Reg Jones Expert's View

I wrote about the new self plus one option in the Federal Employees Health Benefits program in my October 7 and 14 articles, noting that it will be of special interest to enrollees who currently have family coverage but who have only one eligible family member.

In many cases that means couples whose children have passed the age 26 cutoff—especially common among retirees—but it also includes couples of any age with no children or a single parent with one eligible child. This is an important new choice in the open season that started November 9.

There’s so much interest in this topic that it is worth revisiting, this time to look more closely at how premiums compare in that option versus family coverage.

Here are the self and family and self plus one biweekly premium rates, for active employees, for a sampling of the nationwide fee-for service plans. To find the monthly premium rates for retirees, multiply the biweekly dollar amount by 26 and divide the product by 12.

Self and Family     Self Plus One

APWU High $215.60            $155.07

APWU CDHP $124.65          $114.27

BC/BS Standard $238.24    $231.31

BC/BS Basic $164.20           $160.75

Foreign Service 156.29         $157.96

GEHA High $256.93            $229.16

GEHA Standard $122.48    $111.25

GEHA High Deduc. $127.71 $116.10

MHBP Standard $162.64      $176.77

MHBP Value Plan $142.95   $140.15

NALC High $158.68              $162.28

NALC Value $ 93.60                $93.59

Rural Carrier $144.43             $141.59

Samba High $344.69              $302.74

Samba Standard $145.91       $139.57

Note: Category 1 and Category 2 Postal employee premiums are lower, as a result of union negotiations. However, the differences between self and family and self plus one are proportionately the same.


It won’t take you long to see that the differences between self and family and self plus one rates vary widely. In general, the self plus one rate is less than the self and family, although not much lower in a few cases. In fact, there’s one – NALC Value – where the difference is only a penny. And in a few others, the self plus one option is higher than the self and family. In one case – MHBP Standard – much higher.


In my October 7 column, I included the gist of an OPM explanation for how that could be. Again, because there’s so much interest, here it is again, in full this time and exactly how OPM wrote it:


Q. Why are the enrollee shares for some self plus one enrollments higher than self and family enrollee shares for the same plan?

A. For most enrollees, the enrollee share for Self Plus One will be lower than the enrollee share for Self and Family. However, it is possible that some plans will have higher enrollee shares for Self Plus One enrollments than for Self and Family enrollments. The statutory formula that is used to calculate the Government Contribution is based on the average of all plan premiums and requires that OPM calculate a maximum contribution for each enrollment type. In other words, there is a limit to how much the government will contribute towards the cost of a Self Only, Self Plus One, or Self and Family enrollment. The government contributes the lesser of the maximum contribution or 75% of the total premium. The remaining amount is the enrollee share (how much the enrollee must pay). In some cases, such as plans with a premium cost that is above the program average, this calculation may result in a higher enrollee share for a Self Plus One enrollment than a Self and Family enrollment.


In my earlier column, I asked if that was as clear as mud. I heard back from a number of you that mud is far more transparent.


Like it or not, that’s how they calculate these numbers and this is how the numbers came out for the 2016 plan year.


If you have only one eligible family member and you want to stay with your current plan, it will be easy to decide between the self and family and self plus one option—go with what’s cheaper.


(Remember, if you switch to self plus one and you later gain an eligible family member—a single parent marries, for example, or a childless couple has or adopts a child—you could go back up to family coverage outside an open season because that is a “qualifying life event” that allows an enrollment change.)


If you are thinking about changing plans to get a better premium rates, you need to consider other factors that will influence your total costs. For example, which benefits that are covered and at what level, restrictions on doctors and hospitals you can use, deductibles and coinsurances you must pay, etc.


Be sure to read the fine print. The dollars saved in premiums might be outweighed by out-of-pocket costs above those of your former plan.