As part of the implementation of the PSHB, OPM set up an enrollment portal with features including for verifying eligibility, but so far that's only been applied to new enrollments in FEHB or coverage changes. Image: Andrii Yalanskyi/Shutterstock.com
By: FEDweek StaffThe inspector general’s office at OPM has expressed continuing concerns about ineligible persons getting coverage under federal employee health insurance programs, including among enrollees who transferred from the FEHB program to the PSHB program on the latter’s launch at the start of this year.
The report was one of a series on that transition, with the IG saying that it considers recommendations of several earlier reports to be closed. Those related to the documentation for the “authorization to operate” the PSHB and planning for customer service in the initial PSHB open season last fall.
However, the report continued a series of cautions from the IG’s office and the GAO about ineligible persons getting coverage as family members, at a cost that is shared by enrollees and the government in the form of higher premiums.
It said that while OPM in recent years has increased attention to that issue, “The current FEHB process for enrolling members and collecting and maintaining documentation supporting the eligibility of members is decentralized. This decentralization creates an environment where roles and responsibilities amongst responsible parties are unclear and no one party has the final say.”
As part of the implementation of the PSHB, OPM set up an enrollment portal with features including for verifying eligibility, which is designed to be scalable to cover the FEHB as well, it said. However, that has been applied only to new enrollments and changes in coverage due to life events (such as marriage or childbirth) and “a majority of the PSHB dependent members may go unverified and unvalidated, allowing the potential for ineligible dependent members to remain within the PSHB for an unknown amount of time,” the report said.
The IG said it recognizes that collecting documentation to support eligibility for those who transferred “would require significant resources that, according to OPM, are not available.” However, it said OPM nonetheless should fully develop a plan to do so.
The report also noted that OPM received funding in the tax and spending policy law enacted in the summer to conduct a full audit of FEHB enrollment. However, that law did not contain the request for funding over 10 years to bring the FEHB into the portal developed for the PSHB. “We continue to recommend a long-term solution to address the underlying issues in FEHB enrollment and eligibility verification resulting from the current decentralized process,” it said.
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