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Guide to Open Season in Federal Government


TABLE OF CONTENTS INTRODUCTION

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Navigating Open Season: A Survey Analysis - - - - - - - -

- - - -4

Consulting a Benefits Expert: Interview With Walt Francis - - - - - - - 10

Demystifying FEHB: Health Plans - - - - - - - - - - - - - - - - - - - - 12 Looking at Liability, Life and Disability Insurance - - - - - - - - - - - - - 19

Shedding Light on FEDVIP: Dental & Vision Plans

- - - - - - - - 22

Explaining FSAFEDS: Flexible Spending Accounts - - - - - - - - 30 5 Steps for Making the Most of FSAFEDS - - - - - - - - - - - - - - - - - - 35

Open Season Cheat Sheet

- - - - - - - - - - - - - - - - - - - - - - - 37

Summary & Conclusion - - - - - - - - - - - - - - - - - - - - - - - - - - - 39 Resources

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 40

Acknowledgements

- - - - - - - - - - - - - - - - - - - - - - - - - - - 41

Appendix A: Glossary - - - - - - - - - - - - - - - - - - - - - - - - - - 42 Appendix B: Typical Dental and Vision Plans Under FEDVIP - - - - - - - - - - - 44 1.

Guide to Open Season in Federal Government


INTRODUCTION

If you receive health benefits as an employee of the federal government, you are one of the most fortunate people in the United States. Federal employee health benefits are among the best in any sector, and you want to be sure to take full advantage of them based on your priorities, preferences, and particular state of life. That’s why we created this “Guide to Open Season in Federal Government: A Step-By-Step Approach to Selecting Your Perfect Plan.” Specifically, this guide includes: ´ ´ Insights based on a survey of more than 250 federal employees ´ ´ Interviews with Open Season subject matter experts, authors and human resource professionals ´ ´ Recommendations based on your unique state of life

´ ´ Resources and tools to assist your decisionmaking ´ ´ Definitions of common acronyms and terms used during Open Season We understand that federal Open Season can be overwhelming due to the amount and complexity of information available to you, and we hope this guide assists in demystifying the process, pinpointing the best resources and helping you to narrow your options.

GET TO THE “CHEAT SHEET” VERSION There are dozens of gems within this guide and we’d encourage you to read through it carefully. However, if you’re the type of person who wants a quick summary of the content in this guide, we’d invite you to jump to page 37 where we’ve put together a “cheat sheet” for you.

A Step-By-Step Approach to Selecting Your Perfect Plan

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Guide to Open Season in Federal Government


Navigating Open Season: A Survey Analysis

In preparation for this guide, GovLoop conducted a survey of 257 federal employees in order to understand the challenges and resources that are part of their annual Open Season experience.

Figure 1: Years in Government

18%

S EASONED SU R V E Y R E SP O ND E NT S Seventy-six percent of respondents were federal employees involved in making benefits decisions, while another eight percent were federal human resource professionals or benefits consultants. “Other” respondents comprised sixteen percent of the survey participants, including state and local government employees and industry professionals that provided additional insights based on their unique experience making benefits decisions. We also wanted to understand the perspective of federal employees based on age and years of experience. Figures 1 and 2 reveal the demographic breakdown of survey participants. Respondents clearly trended toward more experience, with the highest percentage of respondents being in their 50s and boasting more than 20 years of

More than 20

32%

Less than 5

21%

5-10

29%

11-20

Figure 2: Ages

20’s

60’s

30’s

7%

14%

15%

40’s

50’s

25%

38%

A Step-By-Step Approach to Selecting Your Perfect Plan

4.


Figure 3: Life Status

federal employment. Of course, there was still a significant portion of respondents (29%) with less than five years of experience. This guide provides insight for both ends of the spectrum.

9%

LIFE STAT US Most federal employees fall in one of four categories when it comes to their state of life and how they make benefits decisions. Survey respondents represented a relatively even distribution across these four life situations (as shown in Figure 3).

Marri

17%

27%

22%

25%

Single

Marri

Neari

Other

Among the “Other” responses, there were a considerable number of retired or rehired annuitants as well as single parents. We address each of these unique circumstances later in the guide.

Married With Kids Single

O NLINE INFORM AT I O N I S M O ST VA L UA BL E

Married Without Kids

GovLoop also inquired about the value and accessibility of information to help open season participants with their decision-making process. Survey respondents indicated that the best resources are found online, as 27 percent of respondents said that that’s been the most helpful place for them to find good information. Just 18 percent have found their agency benefits professionals to be the most helpful resource and 12 percent of respondents either turn to their co-workers for advice or read through printed resources. Figure 4 reveals the relative value of each resource.

Nearing Retirement Other

Figure 4: Most Valuable Open Season Resources

Online resources

28%

Agency benefits professionals

17%

Print resources

13%

Co-worker advice

12%

Health care provider

9%

Vendor benefits professionals

8% 0

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Guide to Open Season in Federal Government

5

10

15

20

25

30


According to participants, the top online resources that they consulted were: ´ ´ Benefeds.com: Offers information and enrollment options for FEDVIP plans. ´ ´ Checkbook.org: Provides nonprofit ratings and evaluations of local service companies and health care providers. ´ ´ FedSmith.com: Features stories that impact the lives of federal employees, including regular advice on health benefits. ´ ´ FedsProtection.com: Offers information and enrollment options for professional liability insurance. ´ ´ FSAFeds.com: Provides resources and materials for setting up and managing a flexible spending account.

´ ´ PlanSmartChoice.com: Helps federal employees to compare medical, dental, and vision insurance plans. Fourteen percent of respondents said they use “Other” resources to make their health benefits decisions, including their own agency websites, health fairs, union resources, financial advisors and family members that have served in government. Vicki Lane, a federal employee who is nearing retirement, appreciated the fact that, “Even though my agency’s HR Office is 500 miles away, we have someone on location who puts on health benefit education meetings with all our major providers.” Kirby Coon, a survey respondent who has served in federal government for more than twenty years, said that he uses “multiple vendor websites pulled up side by side” as he performs his research. Many others referenced their agency’s designated web page as a key source of information.

´ ´ OPM.gov/healthcare-insurance: Serves as the official source of health care information for federal employees, presenting information on FEHB, FEDVIP, and Flexible Spending Accounts.

A Step-By-Step Approach to Selecting Your Perfect Plan

6.


While only twelve percent said they consult coworkers, Lisa Jones, a Health Insurance Specialist at the Centers for Medicare and Medicaid Services, cautions against too much co-worker advice and prefers to take a blended approach that includes both colleagues and web-based content: “You get into a lot of word of mouth in the federal government. One thing you hear a lot of during open enrollment, everyone is telling you what their experiences are or they are telling you why they are staying where they are. Another thing that helps me is checking online. What is the rating for this company? You would be surprised that just by Googling insurance plans, you get an idea of what people are saying. Even Yelp is helpful.” If you decide to check out a plan online, consult with your agency benefits professionals to ensure that you are getting accurate information for your particular agency.

I N FOR M ATI ON I S A M P L E , BU T S CAT T ERED While there are a number of resources available to the Open Season shopper, it’s not necessarily easy to bring it all together and see a clear picture of your options. As shown in Figure 5, 33 percent of participants said their primary challenge with the entire process is that information is scattered across the web, making it hard to compare plans. Another 24 percent said there’s just too much information, leading them to feel overwhelmed. Only 22 percent said that the information was both sufficient and well-organized and a cumulative 10 percent indicated that they either didn’t know where to find information (7 percent) or that it was too scarce (3 percent). Ultimately, there is no path in making a benefits decision that doesn’t require a bit of effort. That’s why we appreciated this additional advice from Jones: “Read everything during Open Season. Don’t read only the federal employee literature, but educate yourself on healthcare reform and future changes. Don’t decide based on others’ word or hearsay. An educated consumer is a wise consumer.”

Figure 5: Perspectives on Open Season Information Information is scattered across the web and hard to compare

33%

There’s too much information and I’m overwhelmed

24%

Information is sufficient and well-organized

22% 7%

I don’t know where to find good information I don’t have enough information

3% 0

7.

5

Guide to Open Season in Federal Government

10

15

20

25

30

35


FE ELING INFORM E D (O R N OT )

Several respondents shared additional commentary on the degree to which they feel knowledgeable of their benefits options during Open Season. One respondent admitted that, “There is a lot of information and I know employees feel overwhelmed. OPM organizes it very well, but employees do have to spend time. There will not be one click and find all the answers.”

The benefits process can be frustrating for many federal employees due to the number of options and the amount of work it takes to gather relevant information. Fortunately, our survey revealed that just 9 percent of respondents were “frightfully confused” in the process. That being said, more than half of respondents did say they felt “fuzzy” and think they know just enough to make a decision. Roughly thirty-one percent indicated that they were “fully informed and knowledgeable.” Figure 6 highlights the distribution of knowledge levels.

Others lamented the difficulty of making a one-time decision without knowing their life circumstances in the year ahead. “While the info is generally there,” said one respondent, “it’s hard to guess what my family’s needs will be in the coming year.”

Figure 6: How Employees Feel During Open Season

Fuzzy, but know just enough to choose

52% 31%

Full informed and knowledgeable

9%

Frightfully confused

0

10

20

30

40

50

60

A Step-By-Step Approach to Selecting Your Perfect Plan

8.


When it comes to the most effective decisionmaking process, the basics really boil down to the following respondants advice: “I research each option’s websites and compare the benefits, premiums, out-of-pocket expenses and deductibles. Only then can I make a rational decision.” One of the reasons that GovLoop survey respondents said it was so difficult to pick a benefits plan is that there are hundreds of configurations. Although having a number of choices is extraordinarily advantageous for federal employees, this reality creates additional challenges when it comes to narrowing down the best plan. The next section of the guide is designed to help you do just that whittle down your options based on a variety of parameters and preferences. As you browse this guide, please keep in mind these three tips of advice that we received from survey respondent Shari Hunt:

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Guide to Open Season in Federal Government

´ ´ Take yourself and your health seriously; don’t be overwhelmed and not make a decision. ´ ´ Determine what research method works for you printed materials, online, advice - and compare each option using the same method. ´ ´ Don’t be afraid to ask questions: to both professionals who currently share similar statistics and those who are where you want to be in a few years. The remainder of this guide provides a step-by-step reference that should serve as one of your top resources in making benefits decisions during Open Season. We’ll walk through FEHB, FEDVIP and FSAFEDS, sharing insights and advice based on both the survey as well as our own research and expert interviews.


