Publisher's Perspective

Federal employees and retirees with small families, or just a spouse and no young children, for years have had a major complaint about the Federal Employees Health Benefits program: no self-plus-one option.


In FEHB, for decades there have been two coverage options. Self-only, which of course is mainly for unmarried people, and self plus family. While having family coverage is extremely valuable—ask anyone who’s had a toddler with an ear infection—there is a built-in unfairness, in the view of some.

That is, family coverage premium rates are the same regardless of how many family members are on the policy. The premium you pay is the same if it’s just you and your spouse, or if your household outdoes the Brady Bunch.

For people in the latter category, that flat rate is a really good deal. For those in the former category, not so much. And retirees, even if they had covered children at one time, tend not to have them anymore–because eligibility for children cuts off once they hit age 26. But the same consideration applies to a married couple without children.

Recently, the White House in its budget proposal advocated a range of changes in the FEHB program, including allowing a self-plus-one option in FEHB.

Here’s how a document from OPM justifies the proposal: "The proposal will align the FEHB Program with the commercial market and serve to spread costs across different enrollment types. The offering of a self-plus-one enrollment option by itself will not change the overall cost of the program, but will shift costs among program participants.

"Current enrollees with self and family coverage who only have one dependent will benefit from lower premiums. Those with more than one dependent will incur higher premiums. A large percentage of annuitants who currently have self and family coverage would likely benefit from a self-plus-one premium tier, resulting in savings to the government because the government share of annuitant premiums will decrease."

OPM didn’t say it, but there is precedent. The Federal Dental Vision and Insurance Program, created during the Bush administration, does include self-plus-one coverage in addition to self-only and self and family coverage. Premiums for that option fall about in the middle of the other two, producing a saving that in the case of FEDVIP goes entirely to the enrollee because the government doesn’t contribute toward FEDVIP premiums.

Under that program, the "one" has to be someone who would qualify for coverage as a family member under the family option. Thus, an enrollee can cover a spouse, or if unmarried, an eligible child—but not the next-door neighbor. Presumably it would work the same way in FEHB.

This is just a proposal and there are many hoops for it to go through becoming law, including how Congress will deal with another part of the same package, to make domestic partners eligible under FEHB. And the earliest it could happen would be for the 2015 plan year. But if your future looks like it will feature a household with just two persons over the age of 25, you will want to be paying attention.