Reg Jones Expert's View

Federal employees and retirees with only one family member eligible for FEHB coverage are still dissatisfied about the fact that the FEHB self plus one option didn’t come on line in time for the 2015 plan year. Those people—primarily married couples with no children under the age 26 cutoff; a single parent with one eligible child also would meet the definition—have long argued that they are unfairly being required to subsidize enrollees with families reaching Brady Bunch dimensions and beyond for the same price in family premiums.

According to OPM, self plus one could not be ramped up in time for 2015 but it will be offered during the next annual open season, which begins November 9. If you choose that option then, it will cover you for 2016. So, with nothing to be done about the past, let’s look ahead.

A main reason Congress in late 2013 endorsed adding the option was the assumption that premiums for self plus one will be lower than those for family coverage. Thus, as current family enrollees with only one eligible family member switch to self plus one, the employer contributions toward their premiums, which make up about 70 percent of the total cost, will go down too. Presto, a saving for the government budget!

Not to be a wet blanket or anything, but . . . years ago when I was in charge of the FEHB program, the data showed that offering a self plus one option wouldn’t decrease the premiums for those enrollees but would, in fact, result in an increase.

Now that the additional category is coming regardless, inquiring minds want to know what the difference in premiums will be for those who switch to it from family coverage. Will they really be lower, as the more recent assumptions projected, and if so, by how much? And if self plus one premiums are lower, will those for family enrollees go up by more than they would have otherwise? If so, by how much?

We’ll get the first indication in the fall when the 2016 premium rates are announced. The first round of rates will be only an estimate, though, based on general health insurance industry experience projected onto the FEHB. It likely will require several annual cycles until the actual claims and enrollment patterns are better established and the premiums settle in.

In the meantime, agencies and payroll offices are being told to ensure they can process the self plus one enrollments when they start in November. OPM has not only told them to have their enrollment policies, procedures, and instructions updated but that “all testing must be completed no later than September 1, 2015 to ensure a smooth implementation.” Likewise, FEHB carriers have been instructed to have self plus one ready to go by that same date.

Meanwhile, OPM is updating its regulations, the FEHB Handbook, the Guide to Federal Benefits, the health benefits election form SF 2809, and its website. And it has made clear that the second person will have to be someone eligible under regular FEHB family policies—meaning, for example, no domestic partners.

How will this all work out? Will this all work out? Keep your fingers crossed.