C ON S U LT I N G A BE N E F I T S E XPERT An Interview with Author Walt Francis

With over 200 federal health plans, it is easy to get bogged down. As our survey showed, many open season participants feel informed, but remain a bit uncertain throughout the federal benefits process. That’s why we reached out to Walt Francis, one of the tried and true experts in federal health benefits. Francis is the Principal Author of “CHECKBOOK’s Guide to Health Plans for Federal Employees.” In an interview with GovLoop, he outlined his four insider secrets to getting the most out of your federal health benefits package.

1. BEFORE YOU PICK YOUR PLAN, GET TO KNOW YOUR OWN HEALTH NEEDS. Ac-

cording to Francis, your first step should be a self-assessment, sitting down and saying, ‘I am thinking about having kids’ or ‘I am going to have knee surgery’ or ‘I am near retirement.’ By isolating your health needs, you can fully leverage your benefits. For example, Francis noted, “There is a little known fact that many, but not all, federal employee health plans give you a special benefit for pregnancy. You pay nothing for maternity care, before, after and during delivery. So you really want to make sure you have a good pregnancy benefit.”

2. TALK TO YOUR DOCTOR. One of the simpler things you can do is to choose your doctor first and

then ask the doctor what plan or plans are accepted by their practice. That information narrows your choices considerably because you have just taken care of one of the biggest questions (e.g. ‘Is my doctor in my plan?’). Francis said, “At that point, it may get a lot simpler because now you can look at the premiums for two or three plans and the structure of the cost sharing, and it is very likely that one of the plans will leap out at you as better than the others.”

3. KNOW YOUR AGE BRACKET. Depending on your age, you will have different health care consid-

erations. For example, Francis noted, “There is a penalty if you don’t sign up for Medicare when you turn 65. It’s not a decision you can really postpone, but there is a loophole. You can choose to not take Medicare until or unless you need it, then sign up for a year or two or three and pay the penalty premium.”

4. DON’T LET THE UNFAMILIAR LANGUAGE INTIMIDATE YOU. In our survey, just 30 per-

cent of survey respondents reported that they really understand how insurance works, or know the nuances of all the terminology, such as HSAs vs. FSAs. “There has been a lot of research about how well consumers understand health insurance and the answer is ‘not well at all,’” said Francis. “So opening a health plan brochure is kind of like opening a book in Greek. It’s complicated and confusing and comparing more than one plan is next to impossible.” Due to the difficulty of deciphering what feels like a foreign language, it’s a very easy thing for people to procrastinate, forget it or say, ‘I am okay where I am.’ Don’t do that,” urged Francis. When it comes to Open Season, the prevailing notion is that most federal employees do nothing, that they stay with the same plan year after year, even if premiums go up and benefits change. As shown in Figure 7, our survey actually found that just under half (46 percent) of respondents have made a change in plans, citing cost, coverage and convenience as the primary factors. Our goal with this guide is give you confidence in making those changes. As Francis said, “Don’t be intimidated. It will save you money and heartache if you take the time to look into your benefits.”

Figure 7: Have You Ever Switched Plans?

46% 53% No Yes


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Guide to Open Season in Federal Government


Demystifying FEHB: Health Plans “Start early! Think about what is important to you in a plan and immediately remove as options those plans that are completely incompatible - this gives you fewer plans to have to drill down into for comparison. Think carefully about your tradeoffs - is a $10 copay difference really that important versus the ability to choose your own providers? If it is, that’s fine - but be sure you know what you’re giving up to get.” - Debra Thangarajah, Survey Respondent

With hundreds of health care plans under the Federal Employee Health Benefits (FEHB), the first thing to know is that plans vary based on your agency and geographic location. That’s why an important first step is cutting away extraneous options.

C LARIFYING YO U R P R I O R I T I E S There are several tools that are designed to help you narrow the choices based on your preferences and priorities. Before we share the tools themselves, we’d like to help you in the process of prioritization. Our survey indicated that most people make their health benefits decisions based on one of four primary factors - and that these factors can help you to determine what’s important based on your life situation: ´ ´ Coverage: Does your current or another preferred doctor accept this type of insurance? Are your unique needs and required care covered under this plan? If you have a spouse and/or children, how do the benefits extend to them?

´ ´ Cost: What’s the deductible? How about the co-pays? How much do you want to pay out-ofpocket and what amount of liability do you want to absorb when it comes to unexpected health events? ´ ´ Choice: How much freedom do you have to change health care providers if you want to make a switch? Do you travel frequently and need to have access to health professionals in a number of different places? ´ ´ Convenience: Does your health plan integrate well with your dental, vision and flexible spending account? Is it easier to continue similar coverage from a previous employer? Do your claims process quickly and accurately? Does it cover providers that are close to your home or office? It’s important to really zero in on one or two factors, as benefits expert Walt Francis explained: “If your question is narrow, it is very often quite easy to find a plan that really fills your needs. The part that is hardest is someone who really doesn’t know

A Step-By-Step Approach to Selecting Your Perfect Plan

12.


what they want, who really just wants to minimize their costs. It is a daunting and essentially impossible task for someone to compare plans on the deductible on the maximum amount out of pocket, the cost sharing for physicians etc. There are a hundred variables.” Francis also noted that, “premiums tend to be a pretty good guide for choosing a plan. Most of the plans have pretty good benefits so if you go for a plan with a lower premium you are on the right track,” said Francis. Before you pick on premium alone, however, consider the following thoughts from Health Insurance Specialist Lisa Jones: “A lot of people get stuck on what is the premium and what is the cost sharing, but that isn’t the right focus. It is an important piece of the puzzle, but it shouldn’t be the first piece. Honestly, everyone is concerned about his or her wallet and I can’t blame them. But it is important to keep in mind that the least expensive plan that might save you some money upfront, could cost you a lot more down the road in case you end up needing the service.“ Jones explained how she gets beyond premium to consider priority: “I start looking at what providers are available to me, how far can I go, how comprehensive is the benefit package? Is it bare bones? Limited? Or are there value added products? For example, several plans have discounts to Weight Watchers. That’s worth it to me. There are a lot of little extras that I might find some value in. After all that, I start looking at the cost sharing. Everyone has his or her own “little extras.” Determine what those are for you and whittle down your choices before worrying too much about your wallet. Below are a few examples: ´ ´ Alternative medicine, such as chiropractic care, acupuncture or massage ´ ´ Artificial insemination or other infertility treatments ´ ´ Assisted reproductive technology, such as in vitro fertilization ´ ´ Childhood immunizations

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Guide to Open Season in Federal Government

´´ ´´ ´´ ´´ ´´ ´´ ´´

Diabetic testing supplies Gym memberships Hearing aids Orthodontics Over-the-counter (OTC) medicine and supplies Tobacco cessation services and medications Transportation for medical care

For a full list of frequently questioned services and the degree to which they’re covered by health insurance, please visit http://www.opm.gov/retirementser vices/publications-forms/benefits-administrationletters/2013/13-401attachment3.pdf.

A good example of prioritizing beyond premiums came from one GovLoop survey respondent. “I wanted direct access to a wide variety of providers, with freedom to see doctors in any state and no gatekeeper,” she said, while also recognizing the trade-off. “I don’t love my deductible, but I recognized that I would have to pay a deductible to afford the level of independent choice I wanted.” Another survey participant indicated that he chose his plan because it would provide him “with access to lots of providers and offer sufficient coverage at a not-too-high cost.” He also noted that, “It is integrated with the FSA so I don’t have to send in Explanation of Benefits (EOBs) for reimbursement.” While cost was one factor, coverage and convenience ranked just as high for him. Before you even start to look at a plan, give some thought to these four factors and rank them in order of importance using something similar to Figure 8.

Figure 8: Prioritization Chart

Factor Coverage Cost Choice Convenience

Rank


DIST ING U ISHIN G A M O N G T Y P E S O F PL A N S The next step is to compare the types of plans. Figure 9 is a quick matrix that allows you to quickly understand the different types of plans and generally how each of them might affect you along a variety of parameters, from the amount you pay for care, the services covered and the amount of paperwork you need to fill out. Figure 9: Plan Comparsion Matrix Pay More for Care

Pay Less for Care

Fewer Preventive Services Covered

More Preventive Services Covered

Lack Some Services

File Claims Yourself

Less Paperwork for You

Limits on Doctors / Providers

Co-Pays and No Deductibles

FFS Plan, Don’t Use PPO

FFS Plan, Use PPO FFS Plan, PRO-Only HMO POS, Only Network Providers POS, Not Network Providers / Network HDHP, Use Network Providers

LEARNING THE LANGUAGE If words and acronyms like FFS, HMO, PPO, HDHP and CDHP are foreign to you, here’s a quick list to decipher Figure 9: ´ ´ CDHP: Consumer-Driven Health Plan – designed to give you more control over what you spend by paying through a health fund with money that you set aside. ´ ´ FFS: Fee for Service - pay your medical provider directly or they reimburse you for your medical costs after you file an insurance claim. ´ ´ HDHP: High Deductible Health Plan - with lower premiums and higher deductibles than a traditional health plan. Being covered by an HDHP is also a requirement for having a health savings account. ´ ´ HMO: Health Maintenance Organization – a health plan organized around a network of doctors and hospitals in a particular geographic or service area. ´ ´ POS: Point of Service - allows you to use medical providers outside of your HMO network. ´ ´ PPO: Preferred Provider Organization – access to a specific network of doctors and hospitals. Please also be sure to check out our more extensive glossary in Appendix A on page 42. A Step-By-Step Approach to Selecting Your Perfect Plan

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Figure 10: OPM Tool: Health Plans by State

Of course, in our interview with Walt Francis, he said that, “Technically all the national plans are fee-forservice plans...but they all now have preferred provider networks.” In fact, Francis noted that “every plan in the FEHBP has a preferred provider network. The question for you is not are you going to use one, but given that, what plan is the better deal?” Francis also provided the following clarification on how and when to choose a PPO versus an HMO: “It is usually to your benefit to use a doctor in the network because he/she has agreed to accept the plan’s reimbursement as payment in full. In fact, one of the plans is only a PPO and you can’t go out of network at all. HMOs operate very similarly as they have a network of physicians. It is typically, but not always, smaller than the national plan networks. So you always want to be using a preferred provider. Within the world of HMOs, there are really two groups: those that have a substantial preferred provider network and then there are a few group plans that actually hire their own physicians.” Francis explained that choosing an HMO that hires their own doctors has positives and negatives. On the plus side, these plans “don’t pick crumb bum doctors.” They “pick doctors that are better and deliver higher quality care and are less likely to perform unnecessary services - so there is some quality control built into the idea of a network.” The negative, of course, is that the plan might allow you to go out of network, but you’re mostly limited to that HMO’s providers. If you’re trying to balance quality and choice among health care providers, this distinction is important and you will want to inquire with the plans to learn more about their cadre of health care professionals.

