Audit of the Federal Employees Health Benefits Program Termination Process at Health Plan of Nevada, Inc.

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Date Issued

Wednesday, February 15, 2023

Submitting OIG

Office of Personnel Management OIG

Other Participating OIGs

Office of Personnel Management OIG

Agencies Reviewed/Investigated

Office of Personnel Management

Components

Federal Employees Health Benefits Program

Report Number

2022-CRAG-0010

Report Type

Audit

Agency Wide

Yes

Number of Recommendations

Questioned Costs

Funds for Better Use

External Entity

Health Plan of Nevada, Inc.

Open Recommendations

This report has 5 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
18	No	$0	$0
We recommend that OPM request that NFC revise the CLER system platform to establish an excessive discrepancy code fail count threshold and oversee the system to hold both agency payroll offices and Carriers accountable for making progress to resolve all discrepancy codes within an established period of time.
16	No	$0	$0
We recommend that OPM conduct a comprehensive overview of the 2809/834 Companion Guides and 834 layouts to address dependent terminations due to tier reductions and changes to ensure all possible value combinations advise Carriers of the applicability of the 31-day EOC as required under the Standard Contract terms.
20	No	$0	$0
We recommend that OPM review its current and archived FEHB CLs on its website, OPM.gov, to ensure that all CLs are posted and available for Carriers and other users.
19	No	$0	$0
We recommend that OPM develop procedures to monitor and enforce progress towards resolution of the CLER for fail counts of 4 or higher for code 160. This includes ensuring payroll offices and Carriers are aware of and resolving the enrollment discrepancies. OPM should also consistently adjust Carrier Plan Performance Assessments for excessive discrepancy code 160 fail counts as a method of enforcing the terms of the Standard Contract.
17	No	$0	$0
We recommend that OPM conduct a comprehensive overview of the paper SF 2809 and the OPM 2809 Form to ensure all necessary information is reported for Carriers to process dependent terminations and determine 31-day EOC applicability as required under the Standard Contract terms.