CBO expects a bill before Congress would cause enrollment to decline by about 100,000 people, on average. Image: pics five/Shutterstock.com
Another report to Congress has estimated an annual $1 billion cost to the FEHB program from ineligible persons being covered as family members, a cost that is passed on to both enrollees and the government in the form of higher premiums.
The Congressional Budget Office estimate—agreeing with one last year from the GAO—was done in an analysis of S-4035, which is pending a vote in the full Senate after Congress reconvenes September 9. A counterpart bill, HR-7868, has cleared the House committee level, as well.
The bills would require agencies to verify the eligibility of dependents enrolled in the FEHB when the employee or annuitant starts or changes a dependent’s enrollment; require OPM to audit dependents’ enrollment in the program; and expand fraud risk assessments of the program to include information on ineligible enrollees.
The analysis notes that the FEHB currently is a $50 billion a year program, and that the “estimated average annual cost to include a dependent in the program is $6,500.”
“CBO expects that implementing the bill would cause enrollment to decline by about 100,000 people, on average, in each year over the 2025-2034 period. Verifications of eligibility during open season would cause a decline of about 10,000 people, on average, in each year over the same period,” it says.
However, that estimate “is subject to significant uncertainty because no similar verification audit of the FEHB program has been undertaken,” it added.
OPM has issued several sets of guidance in recent years aimed at reducing the number of ineligible persons being covered, following several inspector general reports and the GAO’s report. OPM has said that the enrollment and enrollee tracking system being set up for the Postal Service Health Benefits program that is to begin in January as a largely parallel program to the FEHB for postal employees and annuitants will have stronger capabilities to detect ineligible enrollees.
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