DET ERMINING YO U R I D E A L P L A N Once you have a sense of priority in mind and types of plans that are out there, your next step is to use one of several resources and tools that are available to help you narrow your options. The official information is found at the U.S. Office of Personnel

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Guide to Open Season in Federal Government

Management. At their website (http://www.opm.gov/ healthcare-insurance/healthcare/plan-information/), you can click on your state and immediately gain a general sense of the plans that are available to you (as shown in, Figure 10). The website includes downloadable resources, summarizes any changes in 2014 and links to the plan’s website and brochures that you can visit or download to learn more. In fact, benefits expert Francis said that these brochures could be quite helpful, “you can actually search for the word maternity in the brochures and find all the places where it is discussed. The brochures are in a standard format so it’s pretty easy to compare them side by side and get a pretty good sense about how the benefits that matter most to you match up.” Another valuable tool from OPM is found at: http://www.opm.gov/healthcare-insurance/healthcare/ plan-information/compare-plans/

As you can see in Figure 11, this simple tool allows you to quickly find plans by locations, names or plan codes. Note that there are options to pick nationwide plans or to look for coverage if you are staFigure 11: OPM Tool: Plan Comparison


tioned overseas. The calculator walks you through three screens that determine what type of employee you are in government (i.e. Non U.S. Postal Service, Annuitant, Temporary Employee, etc.) and your frequency of pay. From there, your choices will become much more narrow. By checking the box next to a plan or two, you can quickly see rates and benefits information for each plan, which are compared sideby-side. With just this first step, you can narrow your choices considerably. Figure 12 (on the next page), should help you to think about the types of benefits that you’ll be comparing when looking at plans side by side. We also wanted to share some additional wisdom from Walt Francis for each of these three situations: ´ ´ For young, single people: “Believe it or not, a lot of younger federal employees don’t even bother to sign up for health benefits at all. That’s a mistake. You could potentially be penalized under the Affordable Care Act for doing that. But in any event, the choice there is to at the very least find yourself an inexpensive plan that will cover your annual physical. Find a convenient, low-cost plan. Again, I am assuming that at that age you probably don’t have a family doctor or a personal physician so you might want to give serious consideration to an HMO that, in effect, chooses the doctors for you.”

´ ´ Couples with kids. “It’s very important to find a plan that your family doctor or doctors are in. Then it becomes very important to look for plans in which your physicians are in the network. From there you want to look at which plans are the best buys. Take into account both premiums and out of pocket costs.” ´ ´ “For those nearing retirement it depends in large part on your age near retirement. If you are nearing age 65 then you need to give serious consideration to how you want to interact with Medicare in your health plan choices. The main issue there is, ‘do you or do you not take part in Medicare Part B?’ Assuming you take it, the second issue is asking, ‘which of the many plans that coordinate well with Medicare are most likely to be the best buys for you?’ This generally means lowest premium, but you have to take into account prescription drug coverage as well. There is a Medicare-centric set of issues for retirees.” Whatever your state of life, take the time to find a plan that meets your unique requirements.

MEDICARE PART B IN BRIEF Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition. If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions. Part B covers 2 types of services ´ ´ Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. ´ ´ Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts direct payment from Medicare. A Step-By-Step Approach to Selecting Your Perfect Plan

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Figure 12: Benefits Considerations Based on State of Life

Benefits

Married With Kids

Nearing Retirement

Deductibles

Don’t overbuy. If you’re relatively young and healthy, consider choosing a policy with a high deductible, the amount you must pay out of pocket before certain benefits kick in. A plan with a deductible of $1,000 or more is likely to cost you considerably less per month, and could save you money in the long run.

Run the numbers. Is your family plan a per person deductible? Or is there one deductible for the entire family? Look into the difference. The more people you have on a family plan, the more you are going to push for a family deductible. Think of it like a minivan. You can have many people inside the same deductible, rather than four mini-cars.

Think long-term. Over the years ahead, you will likely have more persistent, long-term health issues. As a result, you are going to want a lower deductible, since you will probably be at the doctor more.

Emergency Room Visit

Know urgent vs. emergent. National Hospital Ambulatory Medical Care Survey estimates that one-third to one-half of all ER visits are for non-urgent care. The key here is if you can go to an urgent care facility instead. Do it, and save thousands.

Cover your kids. How many people are in your family and how old are your kids? Depending on the degree to which your youngsters are getting active in sports, starting to drive or engaging in other behaviors and activities that make even the most steeled parent cringe, you’ll want to consider setting this limit higher.

Be honest about your age. Visits to emergency rooms by the elderly have increased more than 34% in the last decade.You might not technically be elderly yet, but as you start to feel your age, you’ll want to know that you’d be covered in the event of an unexpected (and often expensive) trip to the ER.

Primary Doctor Office Visits

Find your favorite doctor. If you have a primary care physician and specialists you like, be sure they’re in the network of any plan you consider buying. Policies generally cover a lower share of the cost of out-of-network care—or none at all.

Consider convenience. You will probably be going to the pediatrician or family doctor fairly often, so you will want a trusted office nearby. The more kids you have, the more office visits you will make. If you've had a new baby you may want one kind of plan that covers those costs.

Will you be a regular? If your children have left home, you may not need as much coverage. Then again, as you age, those chronic, nagging issues start to set in, which may require you to visit a doctor more often.

When FSA = “Family Seeks Affordability.” The majority of Americans take one or more prescription medications on a regular basis. Multiply that by a family and you are looking at lots of money being spent at the pharmacy. Make sure you factor your co-pays into your FSA.

Don’t let ‘em pile on. On average, individuals 65 to 69 years old take nearly 14 prescriptions per year. That can be hundreds of dollars each month. If you think the prescriptions will start piling up, be sure to consider an option that helps to make the more affordable.

Kids = cavities. Make sure you have a plan that has a high annual allowance. Most dental plans cap out at $1,000. If your little ones are prone to cavities, this might not be enough.

Protect your pearly whites. Depending on your state of health, as you approach retirement you may want to consider getting a dental plan with a high annual allowance if you will be going to the dentist frequently for procedures such as dentures, crowns and bridges.

Rx Deductible

Dental Benefits

Orthodontic

17.

State of Life Young and Single

Co-pays are your friend. You’ll want to make certain that the plan’s formulary, or list of covered medications, includes those you take regularly, especially if they are expensive.

Keep it simple. Many of the health plans offer dental and vision benefits. If you have healthy teeth, you might consider getting one of those plans and then adding money to your FSA to cover the additional costs.

Show off your smile. You’ve probably already had braces, so you might consider skipping this benefit.

Guide to Open Season in Federal Government

Brace yourself. Make sure you look at your plan’s lifetime allowance for orthodontic services. There is usually a cap of $1,000-$2,000 per person. If you have a lot of children who need braces, you may need to supplement the costs with money from your FSA.

Assess your allowance. If you’ve been on a dental plan for a significant period of time, double check to see how much money is left in your plan’s lifetime allowance and if you have enough to cover your needs. Consider covering the costs through a combination of your dental insurance and money from your FSA.


C H ANGING PLA N S O U TSI D E O F O P E N S E ASO N: QUALIFYI N G L I F E E VE N TS (Q L ES ) One GovLoop survey respondent suggested that benefits applicants should, “Absorb as much information as possible to make a well informed decision since it will be a whole year before you can change.” While that is generally true, you may make changes to your benefits if you experience a Qualifying Life Event (QLE) in the course of that year. Below is a short list of what constitutes a QLE: A change in family status: ´´ ´´ ´´ ´´ ´´ ´´

Marriage Birth or adoption of a child Acquisition of a foster child Legal separation Divorce Death of a spouse or dependent

A change in employment status: ´ ´ Re-employed after a break in service of more than 3 days ´ ´ Return to pay status after your coverage terminated during leave without pay status or because you were on leave without pay status for more than 365 days ´ ´ Pay increases enough for premiums to be withheld

´ ´ Restored to a civilian position after serving in the uniformed services ´ ´ Change from a temporary appointment to one that entitles you to a government contribution ´ ´ Change to or from part-time career employment You or a family member lose FEHB or other coverage: ´ ´ Under another FEHB enrollment because the covering enrollment was terminated, canceled, or changed to Self Only ´ ´ When enrolled in a prepaid health maintenance organization (HMO) and you or a covered family member move or change worksite outside of the HMO’s enrollment area ´ ´ Under another federally-sponsored health benefits program ´ ´ Under Medicaid or similar state-sponsored program for the needy ´ ´ Under CHAMPVA, TRICARE, or TRICARE-forLife ´ ´ When you have previously suspended your FEHB coverage to participate in one of these programs ´ ´ When your membership in the employee organization sponsoring the FEHB plan terminates ´ ´ Under a non-Federal health plan Typically, you have 60 days from the event to make any changes to your status, so don’t wait.


