FEDweek

Enrollment Options When an FEHB Plan or Option Ends

In recent articles I’ve written about several long-standing little-known but important benefits policies. This time I want to explore something more recent: an OPM rule effective January 1, 2016 that lays out your enrollment options following the termination of an FEHB plan or plan option.

This rule doesn’t change OPM’s standard practice of letting everyone know about any plans or options that intend to leave the FEHB program in an upcoming open season. What it does do is give enrollees an opportunity to enroll in a new plan or option outside of open season if a current plan or option is leaving mid-year.

According to OPM, “In general, the final rule allows OPM and employing agencies to automatically enroll individuals who do not make an enrollment election during the allotted time period into one of the following: in the event of a plan option termination, the lowest cost remaining plan option provided by the carrier that is not a High Deductible Health Plan (HDHP); or in the event of a plan termination, into the lowest cost nationwide plan available. The final rule does not alter current standard practice to enroll individuals into the enrollment type (Self Only, Self Plus One, or Self and Family) that the enrollee carried before the plan or plan option terminated. If enrollees learn of a plan or plan option termination and determine that they do not want to continue FEHB coverage, the decision to cancel should be documented in Part F of the Standard Form (SF) 2809.”

OPM has defined the term “lowest-cost nationwide plan” to mean one that will neither be a High Deductible Health Plan nor an option from a plan that requires an additional membership or association fee. Each year OPM will let everyone know what the lowest cost nationwide plan option is; however, it reserves the right to designate an alternative plan if needed.

The lowest-cost nationwide plan for 2016 is the GEHA standard option. During future open seasons, OPM will announce the lowest-cost nationwide plan when premium rates for the following year are published.

In closing, OPM stated that “The final rule provides annuitants who are involuntarily enrolled into the lowest-cost nationwide plan due to a plan or plan option termination with an opportunity to prospectively change their enrollment within 90 days. Bleated enrollments are only available to both employees and annuitants who are automatically enrolled into the lowest-cost nationwide plan as a result of a plan termination due to a disaster.”