Reg Jones Expert's View

fehb value for federal employees critical

Reg Jones

One of the most important benefits for federal employees, retirees, family members and survivors became law on September 28, 1959. It was the Federal Employees Health Benefits (FEHB) program, the largest employee-sponsored health insurance program in the world.

At present there are about 280 health plan offerings in the program, the majority of which are health maintenance organizations (HMOs).

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In this article and the ones that follow, I’ll review both how the program works and how it interacts with Medicare to provide comprehensive health benefits coverage.

Enrollment
If you are a federal employee, you may enroll and cover any eligible family member in a health plan within 60 days of the date on which you are first hired. If for any reason you don’t enroll when you are first hired, you can do so during any annual health benefits Open Season. Open Seasons run from the Monday of the second full workweek in November through the Monday of the second full workweek in December.

Regardless of when you enroll, coverage is provided without a medical examination and there is no waiting period before that coverage begins.

You have three enrollment options: Self Only, Self Plus One, and Self and Family.

If you elect Self Plus One, that option will cover you and one eligible family member. If you elect Self and Family it will cover you, your spouse, and any children under age 26.

Note: You may also change your enrollment during the year under certain conditions, for example if you are covered under Self Only and you get married, Self Plus One and your spouse dies or Self and Family and your covered child reaches age 26.

Premiums
Based on a formula set in law, the government pays up to 75 percent of the cost of your health benefits premium cost. You pay the rest, typically about 30 percent.

Note: As a result of labor/management negotiations, Postal Service employees pay less for their coverage than do other federal employees. That advantage ends when they retire.

Because there are variations in levels of coverage and cost among the plans, during each Open Season you have the opportunity to switch plans (or options within a plan) to match your anticipated health care needs.

Contractual Benefits
Every year each health benefit carrier contracts with the Office of Personnel Management (OPM) to provide a range of health benefits to everyone enrolled in their plan. Both the contents of the plan and the premiums to be charged are settled through negotiations that occur ahead of an annual coverage and rates announcement in early fall ahead of the open season.

Once the terms are agreed on, the parties prepare a brochure describing in detail what benefits will be available to the plan’s enrollees, including any limitations and exclusions. OPM has the exclusive authority to resolve any disputes over that coverage between an enrollee and the plan.

Next week, I’ll explain the eligibility requirements to carry your FEHB coverage into retirement, and how Medicare Parts A, B, C and D fit into health benefits package.

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2020 Federal Employees Handbook