LOO KI N G AT L I A BI L I T Y , L I F E, AN D DISABILIT Y IN SURAN CE

An Interview with Anthony F. Vergnetti, Esq., President, Federal Employee Defense Services (FEDS) Open Season is an opportune time to take a look at all of your benefits, not just those directly related to health. Three such options are Professional Liability, Life Insurance, and Disability. Though Open Season does not specifically cover these areas, it’s worth using this time of year when you are already evaluating your financial situation to consider these other kinds of coverage. To provide you with some tools and recommendations, GovLoop spoke with Anthony Vergnetti, President of Federal Employee Defense Services (FEDS). PROFESSIONAL LIABILITY INSURANCE “Unfortunately, most federal employees don’t see the need for professional liability insurance, but legal complaints are on the rise and you may not receive legal support from your agency should one arise,” said Vergnetti. Professional liability insurance mitigates the risk associated with federal employment – risks that are not fully eliminated by legislation. While many federal employees share the same professional exposures, the potential liabilities that exist and the reasons for which federal employees purchase professional liability coverage can be different depending upon the type of job you have, the position you hold and your employing agency. Agencies will reimburse up to half the cost of this insurance for federal employees classified as managers, supervisors and law enforcements officers. A $1,000,000 policy is $290 annually, or $145 annually for those eligible for reimbursement – and payroll deduction is available. Vergnetti encouraged federal employees to keep the following factors in mind when it comes to liability insurance: 1. All federal employees and contractors are eligible for liability insurance. 2. You can apply at any time, not just during open season. 3. Do your research on both the companies and their respective options. 4. Talk to an insurance representative to learn the specific level of liability coverage that you need based on your job position and responsibilities. “There are some jobs where you’re more vulnerable and you need to be sure you aren’t left to fend for yourself,” explained Vergnetti. DISABILITY AND LIFE INSURANCE With regards to disability coverage, Vergnetti said that “most federal employees don’t really have adequate disability insurance” and aren’t prepared for longer periods of illness or inability to perform one’s job. Disability insurance can supplement your current coverage, which can really make a difference in the long run. Lastly, Vergnetti suggested that federal employees “evaluate their life insurance coverage, whether it’s FEGLI Option “B” or private coverage to ensure the limits are adequate. Moreover, most federal employees can save a great deal of money replacing the FEGLI Option “B” plan they signed up for when becoming a federal employee.” Free benefit comparisons are available at www.allfeds.com. Ultimately Vergnetti recommended that federal employees and contractors “do a financial analysis and ask yourself, ‘What’s my vulnerability? What’s the likelihood of a particular event happening while on the job and do I have the means to provide for myself and my family?” The answers to these questions will guide you in your decisions regarding liability, life, and disability coverage

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Guide to Open Season in Federal Government


Federal Employee Professional Liability Insurance You can’t afford

NOT to have it!

Complaints and allegations of wrongdoing have simply become the cost of doing business for many federal employees. Whether true or false, and whether exacerbated by media sensation, negative public impact or political agendas, if you don't have professional liability coverage in place, the cost to defend your decisions, actions, or inactions could be cost prohibitive - even if you are ultimately vindicated.

FEDS $1,000,000 Professional Liability Insurance Policy is available for $290 annually, with payroll deduction available. Managers, supervisors and law enforcement officers are eligible for agency reimbursement up to half the cost of this insurance. FEDS Liability Insurance is recommended and endorsed by the leading federal employee associations. Other products available: Supplemental Disability Insurance, Life Insurance Alternatives to FEGLI Option B, and Federal Contractor Insurance. For more information or to enroll today: 866.955.FEDS www.fedsprotection.com A Step-By-Step Approach to Selecting Your Perfect Plan

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SheDding Light on FEDVIP: Dental & Vision Plans

Many people consider dental and vision plans to be more of an afterthought, luxury, or accessory to their current health plan. However, these plans may prove to be a necessity for you and your family. To help you better understand your options for dental and vision insurance, and why you would need separate coverage, the following section provides an overview of the Federal Employees Dental and Vision Insurance Program (FEDVIP) and tips for choosing an appropriate dental or vision plan.

ticipate in FEDVIP, an employee cannot be excluded from the program by any law or regulation. Qualifying family members include spouses and unmarried dependent children under age 22. Dependent children can be stepchildren, foster children, and those legally adopted and recognized as natural children. Coverage may also extend to children with disabilities that are older than 22 and incapable of self-support.

ELIG IB ILIT Y FEDVIP provides dental and vision benefits to federal and postal employees, retirees, annuitants, and qualifying family members. To be eligible for the program, a current federal employee must qualify for the FEHB Program. You should note that an employee does NOT have to enroll in FEHB to take part in FEDVIP. Rather, they only have to be eligible. To par-

THE AFFORDABLE CARE ACT & FEDVIP The Affordable Care Act does not apply to FEDVIP. Children are only covered until their 22nd birthday.

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IMPORTANT POINTS FOR RETIREES

PLANS & OPT IO N S Under FEDVIP, eligible employees, annuitants, retirees, and their family members can choose from four nationwide and three regional dental plans. NATIONWIDE: 1. 2. 3. 4.

Aetna GEHA MetLife United Concordia

REGIONAL: 1. Triple S Salud: applies to the island of Puerto Rico. 2. GHI: applies to all of New York state and some zip codes in Pennsylvania, Connecticut and New Jersey. 3. Humana Dental Company: applies in the states of Alabama, Arizona, Arkansas, California, Colorado, DC, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Missouri, Mississippi, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia and parts of Maryland. YOU ALSO CAN SELECT FROM THREE NATIONWIDE VISION PLANS. 1. FEP Blue Vision 2. UnitedHealthcare Vision Plan 3. Vision Service Plan (VSP) Program participants can sign up for a dental plan, a vision plan, or both. The plans operate on an employeepay-all basis with the premiums for each plan being withheld from an enrollee’s salary on a pre-tax basis. In addition to FEDVIP’s plans, there are three options for coverage: 1. Self Only: This form of enrollment covers only

you as the participating employee or annuitant. You can choose this form of enrollment even if you have a family, but your family members will not be covered under FEDVIP.

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The eligibility requirements for annuitants and retirees are slightly different. First of all, annuitants do not have to be eligible or enrolled in FEHB to qualify for FEDVIP. Second, retirees do not have to worry about reinstating it upon retirement if they had FEDVIP as an employee. FEDVIP enrollment continues automatically if an employee retires on an immediate annuity or for a disability under one of the following three programs: 1. The Civil Service Retirement System (CSRS) 2. The Federal Employees Retirement System (FERS) 3. Any other retirement system for employees of the federal government As a retiree, please remember that your FEDVIP coverage will end if you: (a) retire on a Minimum Retirement Age (MRA) +10 retirement program and (b) elect to postpone the receipt of your annuity You may enroll in FEDVIP again when you begin to receive your annuity. FEDVIP differs from FEHB in that you do not have to have five years of coverage as an employee in order to continue coverage into retirement. There is no service length requirement to receive FEDVIP coverage as a retiree.


2. Self Plus One: This form of enrollment cov-

ers you and one eligible family member that you specify. You may choose this option if you have additional eligible family members, but they will not be covered under FEDVIP.

QUESTION 1: DO YOU NEED SEPARATE DENTAL AND/OR VISION INSURANCE? As benefits expert Walt Francis pointed out, you may not need additional dental and/or vision coverage depending on your health insurance plan:

3. Self and Family: This form of enrollment cov-

ers you and all of your eligible family members. You must list all qualifying family members upon enrollment.

PICK ING T HE B E ST P L A N FO R YO U : Q U E STIONS TO ASK YO U RSE L F You know the plans. You know the options. Now how do you decide? You may be tempted to pull out brochures from each of the dental and vision plans and lay them side by side for comparison, but we would actually recommend against doing that at first. Instead, begin by answering a few key questions about your health needs, preferences, and costs that will help you to better understand what you’re looking for in all those brochures. To help you get started, here are a few suggestions from health care experts and respondents to GovLoop’s survey on Navigating Open Season:

“There is more than one way to get dental and vision coverage and you need to think really hard about what you are after and what you want to do. Some of the health plans actually cover a fair amount of your dental costs. So if your dental costs are low then there is an argument for picking one of the health plans with dental and calling it a day.” Dave Eccard, a GovLoop survey respondent who has been working for the federal government for the past five years, supported this suggestion. “I picked a plan because I like that it offers two levels of coverage and that they provide vision and dental in addition to the medical care. Also, I like that they have centers with multiple specialties so I don’t have to drive all over to see several different doctors.” It’s a good idea to double check with your current health provider to see if they offer dental and/or vision coverage. As one respondent cautioned, “I dropped my separate dental because I discovered after 3 years that I had 2 sets of dental insurance.” Another good thing to ask your health insurance provider is if they can adequately cover your dental and/or vision needs and those of your family. For Sara Mooney, a survey respondent in her 30s with children, the answer to that question was ‘no.’ As a result, she encouraged others to “get separate dental coverage. The scant coverage provided as part of the health insurance policy is horribly insufficient.” To determine whether or not you and your family need separate dental and/or vision insurance, list out your specific dental and vision needs and then compare the amount of coverage that you would receive from your health insurance alone versus from your health insurance and a FEDVIP plan. Figure 13 illustrates how to do this with vision care based on a comparison between a FEHB plan and a FEDVIP plan. When combining health and dental or vision insurance, you should list your health insurance as the “first payor.” This means that your health insurance

A Step-By-Step Approach to Selecting Your Perfect Plan

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will pay benefits first. Your FEDVIP coverage will then kick in, dispensing benefits according to the plan’s coverage rules and allowance. In the scenario in Figure 13 the FEHB plan alone can only cover less than 20 percent of the $280 vision bill. The FEDVIP plan, however, is able to cover the remaining balance when combined with the initial health insurance. Figure 13. Sample Coverage Worksheet FEDVIP Plan Pays

Service

Overall Cost

FEHB Plan Pays

Eye Exam:

$90

$20

$70

Frame:

$130

$0

$130

Lenses:

$60

$30

$30

Total:

$280

$50

$230

QUESTION 2: WHO AND WHAT DO YOU NEED COVERED? Let’s begin with who you need covered. If you have a bigger family, you will need a greater amount of coverage and this has to factor into your decisionmaking. As survey respondent Greg Carter, a single parent and federal employee of more than 20 years, described, “I have a plan with supplements for dental and glasses and am satisfied with the benefits it provides for my children. I chose this plan for the coverage it gives us.” Walt Francis put it this way in our interview with him: “But say you have three or four kids and even if preferred preventative visits only cost 100 bucks or something...if you have 5 or 6 people that need to go every year that adds up. You need to find a plan that covers your visits at little or no costs. Maybe that’s the best dental plan for you and it might not even be a dental plan it could be a health plan.”

