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Friday, November 22, 2013

Federal Employees Health Benefits Program: Available Health Insurance Options

Annie L. Mach
Analyst in Health Care Financing

Ada S. Cornell
Information Research Specialist

FEHBP is generally available to federal employees, annuitants, and their dependents. Eligible individuals may elect coverage in an approved health benefits plan for either individual or family coverage. For the 2014 plan year, there are about 256 different plan choices, including all regionally available options. As a practical matter, an individual’s choice of plans is often limited to 10 to 15 different plans, depending on where the individual resides. While enrollees have a range of choices, they typically decide which options best match their needs, the amount of their wages they will contribute to health insurance, and how risk-averse they are to potential out-of pocke  costs.

While most federal employees or annuitants reaching age 65 are automatically entitled to Medicare Part A, Medicare-eligible employees may also voluntarily choose to enroll in Medicare Part B and Part D. For individuals covered under a FEHBP plan as an annuitant, Medicare is the primary payer and FEHBP is the secondary payer. As a secondary payer, FEHBP could cover a share of Medicare deductibles and coinsurance for any services that are covered by both plans, and FEHBP would continue to reimburse for its covered services that are not covered by Medicare.

FEHBP is administered by the Office of Personnel Management (OPM), which is statutorily given the authority to contract with qualified carriers offering plans and to prescribe regulations necessary to carry out the statute, among other duties. Some of OPM’s additional duties include coordinating the administration of FEHBP with employing offices, managing contingency reserve funds for the plans, and applying sanctions to health care providers according to the prescribed regulations.

Beginning in 2014, Members of Congress and certain congressional staff will no longer be eligible to enroll in a plan offered under FEHBP as an active employee; however, if they enroll in a health plan offered through a small business health option program (SHOP) exchange, they will remain eligible for an employer contribution toward coverage. For information about health benefits for Members and designated staff, please see CRS Report R43194, Health Benefits for Members of Congress and Certain Congressional Staff, by Annie L. Mach and Ada S. Cornell.

Date of Report: November 13, 2013
Number of Pages: 25
Order Number: RS21974
Price: $29.95

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