Expert's View

If you don’t change plans, you will automatically be enrolled in the lowest-cost nationwide plan option as determined by OPM. Image: REDPIXEL.PL/Shutterstock.com

This year more than in the recent past years, the make-up and number of providers under the Federal Employees Health Benefits program are changing. With that in mind, OPM recently issued a Federal Benefits Fast Facts bulletin that began by pointing out the four ways your current FEHB plan enrollment may be affected, namely by:
1. Leaving the program entirely
2. Reducing its service area and eliminating it enrollment code
3. Reducing its service area and keeping its enrollment code
4. Eliminating an option (such as Standard or High)

It then included a series of questions for you to consider, which I’ve summarized below.

How will I know if my enrollment is affected?
Your plan will send you a letter saying that it is either no longer participating in the FEHB program, no longer providing coverage in your area or eliminating an option.

What should I do if my enrollment is affected?
Change your enrollment to another plan during Open Season or during a time period set by OPM.

My Plan is leaving the FEHB Program entirely. What happens if I don’t change to another plan?
If you don’t change plans, you will automatically be enrolled in the lowest-cost nationwide plan option as determined by OPM.

My plan is reducing its service area and eliminating my enrollment code. What happens if I don’t change to another plan?
If you don’t change plans you will be automatically enrolled in the lowest-cost nationwide plan available as determined by OPM.

My plan is reducing its service area where I live or work but keeping my enrollment code. What happens if I don’t change to another plan?
You’ll only have coverage for emergency care services in the new plan year, and you’ll have to travel to the plan’s remaining service area to receive full coverage.

My plan is eliminating my option. What happens if I don’t change to a remaining option or to another plan?
You’ll automatically be enrolled in one of the plan’s options that remain. If a High Deductible Health Plan is the only one that remains, you’ll automatically be enrolled in the lowest cost nationwide plan option as identified by OPM.

If my High Deductible Health Plan (HDHP) is terminating coverage in my service area or is leaving the FEHB program, what happens to my Health Savings Account (HSA) or my Health Reimbursement Arrangement (HRA)?
If you want to continue contributing to your HSA, you’ll have to enroll in another HDHP, If you don’t do that, you won’t be eligible to make contributions to your HSA; however, you will still be able to request withdrawals for qualified medical expenses. Note: Unless you use your HRA credits, they’ll be forfeited once the plan you elected becomes effective.

How do I change my enrollment to another plan?
If you are a FERS employee, you can use your agency’s online self-service system, such as Employee Express, MyPay, Employee Personal Page, EBIS, etc. For additional help, contact your HR office. If you are a CSRS or FERS retiree, you can call Open Season Express at 1-800-332-9798.

When does my current plan or option stop providing coverage and my new plan or option begin?
There won’t be any gaps in coverage. Your current plan will continue to provide benefits until the effective date of the new plan you’ve elected during Open Season or during a time period designated by OPM. Open Season enrollment changes will be effective the first day of your first full pay period in January 2023.

What are my rights if I’m pregnant or have a chronic or disabling condition?
Following notice that a plan is leaving the FEHB program, enrollees who are seeing a specialist for a chronic or disabling condition or who are in the second or third trimester of a pregnancy have a right to continue treatment for up to 90 days or through the end of the post-partum care.

If you are an employee, you can get more information about FEHB plans, premiums, plan comparisons, etc, at  https://www.opm.gov/healthcare-insurance/open-season/active-federal-employees. If you are a retiree, go to https://www.opm.gov/healthcare-insurance/open-season/federal-retirees-other-annuitants.

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