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[IWS] CRS: FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP): AVAILABLE HEALTH INSURANCE OPTIONS [13 February 2013]

IWS Documented News Service

_______________________________

Institute for Workplace Studies----------------- Professor Samuel B. Bacharach

School of Industrial & Labor Relations-------- Director, Institute for Workplace Studies

Cornell University

16 East 34th Street, 4th floor---------------------- Stuart Basefsky

New York, NY 10016 -------------------------------Director, IWS News Bureau

________________________________________________________________________

 

Congressional Research Service (CRS)

 

Federal Employees Health Benefits Program (FEHBP): Available Health Insurance Options

Annie L. Mach, Analyst in Health Care Financing

February 13, 2013

http://www.fas.org/sgp/crs/misc/RS21974.pdf

[full-text, 27 pages]

 

Summary

FEHBP is generally available to employees, annuitants, and their dependents. Eligible individuals

may elect coverage in an approved health benefits plan for either individual or family coverage.

For the 2013 plan year, there are about 230 different plan choices, including all regionally

available options. As a practical matter, an individual’s choice of plans is often limited to 10 to 15

different plans, depending on where the individual resides. While enrollees have a range of

choices, they typically decide which options best match their needs, the amount of their wages

they will contribute to health insurance, and how risk-averse they are to potential out-of-pocket

costs.

 

While most federal employees or annuitants reaching age 65 are automatically entitled to

Medicare Part A, Medicare-eligible employees may also voluntarily choose to enroll in Medicare

Part B and Part D. For individuals covered under a FEHBP plan as an annuitant, Medicare is the

primary payer and FEHBP is the secondary payer. As a secondary payer, FEHBP could cover a

share of Medicare deductibles and coinsurance for any services that are covered by both plans,

and FEHBP would continue to reimburse for its covered services that are not covered by

Medicare.

 

FEHBP is administered by the Office of Personnel Management (OPM), which is statutorily

given the authority to contract with qualified carriers offering plans and to prescribe regulations

necessary to carry out the statute, among other duties. Some of OPM’s additional duties include

coordinating the administration of FEHBP with employing offices, managing contingency reserve

funds for the plans, and applying sanctions to health care providers according to the prescribed

regulations.

 

 

Contents

FEHBP Basics .................................................................................................................................. 1

Eligibility ................................................................................................................................... 1

Election of Coverage and Plan Choices .................................................................................... 3

Plan Facts................................................................................................................................... 3

Premiums ............................................................................................................................. 3

Benefits ............................................................................................................................... 5

FEHBP Carriers ............................................................................................................................... 6

FEHBP Plans ................................................................................................................................... 7

High-Deductible Plans Combined with Tax-Advantaged Accounts .......................................... 8

Consumer-Driven Health Plans ........................................................................................... 9

High-Deductible Plans with an HSA or HRA ..................................................................... 9

Flexible Spending Accounts and Their Role in FEHBP .......................................................... 10

Medicare and FEHBP .................................................................................................................... 11

Affordable Care Act and FEHBP ................................................................................................... 12

ACA Provisions in Effect for Plan Year 2013 ......................................................................... 12

ACA Provisions Not Yet in Effect ........................................................................................... 15

Conclusion ..................................................................................................................................... 16

 

Figures

Figure 1. Top 10 Parent Organizations, by Covered Policy Holders, 2012 ..................................... 7

 

Appendixes

Appendix A. OPM’s Role in FEHBP ............................................................................................. 17

 

Contacts

Author Contact Information........................................................................................................... 24

Acknowledgments ......................................................................................................................... 24

 

 

________________________________________________________________________

This information is provided to subscribers, friends, faculty, students and alumni of the School of Industrial & Labor Relations (ILR). It is a service of the Institute for Workplace Studies (IWS) in New York City. Stuart Basefsky is responsible for the selection of the contents which is intended to keep researchers, companies, workers, and governments aware of the latest information related to ILR disciplines as it becomes available for the purposes of research, understanding and debate. The content does not reflect the opinions or positions of Cornell University, the School of Industrial & Labor Relations, or that of Mr. Basefsky and should not be construed as such. The service is unique in that it provides the original source documentation, via links, behind the news and research of the day. Use of the information provided is unrestricted. However, it is requested that users acknowledge that the information was found via the IWS Documented News Service.

 




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