You may change your enrollment during the year under certain conditions. Image: Minerva Studio/Shutterstock.com
By: Reg JonesThe Federal Employees Health Benefits (FEHB) program is the world’s largest employee-sponsored health insurance program. Currently there are about 275 participating health plans, the majority of which are health maintenance organizations (HMOs).
In this article and the one that follows, I’ll explain both how the program works and how it interacts with Medicare to provide comprehensive health benefits coverage.
Enrollment
As a federal employee, you may enroll and cover any eligible family member in the health plan of your choice within 60 days of the date on which you are first hired. If you don’t enroll then, you can still do that during any annual health benefits Open Season. (Open Seasons run from the Monday of the second full workweek in November through the Monday of the second full workweek in December.) Regardless of when you enroll, coverage is provided without a medical examination and there is no waiting period before that coverage begins.
You have three enrollment options: Self Only, Self Plus One, and Self and Family. If you elect Self Only, that will cover you alone. Self Plus One will cover you and one eligible family member. If you elect Self and Family, it will cover you, your spouse, and any children under age 26.
You may also change your enrollment during the year under certain conditions. For example, if you are covered under Self Only and get married, you can switch to Self Plus One. Or if you are covered by Self Plus One and a baby is born or adopted, you can switch to Self and Family.
Premiums
The government pays up to 75 percent of the cost of your health benefits premium cost. You pay the rest. Because there are variations in levels of coverage and cost among the plans, during each Open Season you can switch plans (or options within a plan) to match your anticipated health care needs.
Benefits
Every year each health benefit carrier contracts with the Office of Personnel Management (OPM) to provide a range of health benefits to everyone enrolled in their plan. Both the contents of the plan and the premiums to be charged are settled through negotiations between OPM and each carrier.
Once the terms are agreed on, the parties prepare a brochure describing in detail what benefits will be available to the plan’s enrollees, including any limitations and exclusions. OPM has the exclusive authority to resolve any disputes over that coverage between an enrollee and the plan.
Next week, I’ll explain the eligibility requirements to carry your FEHB coverage into retirement. I’ll also explain how Medicare Parts A, B, C and D fit into your health benefits package.
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