An embryologist adds sperm to an egg in a reproductive lab. OPM has told carriers they will have to provide assisted reproductive technology services coverage. Image: Okrasiuk/Shutterstock.com
OPM has told FEHB carriers to focus on fertility benefits and coordination with Medicare for the 2024 plan year, while also either ordering or encouraging them to expand benefits for certain other conditions. OPM meanwhile continued a long-running emphasis on managing prescription drug costs – especially for high-cost specialty drugs – as well as more recent initiatives on gender affirming care and services, maternal health, prevention and treatment of obesity, and mental health and substance use disorders.
The annual “call letter” begins the negotiation process between OPM and health insurance companies that ends with announcements of new plan rates and terms in the fall, with a late-year open season for eligible persons to elect coverage for the following year.
OPM said that growing numbers of states and large private sector employers have been increasing coverage for assisted reproductive technology (ART) services such as drug therapy, intrauterine insemination, in vitro fertilization and egg freezing. “OPM strongly supports the provision of benefits that will help enrollees build their families and recognizes the valuable role ART and other fertility benefits play in recruitment and retention,” it said.
It said carriers will be required to provide coverage for artificial insemination procedures, costs of drugs related to them, and the costs of in-vitro fertilization drugs for three cycles annually. They also are to more clearly explain terms of such coverage in their brochures and other communications and were encouraged to offer benefits beyond those required.
OPM also encouraged the expansion of financial incentives for FEHB enrollees eligible for Medicare to enroll voluntarily in that program, which takes over as the primary payer–with FEHB acting as a supplement—for those who have both. It added that those enrollees “must not receive reduced FEHB benefits based on the added coverage. Your members for whom Medicare is primary must receive coverage equal to or greater than the coverage they would have received without Medicare.”
Carriers meanwhile were told they may not adopt “copay maximizer or optimizer programs” which are designed to capture certain manufacturer discounts in prescription drug formularies. Such programs can work against the interests of enrollees by leaving them with unanticipated drug costs, OPM said.
Other points of emphasis in the call letter include that carriers should update their coverage to reflect current standards of care for gender-affirming care, maternal health, substance use disorders; and anti-obesity drugs.
OPM also said carriers are to integrate mental health and primary care; expand mental health provider networks; cover mental health services provided by out-of-network providers at in-network rates when needed to provide timely access to specialized care; and focus on providing comprehensive mental health and substance use disorder benefits to meet mental health needs of younger persons.
Shutdown Meter Ticking Up a Bit
Judge Backs Suit against Firings of Probationers, but Won’t Order Reinstatements
Focus Turns to Senate on Effort to Block Trump Order against Unions
TSP Adds Detail to Upcoming Roth Conversion Feature
White House to Issue Rules on RIF, Disciplinary Policy Changes
Hill Dems Question OPM on PSHB Program After IG Slams Readiness
See also,
How Do Age and Years of Service Impact My Federal Retirement
The Best Ages for Federal Employees to Retire