OPM has asked agencies to call to the attention of their employees that some rates for self plus one coverage once again will be more expensive in the FEHB program in 2023 than those for family coverage.
That will be the case in three national plans—NALC Health Benefit Plan, Rural Carrier Benefit Plan and Foreign Service Benefit Plan—as well as some 80 regional plans out of the total of 271 that will participate in the 2023 plan year, OPM said in a message to agency benefits offices.
In self plus one, an enrollee covers only one additional person (who must be eligible under family coverage rules, which for the most part means spouses and children under age 26) while under family coverage there is no limit to the number of persons who may be coverage, again so long as they are eligible.
Self plus one was introduced into the program a decade ago on the theory that with just self-only or self and family options available at the time, by having to enroll in family coverage persons with only one eligible family member to cover—a married couple with no eligible children or a single parent with one eligible child—were subsidizing enrollees with more than one, and that premiums would be lower for self plus one.
That has largely proven to be the case but there has been an anomaly in some plans each year since self plus one has proven to attract a disproportionately high enrollment of older couples with no eligible children, who tend to consume more health care than the program-wide average. Under the FEHB program’s design, each of the three coverage options is to be self-funding within a plan, with no subsidy from one to another.
“Enrollees should carefully check the 2023 rates of their current plan and any other plan choices they are considering for 2023. For enrollees wishing to change, they must do so during Open Season, which is held from November 14 through December 12,” OPM said in its message.