From Nov. 11 through Dec. 9, employees, retirees, and survivors who are enrolled in the Federal Employees Health Benefits (FEHB) program can once again take advantage of their annual opportunity to decide which health benefits plan or option they want to be covered by in the next calendar year. And employees who aren’t already enrolled will have a chance to sign up.
Continuing its Green Initiative, the Office of Personnel Management is encouraging employees to use the electronic health plan brochures, which will help lower administrative costs and conserve resources. Copies of every FEHB plan brochure will be available at www.opm.gov/FEHBbrochures. You can also view the display of quality healthcare scores.
In addition, FEHB plans have summary documents that provide detailed information about their benefits and coverage. Those Summary of Benefits (SBC) documents will be available at www.opm.gov/healthcare-insurance/healthcare/plan-information/summary-of-benefits.
The SBC document will allow you to easily compare different plans and options because it includes the following information:
- Cost, including deductibles, co-pays, coinsurance, and out-of-pocket limits.
- Coverage, including covered service, examples of covered services, and excluded services.
- Rights, including rights to continue coverage, as well as grievance and appeal rights.
- A statement that coverage under the plan qualifies as “minimum essential coverage.”
- A statement that the health coverage of the plan meets the minimum value standard for the benefits the plan provides.
According to OPM, “Plans will continue to provide information in their Open Season materials to their enrollees about where to find their SBC on their website as well as how to obtain a paper copy of the SBC, The plans may also have their SBC available at health fairs.” While this Summary of Benefits document is a handy guide, the actual plan brochure remains the official statement of benefits and exclusions.
OPM has also provided information about how agencies should handle enrollments when an FEHB plan or plan option is terminated and an enrollee fails to make an enrollment decision during the window provided. So, if your plan option or the plan itself is canceled and you don’t take timely action to choose another, your agency will automatically enroll you into one of the following:
- If your plan option is terminated, you’ll be enrolled in the lowest cost remaining plan option provided by the same carrier that isn’t a High Deductible Health Plan (HDHP).
- If your plan is terminated, you’ll be enrolled in the lowest cost nationwide plan available.
OPM will announce the lowest-cost nationwide plan in early October during the Open Season rollout when rates for 2017 are released to the public.
Remember, you can always get the answers to specific questions by talking to your agency’s benefits officer. If you don’t know who that is, go to https://apps.opm.gov/abo, where you’ll find a list of agencies and their headquarters benefits officers.
As you know, the FEHB program offers a broad array of health benefit plans and options from which you can choose. What you may not know is that there’s an added benefit to enrolling in it. If you have been enrolled continuously for 5 years before retiring, you can carry that coverage into retirement. The “enrolled continuously” requirement includes situations where you were enrolled, left government and, on your return, immediately re-enrolled.
You can also carry your FEHB coverage into retirement with fewer than 5 years if you meet one of the following criteria:
- You were enrolled in the program from your first opportunity to do so and retired before completing 5 years of coverage; or
- You were enrolled in the program before your agency’s latest offer to retire under the Voluntary Early Retirement Authority and you accepted that offer.
One last point for those of you who are already enrolled in the FEHB program. If you are happy with your current enrollment, you don’t have to do anything. Your current coverage will continue without interruption.
