Q. I was excited to see FEHB offer Self Plus One coverage for the first time. Since I am now retired with 38 years of service and have paid Self and Family for almost 35 years, my wife and I thought we might save money. But when I saw the BCBS premiums for 2016 and the difference between my Self and Family and Self Plus One, I was hugely disappointed. Why is it only about $8 less per month?
A. Here’s the explanation provided by the Office of Personnel Management:
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.
Consider yourself lucky. The Self Plus One rates for a some plans are the same as Self and Family, and, in a few cases, they’re higher (in one case, much higher).