WHAT IS TYPICALLY COVERED UNDER FEDVIP?

DENTAL

VISION

FEDVIP’s dental plans often fully cover the following:

FEDVIP’s vision plans often fully cover:

´ ´ Examinations ´ ´ Cleanings ´ ´ X-Rays

´ ´ Eye Exams ´ ´ Lenses ´ ´ First Annual Set of Contacts

Other dental procedures are generally covered up to a certain percent depending on the plan:

Enrollees are given an allowance to cover other vision needs and a discount for any expenses that exceed the allowance.

´´ ´´ ´´ ´´ ´´ ´´ ´´

Fillings Simple Extractions Crowns Root Canals Dentures Bridges Periodontal Maintenance and Surgery

Enrollees in FEDVIP’s dental plans are given a lifetime maximum allowance of anywhere between $1,000 and $2,000 per person for orthodontic services.

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Guide to Open Season in Federal Government

´ ´ Frames ´ ´ Treatments or Options for Lenses ´ ´ Warranties on Lenses or Contacts


With regards to what you need covered, that will require some pre-planning and self-evaluation on your part. You know best what you need when it comes to your health, and planning ahead will help you to find the best insurance to cover those needs at little to no costs to you. As one respondent commented, “I have Health, Vision and Flex spending. I should have chosen a dental plan, too. I will need continual prescriptions throughout my lifetime. I wear glasses and I hoped that the pre-taxed dollars would save me some money.” Lisa Jones made a similar observation, stating: “On the vision end, in the past, that was a big issue for me, because I did need glasses, and I like to have nice glasses and more than one pair of glasses. Again, you have to think about what your physical condition may be. For me figuring out what network of providers I could go to was important and what their products were like.” Coming to a different conclusion after a careful analysis of her health needs, survey respondent Carol Kruse, a fed in her 60s and nearing retirement, shared that she has “just health, no vision/dental. I have had so few expenses there that it’s cheaper to pay occasional big bills than to pay the high insurance premiums.” Again, it really depends on your unique circumstances and your projections for the year ahead. QUESTION 3: DOES LOCATION MATTER? From the outset, FEDVIP offers you a choice based on location when it comes to dental plans, with some of the plans being available regionally versus nationally. However, both respondents and experts advised against picking a plan simply because it is available in your area. Instead, they advocated for choosing your doctors first and then asking them for the plans that cover them. As survey respondent Jan Stotts, a federal employee for more than 20 years, recommended, “Be realistic when choosing coverage. If you have a doctor you want, make sure they accept the coverage. Don’t pay for something you won’t use.” Lisa Jones seconded the notion of starting with your health care provider. By choosing your doctor first, she said you can actually make your choice of plans simpler:

FEDVIP’S AUTOMATIC RE-ENROLLMENT FROM YEAR TO YEAR If you are currently enrolled in FEDVIP and do not wish to change your plans or options, your enrollment continues automatically. You should be aware, however, that premium costs on your plan might change from year to year.

“Dental is still very important, but to me at least it is not necessarily involving the same scrutiny because with the dental programs you are seeing one dentist. You may get referred out if you are in a DMO to a facial surgeon or orthodontist. But, for the most part, you are only dealing with one doctor.” The same can be said of vision plans. Since you are typically dealing with one provider, it would be wiser to make that decision first, and then ask them for the plans they accept. Concluding this idea of ‘doctors first, plans second,’ Walt Francis observed that: “Far and away, the most important thing you need to know about these plans are that the big part of their usefulness to you is their network benefits. The network deal is that the dentist has agreed to accept their payment for your crown or your bridge and it’s a whole lot lower than what he charges other people. The plan pays half or two-thirds of that and then the charge is low to begin with so what you really want to do in the case of dental plans is choose the plan that your dentist is in. If he is Plan A but not Plan B, that’s probably the way you should go.” QUESTION 4: HOW DO COSTS PLAY A FACTOR? You can check the premiums and pay frequency of FEDVIP’s plans using BENEFEDS’ plan comparison tool. However, before you race off to do that, use the answers from the three previous questions to determine which plan is the most cost-effective based on your needs. You want to save money, but not at the expense of your health needs or your preferred doctor.

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As Lisa Jones explained earlier in this guide: “A lot of people get stuck on what is the premium and what is the cost sharing, but that isn’t the right primary focus. It is an important piece of the puzzle but it shouldn’t be the first piece... ...Honestly everyone is concerned about their wallet. And I can’t blame them. But it is important to keep in mind that the least expensive plan that might save you some money upfront, could cost you a lot more down the road in case you end up needing the service.” Walt Francis supported this opinion, explaining how a more expensive plan that covers a larger amount of your dental and vision costs may save you more money in the long run: “The other thing is these plans also have called maximum payments. They will not than X dollars in treatment costs. Some of ings are pretty low - couple of thousands

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Guide to Open Season in Federal Government

Some of them are a lot higher. So if you have a mouthful of expensive dentistry, you probably want to pick one with a higher limit.” By planning ahead and figuring out your dental and vision needs, you will be able to effectively select a plan that suits all your needs for you and your dependents. To further help you make an informed decision and identify the right plan for you, please see Appendix B on page 44 where we show how to analyze a benefits summary for a FEDVIP dental and vision plan.

H OW TO A P P LY, C H A N G E , OR CA N C EL YO UR F E DV I P E N ROL L M E N T: During Open Season, federal employees can enroll in a FEDVIP plan, cancel their enrollment, or change from one FEDVIP plan or option to another. You will


use BENEFEDS as your one stop resource for all of these activities. We give you some quick tips for each action below: APPLY: ´ ´ If you are a newly hired or eligible employee, you have 60 days to enroll. ´ ´ Once you enroll in a FEDVIP dental or vision plan, that’s it. You will not have the opportunity to change your enrollment until the next Open Season. ´ ´ Coverage begins on the first day of the first pay period after your request is received. CHANGE: ´ ´ Outside of Open Season, you can only alter your enrollment in FEDVIP if one or more of the following Qualifying Life Events occur:

´ ´ Change in family status (i.e. marriage or having children) ´ ´ Change in employment status (i.e. new hire or military deployment) ´ ´ Loss of vision and/or dental coverage by you or a family member CANCEL: ´ ´ You can only cancel your enrollment in a FEDVIP plan during Open Season, unless: •• Your employment status is changing. •• You have been transferred to a position in the federal government where your agency offers dental and/or vision coverage and pays more than 50 percent of the premiums associated with that coverage. ´ ´ You must do so either 31 days prior or 60 days after the change. Please Note: You cannot cancel your enrollment in FEDVIP because of retirement or the inability to pay the health insurance premiums.

“HONESTLY EVERYONE IS CONCERNED ABOUT THEIR WALLET. AND I CAN’T BLAME THEM. BUT IT IS IMPORTANT TO KEEP IN MIND THAT THE LEAST

HOW TO HANDLE MOVING UNDER FEDVIP

EXPENSIVE PLAN THAT MIGHT SAVE

If you have a regional dental plan, but move out of that plan’s coverage area, you may change your dental plan apart from Open Season. You may not, however, cancel your enrollment in FEDVIP.

YOU SOME MONEY UPFRONT, COULD COST YOU A LOT MORE DOWN THE ROAD IN CASE YOU END UP NEEDING THE SERVICE.”

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Explaining FSAFEDS: Flexible Spending Accounts

“Do it.” That’s the advice given by every single federal benefits expert we interviewed for this guide when asked if employees should take advantage of a Flexible Spending Account (FSA). One survey respondent said, “I think the FSA is a pretty good way to go if you can manage it. It can help with budgeting for health care costs.”

Walt Francis noted:

However, before we get into why you should take advantage of a FSA, you first need to know how it works. A FSA, known to federal employees as FSAFEDS, allows you to set aside a portion of earnings to pay for qualified medical expenses. Money deducted from your pay into a FSA is not subject to payroll taxes, resulting in substantial payroll tax savings. You are able save on a wide variety of everyday medical, dental, vision and day care expenses.

The decision to use a FSA really comes down to your life situation. Survey respondent Debra Thangarajah noted that her family “currently has no FSA, but plans to start a FSA again this year as our expenses have increased enough to warrant it and our primary care physician left all federal insurance plans and we want to keep her, which means more out of pocket costs.”

“The key is that money in your FSA is tax-deferred money, which effectively gives you about a one-third discount. People don’t realize how high their marginal tax rates are. Not setting aside the money is foolish. You are basically throwing money away.”

