As happens nearly every year, there will be some FEHB plan dropouts and restrictions on coverage areas for 2018–changes that will affect some 3,200 enrollees, up from fewer than fewer than 1,000 impacted by similar changes for the 2017 plan year and about the same as for the 2016 plan year.
“The plans’ reasons for leaving continue the pattern we’ve seen over recent years. In most cases, the plan is making a business decision based on enrollment, penetration in the market place, and overall margin/profitability,” OPM said in a fact sheet.
“All terminating plans are required to mail a notice to their members advising them of their decision to withdraw from the program. Also, because of the transitional care provision in the patients’ bill of rights, enrollees with chronic or disabling conditions, or in the second or third trimester of pregnancy, may be able to continue seeing their specialist even after the plan’s termination date,” it added.
Affected enrollees must make a new plan choice for 2018 during the open season that will run November 13-December 11; if they don’t, they will be enrolled by default in the GEHA standard option, per OPM regulations providing automatic enrollment in the lowest-cost nationwide plan in that circumstance.
The dropouts are: Blue Cross and Blue Shield of Illinois in the Chicago area; New Mexico Blue HMO Preferred in all of New Mexico; Paramount Health Care in Northwest Ohio; Aetna Whole Health in the Houston area, the Newport News, Va. area and the Milwaukee, area; United Healthcare Benefits of Texas, Inc. in the San Antonio area; and Innovation Health Plan in Northern Virginia. Also, Aetna Open Access will drop coverage in all of Washington state.
The new plans and new plan options are: Blue Open Access POS High option will be available in the Atlanta area; Health Net of California is adding a Basic option in Northern California; Humana Health Plan, Inc. is adding a Basic option in Denver, and Colorado Springs, Colo., Chicago and northwestern Illinois; Humana Employers Health Plan of Georgia, Inc. is adding a Basic option in the Atlanta and Columbus, Ga. Areas; Kaiser Foundation Health Plan of the Mid-Atlantic States is adding a Basic option in Northern Virginia, the District of Columbia and the Baltimore area; Medical Mutual of Ohio (formerly Health Span Integrated Care) is adding a Basic option in Northeast Ohio; Humana Health Plan of Texas, Inc. is adding a Basic option in San Antonio, Austin, Corpus Christi, and Houston, Texas; and Scott & White is adding a Basic option in Central and West Texas and North Texas.