The letter, which begins the process of negotiating coverage and premiums, was issued in the last days of the Biden administration and could be changed under Trump. Image: sasirin pamai/Shutterstock.com
By: FEDweek StaffIn its annual “call letter” to carriers in the FEHB and PSHB programs outlining requirements for the 2026 plan year, OPM has stressed easing administrative burdens on enrollees and continuing initiatives of recent years in areas including fertility, mental health and obesity treatment coverage.
Because the letter, which begins the process of negotiating coverage and premium rates for the upcoming year, was issued in the last days of the Biden administration, it is subject to change by the Trump administration.
Under the category of ease of use, OPM said it expects carriers to “make it easier to submit out-of-network claims online; provide clear information about the Carrier’s Plan in-network providers, including at the office location level, if there are multiple practice offices within a service area; and make the information on how to appeal claim denials more accessible on the Carrier’s Plan website.”
Improving online claims filing should include, for example, an online portal that allows enrollees to complete and submit fillable claim forms directly and submit supporting documentation for the claim; and that will “timely acknowledge receipt of filed claims and clearly articulate the timeframe for review and processing.”
Carriers also are to “offer members an easy-to-use provider lookup tool accessed by a link displayed on the Carriers’ Plan home web page” and “provide easy-to-access information on their website fully explaining” the process for disputing denials of claims.
OPM also said carriers are expected to keep current with industry standards for coverage of: preventive care including immunizations; fertility benefits including in vitro fertilization; and obesity prevention and treatment. It further encouraged them to “continue to expand the number of providers in their networks above and beyond those obtained in 2025, including but not limited to, adding options to decrease member appointment wait times and expanding the use of out-of-network provider benefits.”
Federal Pay Raise in 2026 Unlikely; Trump Expected to Affirm Decision by End of Month
DoD Announces Civilian Volunteer Detail in Support of Immigration Enforcement
Urban Policing Order Calls for Hiring Federal LEOs, Deputized Guard Unit
Ruling on CFPB Job Cuts Could Affect Challenges to Other RIFs and Reorgs
Schnitzer: How to Challenge a Federal Reduction in Force (RIF) in 2025
See also
Attorney Schnitzer: How to Challenge a Federal Reduction in Force (RIF) in 2025
Alternative Federal Retirement Options; With Chart
Primer: Early out, buyout, reduction in force (RIF)
Retention Standing, ‘Bump and Retreat’ and More: Report Outlines RIF Process
