OPM said it will ask them for detailed information on their coverage for mental health and substance use disorder services. Image: Vitalii Vodolazskyi/Shutterstock.com
By: FEDweek StaffTerms of FEHB coverage have received attention from both OPM and Capitol Hill ahead of the annual announcement of premium rates and coverage terms for next year.
In one recent letter to carriers, OPM said it will ask them for detailed information on their coverage for mental health and substance use disorder services, which OPM has emphasized in recent years. OPM said it will review their responses and “will follow up with a roadmap that takes us from the current state to one where all FEHB carriers are facilitating access to behavioral health networks based on a common set of standards.”
In another, OPM encouraged carriers to work with health care providers to collect more information on “non-medical challenges individuals encounter that may negatively impact their health” such as “living in an unhealthy or dangerous environment or eating unhealthy foods.” It also encouraged carriers to focus on making referrals to social services provided by governmental or non-profit entities that help individuals with life and non-medical challenges.”
In a letter to carriers sent earlier, OPM had said that it expects that carriers “will propose enhanced coverage of services related to the treatment of gender dysphoria” for 2024 and that they should not deny coverage if they “cover the same procedures or treatments for other diagnoses.”
However, House Republicans have added a provision to the general government spending bill for fiscal 2024 to prevent FEHB plans from providing any coverage for gender-affirming care.
Meanwhile, a group of nearly three dozen House Democrats asked OPM to broaden coverage for fertility treatments, saying the current standards in effect discriminate against single persons and same-sex couples.
The announcement of plan terms and premium rates typically is made in late September or early October, ahead of the annual open season in mid-November through early December.
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