Authority of OPM to Direct Health Insurer Not to Enroll Individual Deemed Eligible by Employing Agency

Under both the regulations it has issued for administering the Federal Employees Health Benefits Act and its contract with the insurance carrier, the Office of Personnel Management has authority to direct a carrier not to enroll an individual in a health plan if OPM disagrees with the employing agency’s determination that the enrollment is permissible under federal law.

In the circumstances presented here, the law does not allow OPM to exercise its general administrative discretion in a manner that would permit such an enrollment to proceed.