Fedweek

OPM has postponed indefinitely an audit it previously announced of family member coverage under the FEHB, a possible prelude to a crackdown on those getting benefits even though they are ineligible. No such audit has been performed in many years, and OPM in its initial announcement cited overall health industry estimates that as many as 10 percent of private health claim benefits are incurred by persons not eligible for family coverage. The FEHB pays out about more than $20 billion in benefits each year, costs that are shared by the government and enrollees. It said that while agencies and FEHB carriers both have responsibility for family member eligibility determinations, eligibility is not verified in a systematic way at the time of the initial enrollment, when enrollment is changed during open season, or on experiencing a qualifying life event. It raised the prospects of creating a centralized enrollment system including names of family members whose eligibility is verified.