Issue Briefs

Following is a fact sheet that OPM sent to agencies on the key considerations for enrollees and potential enrollees in the FEHB, FEDVIP and FSA programs in the upcoming open season.

Open Season is the time of year when you have the opportunity to make decisions about your benefits under the Federal Flexible Spending Account Program (FSAFEDS), the Federal Employees Dental and Vision Insurance Program (FEDVIP), and the Federal Employees Health Benefits (FEHB) Program.

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If you already have an FSAFEDS account, it will not continue automatically: you must re-enroll for 2019.

If you take no action, your current enrollment in FEDVIP and/or FEHB will continue automatically for 2019. You will be subject to any changes in premiums, benefits, and service areas.

We strongly recommend you evaluate your current enrollment status in the Programs. We have listed three basic questions to ask yourself. All are equally important and should be considered carefully.

1. What are my and/or my family’s expected health care needs for 2019?

• Federal Flexible Spending Account Program (FSAFEDS)

What are my out-of-pocket expenses going to be (e.g., deductibles, copays, coinsurances, day care and elder care expenses, over-the-counter drugs and medicines [prescription required except for insulin] and other over-the-counter products)? Does my child need braces or use acne treatments? Will I send my children (under age 13) to a non-overnight summer camp next year?

• Federal Employees Dental and Vision Insurance Program (FEDVIP)

Do I only need routine dental care? Will I need a crown or a root canal? Does my child need braces?

Do I need glasses and/or contact lenses? Am I considering Lasik surgery?

• Federal Employees Health Benefits (FEHB) Program

Am I expecting a new baby? Do I need surgery? Will my medication needs change?

2. What benefits are available in 2019?

Now that you have an idea of what services you may need, the next step is to determine what benefits the plans provide in 2019. If you are already enrolled, please review the “How We Have Changed for 2019” section of your 2019 FEDVIP brochure and Section 2 “Changes for 2019” of your 2019 FEHB plan brochure for any benefit changes.

FSAFEDS

• Should I enroll in a health care account and/or a dependent care account? How much should I contribute to my FSAFEDS account(s)?

FEDVIP/FEHB

Are there plan limitations (i.e., number of visits or dollar maximums) which will result in out-of-pocket expenses?
Are any services I may need (such as chiropractic care or Lasik surgery) not covered?
What is my share of the cost of prescription drugs? (FEHB only)
What deductibles, copays, and coinsurances must I pay?
Do I have enough coverage for extensive dental work?
Do I have enough coverage for glasses, exams, contact lenses, or other vision services?
Is my FEHB plan terminating or reducing coverage in my service area for the next contract year? If so, do I need to choose another health plan?

3. How much will it cost?

Now that you have an idea of what services you may need and what types of benefits are provided by FSAFEDS, FEDVIP, and/or FEHB plans, the third consideration is cost.

Enrolling in FSAFEDS is free to you. You just have to decide how much to contribute from your salary, which you’ll get back when you incur eligible expenses. You can contribute a minimum of $100 to a maximum of $2,650 per participant for a health care account and/or $5,000 per household for a dependent care account. If you haven’t spent all the funds in your health care FSA by December 31st, you can carry over up to $500 into another health care FSA into the subsequent year. Look at the 2019 premiums for the FEDVIP and/or FEHB plan you are already enrolled in or considering enrolling in. You can find the premiums in the 2019 FEDVIP and FEHB brochures and on our website at www.opm.gov/insure.

4. What do I do now?

Now that you have considered these questions, you are on your way to making more informed decisions about your benefit choices for 2019. If you want to participate in FSAFEDS for 2019, you must make a new election. If you are satisfied with your FEDVIP plan and/or FEHB plan, you do not have to do anything. Your FEDVIP and/or FEHB enrollment(s) will continue for 2019. If you are not satisfied with your current enrollment status, please visit our website and your human resources office and look at the following resources to assist you in making decisions.

FSAFEDS brochures at www.FSAFEDS.com
FEDVIP brochures at www.opm.gov/healthcare-insurance/dental-vision/plan-information
FEHB brochures at www.opm.gov/FEHBbrochures
OPM’s plan comparison tool at www.opm.gov/fehbcompare
Another plan comparison tool – Checkbook at www.checkbook.org/newhig2/hig.cfm

Free Webinar: FEHB And FEGLI Open Season: How to Make the Right Choices