Thursday, February 14, 2013
Tweet[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
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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
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