OPM has estimated the potential cost of claims filed by ineligible participants at $1 billion a year, including in the form of higher premiums. Image: izzuanroslan/Shutterstock.com
By: FEDweek StaffMany tasks remain ahead for OPM to put the new Postal Service Health Benefits Program in place in time for it to replace the FEHB for postal employees and new retirees starting in 2025, but there’s also an opportunity to address a long-running issue – ineligible persons being covered by FEHB.
“It will be a challenge to stand up the PSHBP and begin to process carrier applications to the PSHBP in such a short timeframe, while continuing to ensure that sufficient resources are devoted to the continued management of the broader FEHB,” says and annual “management challenges” report from the OPM inspector general.
It said OPM will need to: adapt software so that carriers submit their applications, benefits and rates to both programs; develop a new centralized enrollment and decision support system; work with health insurance carriers to develop benefits and rates; coordinate with the SSA and Medicare regarding a special enrollment period to be held next spring for current retirees not in Medicare but who wish to join; and conduct a separate open season next fall for the postal population.
It added, though, that “The development of the PSHBP also provides OPM the opportunity to update or improve existing systems used to manage the FEHB, such as establishing a centralized enrollment system and a comprehensive data warehouse to support management decision making.”
Having a centralized enrollment system would address an issue raised in several reports by the IG and by the GAO—that the current system of validating eligibility by either employing offices or the carriers has allowed for ineligible persons to be covered in the program. OPM has estimated the potential cost of claims they file at $1 billion a year, a cost that is passed on to both the government and individual enrollees in the form of higher premiums.
The report noted that OPM has issued guidance aimed at finding and removing ineligible persons, such as by stressing requirements that enrollees prove that a covered person is eligible. However, those efforts themselves “face substantial challenges due to the previous lack of, or minimal, oversight efforts on the issue.”
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