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•• The Federal Employees Dental and Vision Insurance Program (FEDVIP) •• Any other insurance coverage ´ ´ You MUST be enrolled in, or covered by, a High Deductible Health Plan in 2014 AND have a Health Savings Account in 2014 ´ ´ Covers expenses for you and/or your tax dependents; including adult children, through the end of the calendar year in which they turn 26 ´ ´ $2,500 maximum is NOT a household limit; your spouse can have a separate account

Per the Office of Personnel Management’s website, FSAFEDS offers three different types of FSAs for federal employees: 1. A Health Care Flexible Spending Account (HCFSA) ´ ´ Reimburses eligible health care expenses not covered or reimbursed by: •• The Federal Employees Health Benefits Program (FEHB) •• The Federal Employees Dental and Vision Insurance Program (FEDVIP) •• Any other insurance coverage ´ ´ Covers expenses for you and/or your tax dependents; including adult children, through the end of the calendar year in which they turn 26 ´ ´ $2,500 maximum is NOT a household limit; your spouse can have a separate HCFSA 2. A Limited Expense Health Care Flexible Spending Account (LEXHCFSA) ´ ´ Reimburses ONLY eligible dental and vision expenses not covered or reimbursed by: •• The Federal Employees Health Benefits Program (FEHB)

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3. A Dependent Care Flexible Spending account (DCFSA) ´ ´ Reimburses eligible day care expenses for your: •• Children UNDER age 13 •• Dependents on your Federal tax return who are incapable of self-care ´ ´ You (and your spouse, if married) must be: •• Working, or •• Looking for work (with income during the year), or •• Attending school full-time ´ ´ $5,000 maximum IS a household limit •• Includes child care subsidy amounts and other FSA dependent care accounts •• $2,500 maximum, if married filing separately Lisa Jones said: “The great news about FSAs is that you can tap into the funds on day one. For many dental and vision plans, it could take a few months for your benefits to kick in. However, on January 1st you can start using your flexible spending account in full.”

WH E N CA N YOU E N ROL L? Eligible employees can enroll in FSAFEDS each year during the Federal Benefits Open Season. Open Season enrollments are effective January 1st of the following year. Eligible employees who wish to enroll in this program must do so within 60 days after they become eligible, but before October 1st of the calendar year.


CALCU LAT ING YO U R FSA One of the most difficult aspects of optimizing your FSA is figuring out just how much money should be put in the account. However, you can follow the steps below to get the best sense of what you’ll need to set aside.

Calculating the correct amount to put in your FSA can be a challenge, but if you do it correctly you can save big. For example one survey respondent said, “Without the FSA, I am unable to afford my prescriptions each month.”

1. Look Backwards: Look over your health care receipts from last year. See how much you spent on co-pays, medications etc. If you use a program like Mint or Quicken, you can quickly search and find your relevant, previous expenditures to come up with a solid estimate.

THE MATH EQUATION ENDS UP LOOKING LIKE THIS:

2. Think Forward: Look ahead, too. Do you know for certain you will be having a specific surgery or needed. For example, if you were going to have Lasik eye surgery and it wasn’t covered by your insurance, you could put those costs in your FSA. Or if you want to see a psychiatrist who is out of your network, calculate those costs. 3. Add It Up: Put those costs together and you can get a relatively close idea of how much you will likely spend and what you need to set aside.

What does this calculation look like in real life? Here are some examples: ´ ´ Let’s pretend that Laura is a single federal employee. She is relatively healthy. However she does suffer from allergies. Every two weeks Laura goes to the pharmacy to fill a prescription for allergy medication. The co-pay for the medication is $15. That means every year Laura spends $360 dollars on her allergy medication. Laura also knows she is going to need new glasses and her FEDVIP plan only provides $200 for new glasses. The pair Laura wants is $650. So Laura’s FSA calculation would look like: •• $360 + $450 = $810

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´ ´ Now let’s say Laura gets married to a nice guy named Tim. Laura and Tim have two kids. Laura follows the same calculation as before to figure out how much the entire family spends on prescriptions/doctor visits for her and the family. That amount goes towards the family FSA. Since both Tim and Laura work they decide to enroll in DCFSA. You can set aside up to $5,000 a year for dependent care. Each week Laura spends $150 dollars to send her kids to childcare. That amounts to $6,240 dollars a year. Therefore Laura qualifies for the full $5,000 coverage through DCFSA. •• $150 x 52 (weeks) = $6,240 THE CATCH: Current enrollees must remember to enroll each year to continue participating in FSAFEDS. Enrollment does NOT carry forward year to year. Basically, it is use it or lose it. “Most consumers that wish to use a FSA have to be really aware or willing to learn about their usage patterns. It is very easy in the first year to miscalculate and put either too much money in their FSA or too little,” said Jones. Sometimes you have a grace period of a couple months into the following year, but don’t rely on that extra time to submit reimbursements. Estimate conservatively so you don’t end up with unspent money in your account.

HOW CAN I SP E N D M Y FSA ? ´´ ´´ ´´ ´´ ´´ ´´ ´´ ´´

Co-payments, co-insurance and deductibles Acupuncture Blood pressure monitors Body scans Childbirth classes Chiropractic care Contact lenses, solutions, cleaners and cases Dental care (including crowns, endodontic services, fillings, implants, oral surgery, periodontal services and sealants, but not toothpaste or porcelain veneers) ´ ´ Diabetic supplies ´ ´ First aid kits

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´ ´ Flu shots ´ ´ Foot care (e.g., athlete’s foot products, arch supports, callous removers, etc.) ´ ´ Hand sanitizer ´ ´ Hearing aids (including batteries) ´ ´ Home diagnostic tests and kits (e.g., cholesterol, colorectal screenings, etc.) ´ ´ Home medical equipment (e.g., crutches, wheelchairs, canes, oxygen, respirators, etc.) ´ ´ Laser eye surgery ´ ´ Learning disability treatments and therapies (including speech therapy and remedial reading)


WHERE CAN’T I SP E N D M Y FSA ? ´ ´ Cosmetic procedures (unless required to restore appearance or function due to disease or illness) ´ ´ Expenses you claim on your income tax return ´ ´ Expenses reimbursed by other sources, such as insurance ´ ´ Fitness programs (unless medically necessary) ´ ´ Hair transplants ´ ´ Illegal treatments, operations, and drugs ´ ´ Insurance premiums, including COBRA ´ ´ Tricare, dental, vision and long term care insurance ´ ´ Over-the-counter drugs and medicines (except insulin) unless prescribed by a physician ´ ´ Physician retainer fees including boutique and concierge practice membership fees ´ ´ Prescription drug discount program fees ´ ´ Weight loss programs and drugs for general wellbeing

M A JOR SAVING S W I T H FE D E R A L FL E X I BL E SPENDING ACC O U N TS: The Office of Personnel Management reports that the average person will save about 30% each year by using flexible spending accounts. With that type of savings, a federal employee earning $50,000 and contributing $2,000 to a FSAFEDS account will have around $600 more to spend each year.

´ ´ HCFSA expenses are reimbursable for adult children, through the end of the calendar year in which they turn 26. ´ ´ You must incur all eligible expenses for 2014 by March 15, 2015. ´ ´ You forfeit (lose) all money remaining in your 2014 FSAFEDS account(s) after March 15, 2015 for which you have not incurred an eligible expense and filed a timely claim. ´ ´ Claims Deadline—You must submit all claims for 2014 by April 30, 2015. ´ ´ Re-Enroll—You MUST re-enroll each year to continue participation. Enrollments DO NOT carry forward from year to year. ´ ´ New Employees—You have 60 days from your hire date to enroll, but you must enroll before October 1 or wait for Open Season. ´ ´ If you leave or quit your job, there is a brief runout period when you can continue to submit reimbursements for expenses incurred before you leave, but any balance after that is forfeited to your employer.

OPM’S FLEXIBLE SPENDING QUICK TIPS ´ ´ As a result of health care reform, the maximum amount that can be contributed to any health care FSA is $2,500, effective January 1, 2013. ´ ´ Over-the-counter drugs and medicines (except insulin) are ONLY eligible for reimbursement when prescribed by a physician.

A Step-By-Step Approach to Selecting Your Perfect Plan

34.


5 STEPS FO R MA K IN G T H E M O S T O F F S A F E D S

An Interview with Bart Turney, Director, ADP Strategic Advisory Services. ADP is the Administrator of the Office of Personnel Management’s FSAFEDS Program. If you are planning to take advantage of the Flexible Spending Account offered through FSAFEDS, then you will likely want a game plan for thinking through how much you want to set aside. In a recent interview with Bart Turney at ADP, which administer’s FSAFEDS, we learned about five steps you can take to make the most of their resources and tools:

1. VIEW THE VIDEO LIBRARY: “If you are a first-time guest to the FSAFEDS.com,” said Turney, “watch a couple of our videos.” Each video is no more than two minutes long, so it provides key information quickly on why you should join, the three types of accounts, eligible expenses, reimbursements and enrollment.

2. BROWSE THE SUMMARY OF BENEFITS WITH FAQS: While the videos provide solid

introductory information, “you can find an answer to just about every question you can imagine in the FAQs,” explained Turney. From learning the basics about an FSA to understanding your eligibility and status to finding financial facts about FSAs, the summary should cover your main inquiries.

3. CONTACT A BENEFITS COUNSELOR: After reviewing that information, “if you still have

something particular to your situation, call one of our benefits counselors,” recommended Turney. They are available toll-free at 1-877-FSAFEDS from 9a to 9p ET Monday to Friday. You may also access a list to find your specific agency’s benefits officer.

4. USE THE ELIGIBLE EXPENSES JUKEBOX: If you have a question about what expenses are reimbursable, check out the Jukebox. “It lists all of the potential expenses from A to Z, stating whether it’s eligible, not eligible or potentially eligible,” explained Turney. Consider it your one-stop resource to find out where you can use your FSA.

5. PREDICT YOUR EXPENSES WITH PLANSMARTCHOICE: If you’re uncertain what your

expenses might be in the coming year or want to compare health plans side by side, go to PlanSmartChoice. com. “You have resources like the decision support tools, which take into account specific health plan limits and levels as well as employee’s estimated expenses and help you to determine your FSA allocation,” said Turney. Turney also noted that now is an especially important time to leverage an FSA. “With retirement cuts, limited pay increases, furloughs, sequestrations as realities facing federal employees right now, these are things you can do very little about. There are few opportunities to save money these days; however, the average person can save around 30% on eligible expenses and end up with $600 more in their pocket due to tax savings with a FSA,” said Turney. “There’s a fairly narrow window to enroll in the program, during Open Season, and this is something that will affect you financially for the coming year. A little homework can make a big difference.”

