Fedweek

OPM said that as of the 2022 plan year, carriers are to comply with protections against “surprise billing” of enrollees—which most commonly occurs when a patient is unaware that a provider is not in a plan’s network.

OPM has encouraged FEHB carriers to enhance their benefit offerings in several areas for the 2022 plan year and to comply with recently imposed requirements to improve transparency.

In its annual “call letter” for the upcoming plan year OPM also continued several long-running initiatives, such as cost controls on prescription drugs and limits on prescriptions for opioids.

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The call letter starts 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 as of the 2022 plan year, carriers are to comply with protections against “surprise billing” of enrollees—which most commonly occurs when a patient is unaware that a provider is not in a plan’s network, which can be the case even if the facility is in-network—enacted into last year as part of the wrapup budget measure for fiscal 2021. That law set limits on out of pocket charges for emergency services provided out of network, and for non-emergency services provided by out-of-network providers at in-network facilities unless the provider complies with certain notice and consent requirements. OPM said it will issue further guidance on those requirements.

Carriers also will be subject in 2022 to new price and quality transparency requirements under rules issued by HHS around the same time, it said.

OPM meanwhile encouraged coverage for medically recommended foods (for example amino acid depleted protein powders) designed for management of certain diseases or conditions regardless of the person’s age; OPM earlier had recommended it for children and pregnant women. OPM said it does not expect plans to provide coverage for products that can be routinely purchased through grocers such as gluten-free foods.

It further encouraged carriers to provide coverage for standard fertility preservation procedures for men and women who may be affected by iatrogenic infertility, which is infertility caused by medical treatment such as chemotherapy, radiation therapy or surgery.

OPM also said it “encourages FEHB carriers to consider and propose new approaches to delivering services more equitably to diverse populations of race and ethnicity, gender identity, sexual orientation, disability, and socioeconomic status, among others.”

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2021 Federal Employees Handbook