Almost one year ago, Joseph A. Beaudoin, President of the National Active and Retired Federal Employees Association, testified before the House Subcommittee on the Federal Workforce, the Postal Service & the Census about the Federal Employees Health Benefits program and hoped that OPM would consider a “self plus one” enrollment category in the FEHB program.
In support of that idea, he said, “Currently, FEHBP enrollees belong to one of two categories: self or self and family. This means a family with three or more members pays the same premiums as a two-person household. The idea of creating a ‘self plus one’ category, as is available in the federal dental and vision plans, has been circulating for years.
“In the past, NARFE has been skeptical [about] establishing a self plus one enrollment category, as it threatens splitting up the risk pool and potentially leading to higher premiums for plans that cover a high percentage of older participants with higher average health costs.
“However, while federal annuitants who are not covered by Medicare Part B are the most costly to insure, the average cost of insuring annuitants with Medicare Part B coverage is lower than the average cost of covering active employees. In other words, self plus one may provide a more affordable option for retirees, which NARFE would support.
“Nevertheless, OPM should provide adequate data and assurances that premiums and other out-of-pocket costs for two person households would decline with the establishment of a self plus one category. NARFE would have serious concerns if federal retirees on fixed incomes would be forced to pay more for the same coverage if this category is established.”
And what do you know, the budget law passed last December approved making such a self-plus-one option available in the FEHB program as soon as contract year 2015. To everyone’s surprise, OPM admitted that it was already working on such a plan and expected to implement it in 2015. Smiles all around. However, according to the latest word from OPM, a self plus one coverage option for federal employees won’t be available until 2016. If then; only time will tell.
While we wait, I still wonder if splitting such a large risk pool won’t simply work to the advantage of some groups – those enrolled in self-only or self plus one – and to the disadvantage of others – those enrolled in self and family. When I was in charge of the FEHB program, I was convinced that the best way to secure lower premiums on average was to keep a risk pool as large as possible. That’s why I have long believed that there should be only one enrollment category.
While those who are in favor of splitting the risk pool believe that it would be fairer, what they really mean is that it would lower their own premiums. No one ever wants change, no matter how fair, that would cost them more.