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Guide to Open Season in Federal Government


Federal employees can save an average of 30% on health care and day care expenses with FSAFEDS. FSAFEDS Health Care and Dependent Care flexible spending accounts offer a tax break that’s simple to use and works for all active employees. Enroll during FEHB Open Season: November 11 - December 9, 2013! Health Care FSA

Dependent Care FSA

• Co-payments, co-insurance and deductibles • Dental and vision care • Chiropractic care • Home medical equipment • Physical therapy • Prescription drugs • Prevention care screenings • And more

• Care for children under the age of 13 including: - Child care at a day care center, day camp, sports camp or by a private sitter - Before and after-school care • Adult day care • And more

Share the knowledge. Spread the wealth. v

e k r o w o c r u o y wit h

rs

www.FSAFEDS.com 1-877-372-3337 TTY: 1-800-952-0450

A Step-By-Step Approach to Selecting Your Perfect Plan

36.


OPEN SEASON

CHEAT SHEET

WELCOME TO YOUR OPEN SEASON CHEAT SHEET!

To review, Open Season is the one month each year (typically in November) that federal employees, retirees, and annuitants have to enroll, change, or cancel their participation in a federal health plan. These federal health plans also include those relating to dental and vision coverage plan, or the establishment and use of a flexible spending account. It’s important to remember that during Open Season, you also have the opportunity to modify the family members covered by your insurance. Of course, there are exceptions to the rule that you are only allowed to make changes to your health insurance during Open Season. These exceptions are called Qualifying Life Events and they include the following:

A CHANGE IN EMPLOYMENT STATUS A CHANGE IN FAMILY STATUS LOSS OF COVERAGE BY EITHER THE ENROLLEE OR HIS/HER FAMILY MEMBERS If one of these events occurs, you have the opportunity to modify your health insurance within a limited amount of time (usually 60 days). With Open Season on the horizon, here are some questions to ask yourself, your doctors, and your agency’s health insurance professional in preparation:

QUESTIONS TO ASK YOURSELF What are your health needs? Answering this question will help you to determine what types of procedures you will need covered by insurance. To respond, evaluate your medical expenses from the previous year and consider your upcoming health needs, for you and your dependents.

What are your health care priorities? We found that for many of our survey respondents and interviewees, once they knew their priorities concerning costs, coverage, and convenience of health care, the field of choices was much more narrow and easier to manage.

How much can you afford? We all want to save money, but the easiest way to do that may not be in selecting the cheapest plan. If you do that, but the plan does not provide the right amount of coverage, you could end up spending more money in the long run. So be realistic about what you need covered and about what you can afford and find the best insurance from there.


QUESTIONS TO ASK YOUR DOCTOR What are my health needs? You understand your body best and what it needs, but your doctor can provide key insights into any upcoming procedures or prescriptions.

What plans and/or providers are you with? Our survey respondents and interviewees all agreed that it’s more important to select your doctor first and then your plan later, based on your doctor’s network.

QUESTIONS TO ASK YOUR HEALTH INSURANCE PROFESSIONAL

Where can I go for information? Your health insurance professional is aware of the different online, paper, and agency resources that you can reference, and can give you tips for using them. They also are a valuable resource for you when it comes to deciphering some of the jargon associated with health insurance benefits and rules.

Which plans do I qualify for? Your health insurance specialist will be able to tell you which plans you qualify for based on factors such as your location, age, family and employment status. These insights will help you make more effective decisions when selecting a health care plan.


CONCLUSION “Choose the plan that is best for you. You have a lot of commitments outside of your health care expenses, but if something does happen, your health and the expenses that are affiliated with it are very important and don’t wait for something to happen to realize how important it is. Start now by picking a good healthcare provider that will help you to take better care of yourself!” - GovLoop Survey Respondent Although the government spends a lot of money each year helping workers and retirees navigate Open Season, only a small number of workers and almost no retirees actually change plans. You aren’t necessarily happy with your plan as it may not be the best deal any more, especially with some plans upping premiums by more than 4.4% next year, but it’s what you know…and sometimes it’s just easier to stick with it. If you want to avoid that Open Season slump, here’s a quick rundown of the lessons you’ve learned in this guide. 1. Before you pick your plan, get to know your own health needs. Ask yourself how much do I spend on prescriptions each year? How much do I spend on co-pays? Do I need to see specialists? Do I have an upcoming surgeries or pregnancies, I should factor in? 2. Talk to your doctor. One of the simpler things you can do is to choose your doctor first and then ask the doctor what plan or plans are accepted by their practice. That data point narrows your choices considerably because you have just taken care of one of the big uncertainties: ‘is my doctor in my plan? 3. Count the costs. Ask the following questions: What are the deductible and co-pay costs? How much can you afford to pay out-of-pocket? What amount of liability do you want to absorb when it

39.

Guide to Open Season in Federal Government

comes to unexpected health events? Don’t forget to consider setting a maximum amount on your catastrophic limit, which applies to both FEHB and FEDVIP programs. 4. Consider the convenience factor. Does your health plan integrate well with your dental, vision and flexible spending account? Is it easier to continue similar coverage from a previous employer? Do your claims process quickly and accurately? Does it cover providers that are close to your home or office? 5. Don’t let bureaucratic language scare you. The language of insurance and health care is almost a foreign language. But you can get through it with the help of our glossary. 6. Look closely at dental and vision. Under FEDVIP, eligible employees, annuitants, retirees, and their family members can choose from four nationwide and three regional dental plans. The plans vary, so use the same narrow-down process you would use for health benefits on your dental and vision plan. 7. Don’t sleep on flexible spending plans. Just do it. Plain and simple, a flexible spending plan will save you money. However, you have to calculate your needs, so you don’t lose money. If you follow these seven tips and the many other insights that have been shared in this guide, you’ll be well on your way to understanding your health plan options during Open Season. We look forward to hearing your stories of navigating the Open Season process a bit more adroitly because you browsed our guide. Please take a moment to share your experiences on GovLoop. By sharing your experiences, you will help countless federal employees improve their decision making process during Open Season.


RESOURCES

FIERCE GOVERNMENT IT RESOURCES http://www.fiercegovernment.com/story/opm-provides-tools-explain-federal-open-season/2012-11-13

BENEFEDS Benefeds.com BRIEF GUIDE TO FEDERAL BENEFITS OPEN SEASON http://www.fedmanager.com/columnswhats-happening/dollars-a-sense/966-a-brief-guide-to-the-federalbenefits-open-season CONSUMERS’ CHECKBOOK Checkbook.org ELIGIBLE SAVINGS JUKEBOX https://fsafeds.com/fsafeds/EligibleExpenses.asp FEDERAL NEWS RADIO TIPS FOR OPEN SEASON 2013 http://www.federalnewsradio.com/182/3115957/ Tips-for-Open-Season-2013

FSAFEDS FSAFeds.com FSAFEDS SAVINGS CALCULATOR https://fsafeds.com/fsafeds/fsa_calculator.asp GUIDE TO FEDERAL BENEFITS FROM NATIONAL FINANCE CENTER https://www.nfc.usda.gov/dprs/70-01.pdf GUIDE TO HEALTH PLANS FOR FEDERAL EMPLOYEES AND ANNUITANTS http://www.checkbook.org/newhig2/hig.cfm OPM OFFICIAL INFORMATION OPM.gov/healthcare-insurance

FEDERAL TIMES - ASK THE EXPERT http://blogs.federaltimes.com/federal-retirement/ category/health-insurance/open-season-health-insurance/

OPM RESOURCES http://www.opm.gov/healthcare-insurance/open-season/resources/

FEDSMITH: FOR THE INFORMED FED FedSmith.com

PLANSMARTCHOICE PlanSmartChoice.com

FEDS: FEDERAL SERVICES FedsProtection.com

THRIFT SAVINGS PLAN (TSP) TSP.gov

EMPLOYEES

DEFENSE

A Step-By-Step Approach to Selecting Your Perfect Plan

40.


ACKNOWLEDGEMENTS GovLoop appreciates the many individuals who shared their experience and expertise with us for this guide through a series of surveys and interviews. We especially want to thank the following individuals for providing critical insight into Open Season and the federal health benefits selection process for this report:

Lead Writers: Andrew Krzmarzick, GovLoop Director of Community Engagement, Emily Jarvis, Online Editor & Producer of the DorobekINSIDER, and Sharon McCoy, GovLoop Graduate Fellow

Lisa Jones, Health Insurance Specialist, Centers for Medicare and Medicaid Services

Editor: Pat Fiorenza, GovLoop Senior Research Analyst

Walton Francis, author, CHECKBOOK’s Guide to Federal Benefits

Lead Designer: Jeff Ribeira, GovLoop Senior Interactive Designer

Dave Eccard, Survey Respondent

Designer: Russell Yerkes, GovLoop Design Fellow

Sara Mooney, Survey Respondent

If you have any questions or feedback pertaining to this guide, please contact andrew@govloop.com.

Greg Carter, Survey Respondent Wynne Kelch, Editorial Review Carol Kruse, Survey Respondent Jan Scotts, Survey Respondent Steven Staats, Editorial Review Ann Vanderslice, Federal Retirement Planning Specialist In addition, GovLoop appreciates its sponsors, Federal Employee Defense Services (FEDS) and FSAFEDS, for their insights and contributions to make this guide possible. Finally, GovLoop would like to acknowledge the members of its internal team that conducted the interviews, coalesced the information, and contributed to the creation of this guide:

41.

Guide to Open Season in Federal Government

Lead Editor: Steve Ressler, GovLoop Founder and President


APPENDIX A Glossary

ANNUITANT: A beneficiary of an annuity or pension. This beneficiary can be a retiree or a retiree that has been rehired by the government on a part-time or short-term basis.

ANNUITY: A fixed payment paid to a recipient on an annual basis, typically for the rest of their life. For certain healthcare plans, premiums may be deducted from an enrollee’s annuity.

BENEFEDS: Is a business system that manages multiple voluntary federal health benefits plans, most notably those as-

sociated with FEDVIP. More specifically, BENEFEDS is responsible for handling enrollment and customer service concerns.

CATASTROPHIC LIMIT: Refers to the maximum amount of certain covered charges that you have to pay out of

pocket during the year. It is in your best interests to set a maximum amount. The Catastrophic Limit provision applies to the FEHB and FEDVIP programs.

