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Health Insurance Enrollment for Federal Employees

by Altaf Shaikh
Health Insurance Enrollment for Federal Employees

Federal employees have healthcare needs that must be met. The Federal Employees Health Benefits Program, or FEHB, was created to offer civilian government employees and their families more choices in their healthcare. There are a few things you will want to understand about health insurance enrollment in these health plans.

First, More About the Federal Employees Health Benefits Program

The FEHB Program offers federal employees, retired federal workers, and their family members a wide selection of health plans. For example, you can get apply during federal employee health insurance open enrollment through a provider like Blue Cross.

Some plans have lower deductibles, while others have lower premiums but higher deductibles and are meant to cover catastrophic illnesses and accidents. 

Nearly nine million people are covered under the FEHB program, making it the largest group health insurance program sponsored by an employer. The Office of Personnel Management (OPM) oversees the FEHB program.

Do I Qualify to Enroll in the FEHB Program?

If you’re an intermittent federal employee who has short-term employment or if any law or regulation excludes your particular job position from coverage, you can’t enroll in the program. But if you meet the following criteria, you qualify to enroll:

  • You’re a permanent government employee 
  • You’re a federal retiree or a surviving spouse 
  • If you’re a longer-term temporary employee who’s appointed more than a year of work
  • If you’re a temporary employee who has completed a year of current continuous employment and has an appointment consisting of 12 months or less (this excludes breaks in service lasting five days or less)

There are a few other groups that meet the eligibility requirements for enrollment in FEHB. OPM.gov has a complete list on its site.

As a federal worker, you’re not obligated to enroll in the FEHB Program. The program’s human resources department will contact you when you first become eligible to participate in the program. 

You’ll be asked whether or not you want to enroll. If you choose not to enroll and change your mind at a later date, you won’t be eligible to enroll again until the next open season or another enrollment event occurs.

What are the Benefits of the FEHB Program?

Enrollment in the FEHB Program offers many advantages beyond basic health insurance.

Enrollees can secure lower-priced premiums by participating with a group rather than an individual enrollment outside of the program. 

There are other benefits too. The government contributes part of the cost of the plan that you choose. You’re also able to add options and customize your plan when the open season, or enrollment time, occurs.  

Once you’re enrolled, your coverage is guaranteed, and there are no medical examinations, waiting periods, or chances that your coverage is restricted because of your age or health.

The biggest advantage in having health insurance is that you and your family are protected if a major unforeseen health event occurs. With a health plan, you can avoid substantial medical bills that could bankrupt you or prove to be a hardship.

There’s also the convenience of deducting your premiums from your paycheck. The majority of full-time federal employees pay only 25% of the total cost of the premium. The government picks up the rest of the tab. However, each year, these amounts are subject to change.

Coverage of your FEHB benefits can continue after you stop working into retirement. If you pass away, your family would still be able to continue coverage.

What Types of Health Insurance Plans are Available Through FEHB?

There are four primary types of health plans offered through the FEHB Program: Fee-for-Service Plans, HMO, PPO, and Point of Service plans. Let’s look at each one.

Fee-for-Service 

A Fee-for-service plan pays the provider for services rendered to you or reimburses you directly. It’s just old-fashioned insurance that’s been around for decades. When you or a family member are sick or need medical attention, you go to the provider or doctor of your choice to receive treatment. 

Then, you or the provider file a claim. You will typically have to pay a deductible, copayment, or coinsurance for each visit. The health plan pays the rest, up to the plan’s limitations. 

Fee-for-Service plans sometimes require a pre-certification or review to determine if some services are necessary. Most plans also have preferred providers, which will usually cost you less. Preferred providers will also file the claim for you.

PPO, or Preferred Provider Organizations

Many, if not most, of the health insurance organizations today fall under the spectrum of PPOs. PPOs are fee-for-service options whereby you see providers in the network who have agreed to reduce their charges as part of the plan’s coverage. If you see a provider outside of the network, it will cost you more. 

However, if you see a provider in the network, you’ll have less out-of-pocket expenses. Some PPO agreements don’t cover certain items, so you’ll need to examine your coverage when you need care. 

For instance, a provider may cover the cost of a hospital visit (room, board, and medications) and physician fees. Still, it may not cover independent practitioners in a hospital, such as a radiologist. 

Health Maintenance Organizations, or HMO

An HMO plan offers coverage through a network of providers in certain geographic areas. The HMO coordinates your health care through the various providers. Just as with a PPO, an HMO’s providers typically reduce their fees to be part of a network. But an HMO plan usually has more restrictions and won’t allow you to seek service outside of the network unless you need emergency care or have an approved referral. Otherwise, most HMO’s will require you to pay for the entire service on your own. 

An HMO will also usually allow you a set number of doctor visits, treatments, or tests. The HMO will usually select a primary care physician for you or have you choose one from the network. That physician will be in charge of your treatment. In many cases, the primary physician will have to refer you when you need care beyond that provider or if you need special tests performed. If you feel you need a specialist and the HMO physician disagrees, it could prevent the type of care you want. 

While premiums are usually lower for HMO plans and deductibles are minimal, if any, most people opt for more choices in their health care than an HMO provides. But there are a few HMO plans out there that allow you to see a specialist within the network without getting a referral from your primary care physician.

Point of Service

A point-of-service plan combines the features of an HMO and a PPO. It’s one of the least utilized and least costly health insurance plans. A point-of-service plan has managed-care coverage with different benefits for in-network providers and out-of-network providers. 

When you choose an in-network provider, your out-of-pocket expenses are less. When you go out of the network, you’ll pay higher out-of-pocket costs and will have more to pay on deductibles, copayments, and coinsurance.

When it comes right down to it, a point-of-service plan is more like an HMO than a PPO. Just as with an HMO, you would choose a primary care physician that’s part of the network. If you want a referral, you’ll have to go through your primary physician to see a specialist. At the same time, it is like a PPO because it will still pay for out-of-network coverage. However, you would be responsible for filing paperwork with the insurance company when you see a provider out of the network. Some point-of-service plans have limited providers within their network, so this is an important thing to consider when choosing a health care plan.

Enrolling in a Health Plan

The 2021 open season enrollment for FEHB began on November 9, 2020 and ends on December 14, 2020. If you’re eligible to enroll in the Federal Employee Health Benefits Program, you can do so during that time. You can enroll, change your health plan, or cancel your enrollment.

Outside Open Season

Only new, eligible employees may enroll outside the open season and must do so within 60 days of their eligibility. If you’re already enrolled and move outside of your current coverage area, you can enroll in another plan that covers your new location. At times, OPM will designate a special open season for certain plans. Some circumstances will also allow you to change your coverage or enroll in FEHB coverage outside the open season.

To view the 2021 health plans available for federal employees, visit the OPM site, and choose your state to discover the plans offered in your area.

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