Health Benefits Options

While FEHB enrollees are faced by a range of choices during each open season, from whether to change plans to vacillating between standard and high-deductible coverage, there is one option that is often overlooked. It’s the choice between self only and self and family coverage.

If you elect self only coverage, only your medical needs will be provided for. And, because you are the only one receiving benefits, the premium costs will be lower.

Choosing the self only option isn’t just for someone who is either unmarried and/or has no eligible children. It’s also an option for married couples. In some cases both work for the federal government and have an entitlement to enroll in the FEHB program on their own. One attraction of having separate coverage is that it allows each of them to tailor their plan selection to their specific needs. Another is that there are times when the premium cost of two self only enrollments will be less than that for one self and family enrollment. However, it needs to be kept in mind that each enrollee will have to meet the co-insurance and deductible requirement plus the catastrophic limit on his or her own.

There are also situations where one of the spouses has a job outside the federal government and where coverage is provided at little or no cost. While electing a self only enrollment in that case looks like a no-brainer, you need to think about the long-term. It’s not uncommon for employees retiring from non-federal jobs to lose their health benefits coverage or have it substantially reduced. It also happens when they get laid off. While it’s easy to switch to self and family coverage during an open season, it would be impossible if you were to die before doing so. If that happened, your widow(er) (and children, if any) wouldn’t be eligible for FEHB coverage.

An even chancier decision is for the federal spouse to be covered under the non-federal spouse’s plan and not enroll in the FEHB at all. If that non-federal coverage were to suddenly end, both of them would be out in the cold. Yes, if you were a federal employee, you could enroll during the next open season; but even if you did so, in most cases you’d have to be enrolled in the FEHB program for the five consecutive years before you retired to be eligible to carry that coverage into retirement. On the other hand, if you were a retiree when that non-federal coverage ended, you wouldn’t be eligible to enroll in the FEHB program.