CONSUMER DRIVEN HEALTH PLANS (CDHP): Refers to a wider range of healthcare options that give

the enrollee greater control over how they spend their healthcare dollars up to a certain amount. Under this plan, the enrollee receives full coverage for preventative care, but has to pay a larger portion of the cost sharing expenses after the initial discretionary funds have been spent.

COINSURANCE: The amount that you pay as your share of the medical services that you receive. Coinsurance is generally a percentage (i.e. 25%).

CO-PAY: The amount that you pay as your share of the medical services that you receive. A co-pay is generally a fixed amount (i.e. $25).

DEDUCTIBLE: The amount of covered expenses that you must pay out of pocket before your healthcare plan begins to pay benefits. A deductible can vary in amount for different services (i.e. prescription or outpatient services) and applies to the FEHB and FEDVIP plans.

FEE FOR SERVICE (FFS) PLANS (NON-PPO): A traditional approach to health insurance, FFS plans without a PPO will either pay your medical provider directly or reimburse you for your medical costs after you file an insurance claim. Under these types of plans, you have the option of visiting the doctor or hospital of your choice, but you need to fill out a greater amount of paperwork for the insurance company. These plans may also be more costly in the long run.

FEE FOR SERVICE (FFS) PLANS (WITH PPO): A version of FFS, this option allows you to pay less money

out of pocket by seeing which medical providers will reduce their healthcare charges because of your plan. When using a PPO, you normally do not have to submit claims or paperwork, thus saving you time as well. NOTE: You may not receive all of your PPO discounts and benefits when going to a PPO hospital. These benefits may only apply to certain services.

FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM (FEDVIP): A program in which eligible federal employees, retirees, and their family members can purchase dental and vision insurance on an enrollee pay all basis. Premiums for these insurance plans are withheld from an enrollee’s salary before taxes.

FEDERAL EMPLOYEES HEALTH BENEFITS (FEHB) PROGRAM: A program in which eligible federal

employees, retirees, and their family members can purchase a wide range of health insurance options. FEHB contains more than 200 healthcare plans with the premiums and benefits of these plans varying widely.

FLEXIBLE SPENDING ACCOUNT (FSA): An account where you can deposit money from your salary on a

pretax basis for medical expenses. Under this structure, you pay out of pocket for your medical care and the healthcare of your dependents and then are reimbursed for those expenses from your FSA.

A Step-By-Step Approach to Selecting Your Perfect Plan

42.


HIGH DEDUCTIBLE HEALTH PLAN (HDHP): A health insurance plan for which the enrollee has to pay a

high deductible of at least $1,250 for Self Only coverage or $2,500 for family coverage. The total annual out of pocket costs for the program cannot exceed $6,250 for Self Only plans and $12,500 for family plans. NOTE: These dollar amounts are for 2013 only. Under a HDHP, enrollees have no deductibles for preventive care, but do have higher copays and coinsurance for services outside of the plan’s network. Funds from a HDHP help set up HSAs or HRAs for eligible enrollees.

HEALTH MAINTENANCE ORGANIZATION (HMO): A health plan organized around a network of doctors

and hospitals in a particular geographic or service area, HMOs limit the amount of money that you have to pay out of pocket for your healthcare. They also eliminate the need for filing insurance claims and paperwork. Healthcare services are coordinated between the group of physicians and medical centers and your eligibility for an HMO is determined by where you live or work. Healthcare received from providers outside of your HMO will not be covered unless it is an emergency or your HMO has a reciprocity agreement with HMOs in other service areas.

HEALTH REIMBURSEMENT ARRANGEMENT (HRA): Also known as Personal Care Accounts, HRAs are

commonly associated with CDHPs. They also exist under HDHPs for enrollees that are ineligible for HSAs. A participant may use funds from a HRA, credited to an individual by the insurance company, to pay medical expenses, similar to a HSA. However, unlike a HSA, the money in a HRA does not accrue interest and cannot be transferred if the enrollee changes health plans. HRAs also differ in that a participant may not make deposits into a HRA and insurance companies may impose a limit on the amount that can be deposited.

HEALTH SAVINGS ACCOUNT (HSA): An option for those enrolled in a HDHP program, a HSA allows par-

ticipants to deposit and withdraw funds on a pretax basis for medical expenses. Funds in a HSA accrue interest and are transferrable. There is also no limit to the amount of money that can be deposited in a HSA. To have a HSA, you cannot be someone’s dependent or eligible for Medicare or a healthcare plan other than HDHP. There are a number of regulations associated with a HSA. These are available on the Treasury Department’s HSA page.

MINIMUM RETIREMENT AGE (MRA) +10: A provision that enables you to retire with benefits if you have

ten years of service and are at least at the minimum age of retirement (at least 55). It is important to know that your annuity will be reduced for every month that you are under the age of 62. This equals an annual reduction of about five percent. To avoid this loss, you can postpone your annuity payments, applying for them again two months before you wish for your benefits to be reinstated.

OPEN SEASON: Determined by the Office of Personnel Management, Open Season is a period during which federal

employees can enroll or make changes to their enrollment in federal healthcare plans. Open Season normally lasts from the Monday of the 2nd full work week in November to the Monday of the 2nd full work week in December.

POINT OF SERVICE (POS) PRODUCT: Applying only to an HMO, the POS product allows you to use medical

providers outside of your HMO network. If you choose to use this service, you will have to pay higher deductibles and coinsurance charges for going outside of your HMO network. You will also have to file a claim for reimbursement with your insurance company.

PREFERRED PROVIDER ORGANIZATION (PPO): Part of a network of doctors and hospitals, a Preferred

Provider Organization, saves participants money in that PPO medical providers will charge less for their services if the participant is part of a health plan with PPO partners.

PREMIUM: The rate or amount that you pay for a particular insurance plan, a premium, can be charged biweekly, semimonthly, every 28 days, or monthly.

PRIMARY CARE PHYSICIAN (PCP): The physician or practice that provides your general medical care. Most

plans, especially HMOs, will ask you to designate a PCP. In a HMO, you will have to get a referral or authorization to see another doctor to ensure that you receive the appropriate care for your condition or concern.

QUALIFYING LIFE EVENT (QLE): An event that allows an enrollee in a federal health plan to make changes to their enrollment outside of Open Season.

For additional glossary resources please see:

´ ´ BENEFEDS’ Glossary ´ ´ OPM’s Glossary ´ ´ OPM’s Health Care Plans Reference

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Guide to Open Season in Federal Government


APPENDIX B

Typical Dental and Vision Plans under FEDVIP

SAMPLE DENTAL PLAN Deductible

Waiting Period

In Network: Pan Plays

Out of Network: Pan Plays

exams, cleanings, x-rays

$0

0

100%

60-90%

fillings, extractions, periodontal maintenance

$0

0

45-60%

40-60%

root canals, crowns, bridges, dentures, periodontal surgery

$0

0

35-60%

20-40%

Plan Coverage Class A:

Class B:

Class C:

orthodontic services

Class D:

50%

$0

12 Months

There is a lifetime max of $1,000-$2,000 per person.

50%

There is a lifetime max of $1,000-$2,000 per person.

LEGEND: CLASS: The class refers to the type of procedure that the insurance covers. Once you have mapped out your dental

needs for the upcoming year, find them here so you can better estimate how much coverage you can obtain for these procedures based on the type of plan that you choose.

DEDUCTIBLE: Most FEDVIP dental plans do not have a deductible. 12 MONTHS, WAITING PERIOD: Most FEDVIP dental plans have a 12-month waiting period for orthodontic services. This is important to keep in mind if you are expecting to need these services in the coming year.

PERCENT OF COVERAGE: These percentages represent the amount of coverage that your plan will give you for each type of procedure. It’s important to remember that all of the funds for this coverage come from your annual allowance which can range from $600-$5,000 per person depending on your plan. In one year, you cannot spend more than your annual allowance.

LIFETIME MAX: All FEDVIP dental plans have a lifetime maximum amount of coverage, which can range from $1,000$2,000 per person.

A Step-By-Step Approach to Selecting Your Perfect Plan

44.


SAMPLE VISION PLANS Standard Option Plan Coverage Eye Exam

Frequency

Copay

Plan Pays

12 Months

$0 - $10

100%

Frames

24 Months

$0 - $20

Covered 100% under certain plans. Under others, $120-$130 annual allowance with a 20% discount after that.

Lenses

12 Months

$0 - $20

100%

NA

$120-$130 annual allowance with a 15% discount after that.

Frequency

Copay

Plan Pays

12 Months

$0 - $10

100%

Contacts

12 Months

High Option Plan Coverage Eye Exam

Frames

24 Months

$0 - $20

Lenses

12 Months

$0 - $10

100%

NA

$150 annual allowance with a 15% discount after that.

Contacts

45.

Covered 100% under certain plans. Under others, $150 annual allowance with a 20% discount after that.

12 Months

Guide to Open Season in Federal Government


LEGEND FREQUENCY: This refers to how often an enrollee can obtain benefits for a particular type of vision care. Most procedures are covered once a year with the exception of frames under the Standard Option, which are covered once every two years.

COPAY: This is the share of the medical services that the enrollee must pay. Under certain FEDVIP vision plans, there is no copay.

ANNUAL ALLOWANCE: This refers to the maximum amount that the plan will cover for certain services. If you

require a certain type of glasses or contacts that are expensive, you may want to consider a vision plan with a higher annual allowance.

DISCOUNT: Most FEDVIP vision plans offer a discount if a particular type of service costs more than the annual al-

lowance. Once again, if you know that you need glasses or contacts that are expensive, you should compare plans based on the type of discount that they offer for those items.

STANDARD VS. HIGH OPTION: There are two primary differences between the standard and high options for vision insurance: (1) the high option has a higher premium and (2) higher annual allowance for certain items and lower copay. This is the second difference, that of a greater allowance and a reduced copay.

A Step-By-Step Approach to Selecting Your Perfect Plan

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47.

Guide to Open Season in Federal Government

Federal Open Season Guide Final  

If you receive health benefits as an employee of the federal government, we created this “Guide to Open Season in Federal Government: A Step...