FEHBP FAQs for open season
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re there any provisions under the Affordable Care Act, popularly known as “Obamacare,” that will affect my health insurance benefits for 2014?
No. Unless you are a member of Congress or a member’s employed staff, there will be no changes to your FEHBP plan or costs that are a result of the health care reform act’s provisions that kick in for 2014. Beginning January 1, members of Congress and their staffs may obtain health insurance only through plans that are created by the law or those offered through the state exchanges. The other major provisions of the law that are effective January 1, 2014, are the individual mandate and certain significant taxes and fees imposed on employers. These will not negatively affect FEHBP plans or enrollee costs.
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ill my current health plan continue to participate in the FEHBP?
Don’t assume that FEHBP plans remain participants or have the same coverage every year. The FEHBP frequently adds new plans and drops others, particularly health maintenance organization (HMO) plans. In addition, medical expenses covered by a plan this year may not be covered next year and vice versa. HMO plans might change the area of coverage, dropping some ZIP codes and adding others. You also will need to know if your HMO plan has split into two separate plans, with separate premiums and areas of coverage. This could result in the enrollee being automatically enrolled in the new plan, unless you make an Open
Season election to stay with your original plan. The best way to stay on top of upcoming changes is to read the information available to you from your health plan and from OPM. Keep your mailing address current with both the plan and OPM so the information you request arrives in a timely manner. Remember, health plans in the FEHBP are no longer required to automatically mail you their plan brochure for the new year. You can view plan brochures online at www.opm.gov/ healthcare-insurance/healthcare/ plan-information, or call your plan using the information on the back of your health plan ID card.
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hat should I do if I don’t understand something in a plan’s
brochure?
Don’t ignore plan features that are unclear to you. Contact the FEHBP carriers directly to clarify plan features and eliminate future misunderstandings. This is very important whenever a plan offers a new option or a new benefit. The telephone numbers can be found at the OPM website listed in the previous answer.
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m I correct in believing that OPM’s online comparison chart gives me all of the information I need to select a health plan that best meets my needs and the needs of my family?
The comparison chart available online at OPM’s website provides a good summary of the plans available to you and the services the plans pay for. Even so, OPM cautions you not to rely exclusively
on the comparison chart or hearsay about health plans. Do an independent review of your family’s and your health care needs – and how well individual plans meet those needs. Be sure to review your plan brochure and the brochure of any other plan that you are interested in for upcoming changes. Compare the benefits offered with your health care needs and those of your covered family members.
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re there other aspects of health plans’ day-to-day business that I need to consider when choosing a plan under the FEHBP?
Don’t forget to check the plans’ records of service and reimbursement, and the availability of preferred provider organizations (PPOs) in your area for contract year 2014. Remember, a plan’s PPOs can also change from one year to the next; and, if you use a nonpreferred provider, it will cost you more in co-pays and/or coinsurance. Also be sure to read and understand the plans’ coordination of benefits policy if you have other insurance coverage such as Medicare or TRICARE.
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s it true that the safest way to select a health plan is to go by the least expensive premium available to you?
Don’t figure the cost of a health plan on premium rates alone. Keep in mind that premiums are only one aspect of your health care costs; benefits are equally important. Review deductible, coinsurance and co-payment features. Some plans have separate deductibles for “major medical” and specializedcare expenses. Some plans may
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