the charges and FEHB benefit payments for physician services apply to physician services, (as defined in section 1848(j) of the Social Security Act), which are:
(1) Covered under both Medicare part B and the retired enrolled individual's FEHB plan; and
(2) Supplied to a retired enrolled individual who does not have Medicare part B.
[60 FR 26668, May 18, 1995]
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.