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UNITED STATES OFFICE OF PERSONNEL MANAGEMENT Washington DC 20415 OCT 5 2010The Director
Dear Tribal Leader
We are writing to initiate a consultation on Section 157 Access to Federal Insurance in the recently reauthorized Indian Health Care Improvement Act (IHCIA) that was passed as a part of the Affordable Care Act This provision authorizes Tribes operating programs under the Indian Self Determination and Educational Assistance Act (lSDEAA) or urban Indian organizations operating a program under Title V of the IHCIA to purchase coverage under the Federal Employees Health Benefits (FEHB) program and Federal Employees Group Life Insurance (FEGLI) for their employees
The FEHB program covers about 8 million Federal civilian employees retirees former employees family members and former spouses It is a voluntary program and paid for through employee and employer contributions The FEGLI program covers about 4 million Federal employees and retirees as well as many of their family members FEGLI provides group term life insurance and does not build up any cash value or paid-up value It is also a voluntary program and paid for through employee and employer contributions More information about the FEHB and FEGLI programs is available at wwwopmgovinsureihealth
The Office of Personnel Management (OPM) which administers these programs is working with the Department of Health and Human Services (DHHS) and the Indian Health Service (lHS) to implement this Affordable Care Act provision We know that implementation of this provision is a top tribal priority OPM and HHSIHS want to consult with Tribes in order to help shape our preliminary plan in a way that best meets the needs of participating Tribes and Tribal organizations This will allow us to maximize the impact of this new provision which will serve to improve access to health care for tribes and tribal organizations throughout the country
While the passage of the IHCIA creates this new authority a mechanism needs to be developed to administer this option Tribes and urban Indian organizations will purchase coverage directly from OPM through a Fiscal Intermediary and will pay the employer portion of premiums which includes an administrative fee to cover operating expenses Tribes and urban Indian organizations will also be expected to assist with employee premium collection (payroll deductions) and conduct human resource functions at the local level As we plan for implementation additional input from Tribes is particularly helpful
Please provide your input within 30 days on the attached questions to assist us in the planning process for successful implementation of this provision
wwwopmgov Recruit Retain and Honor a World-Class Workforce to Serve the American People wwwusajobsgov
We are committed to meaningful consultation with Tribes and Tribal organizations in order to implement this provision as soon as possible and we look forward to a strong partnership with Tribes and Tribal organizations throughout the implementation process
Thank you
Sincerely
John Berry
John Berry Director Office of Personnel Management
Yvette Roubideaux
Yvette Roubideaux MD MPH Director Indian Health Service
Form approved OMB No 3206-0251
Expires 4302011 Public Burden Statement
The public reporting burden for this information collection is estimated to be 20 minutes This burden estimate includes time for reviewing instructions researching existing data sources gathering and maintaining the needed data and completing and submitting the information Send comments regarding the accuracy of this burden estimate and any suggestions for reducing the burden to US Office of Personnel Management Planning and Policy Analysis Attn OMB Number (3206-0251) 1900 E Street NW Washington DC 20415-7900 You are not required to respond to this collection of information unless a valid OMB control number is displayed
FEHB FEGLI Implementation Questionnaire for Tribes and Tribal Organizations
CURRENT COVERAGE
1 The average FEHB premium for the 2010 plan year is about $498 per month for self only and about $1120 per month for family coverage This combines the employer and employee shares and does not include the administrative fees described in the attached letter How does this amount compare to the total monthly premiums for the insurance coverage currently received by your Tribal employees Our premiums are about the same Our premium is HIGHER than the FEHB average Our premium is LOWER than the FEHB average We donrsquot offer health insurance coverage for employees
2 We are trying to have a better understanding of health insurance across Indian country The contract year for FEHB and FEGLI coverage is based on the calendar year If you offer health insurance coverage for employees please share the contract year for insurance coverage currently received by your Tribal employees Calendar Year (eg starts January 1) Other (eg starts June 1 to May 31)
3 Does your Tribe or Tribal organization use an agent or broker to gain access to the health insurance coverage currently received by your Tribal employees No Yes
4 Does your Tribe or Tribal organization have an existing process used for employee payroll deductions and insurance premium collection Yes No
ELIGIBILITY 1 The scope of eligibility under this new provision extends coverage to employees of a
Tribe or Tribal organization carrying out a program under the ISDEAA or an urban Indian organization carrying out a program under Title V of the IHCIA Eligibility
for this program could be interpreted at least two ways 1) only employees of ISDEAA or Title V of the IHCIA programs are eligible or 2) all Tribal employees We would like your input on this issue
ENROLLMENT 1 To help us create a system to be used to enroll your Tribal employees we need to
determine the level of interest in accessing FEHB andor FEGLI coverage for eligible employees Do you believe your Tribe or Tribal organization would plan to take advantage of this program when it becomes available in 2011 Yes (please provide additional information regarding the estimated number of
enrollees from your tribe in both FEHB and FEGLI) Number of total anticipated FEHB enrollees ____________ Number of total anticipated FEHB enrollees if only 638 employees eligible _________ Number of total anticipated FEGLI enrollees ____________ Number of total anticipated FEGLI enrollees if only 638 employees eligible _________
No No not in 2011 but we would possibly enroll in a future year What is the
future target date for your participation _____________________________
2 If you do not want to participate at all please tell us why
Any other comments or input on implementation of this provision are welcome
Please submit your input within 30 days We are asking you to submit your input as soon as possible so we can keep the implementation process moving forward The questions can be returned to us by fax at (202) 606-0633 by email to ianhunteropmgov or by mail at the following address
Office of Personnel Management PO Box 791 Washington DC 20044
Please provide us with your own contact information
Name ________________________________________________________ Tribe or tribal organization ________________________________________ Phone number _________________________________________________
FAX _________________________________________________________ E-mail _______________________________________________________
We look forward to a successful partnership Thank you
The Federal Employees
Health Benefits Program
(FEHB)
Introduction
bull Federal Employees Health Benefits (FEHB) law enacted September 28 1959
bull FEHB Program administered by
the Office of Personnel Management (OPM)
Introduction (Cont)
bull 207 choices currently available in the FEHB Program
bull About 8 million covered lives
bull About $40 billion in annual premiums
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
We are committed to meaningful consultation with Tribes and Tribal organizations in order to implement this provision as soon as possible and we look forward to a strong partnership with Tribes and Tribal organizations throughout the implementation process
Thank you
Sincerely
John Berry
John Berry Director Office of Personnel Management
Yvette Roubideaux
Yvette Roubideaux MD MPH Director Indian Health Service
Form approved OMB No 3206-0251
Expires 4302011 Public Burden Statement
The public reporting burden for this information collection is estimated to be 20 minutes This burden estimate includes time for reviewing instructions researching existing data sources gathering and maintaining the needed data and completing and submitting the information Send comments regarding the accuracy of this burden estimate and any suggestions for reducing the burden to US Office of Personnel Management Planning and Policy Analysis Attn OMB Number (3206-0251) 1900 E Street NW Washington DC 20415-7900 You are not required to respond to this collection of information unless a valid OMB control number is displayed
FEHB FEGLI Implementation Questionnaire for Tribes and Tribal Organizations
CURRENT COVERAGE
1 The average FEHB premium for the 2010 plan year is about $498 per month for self only and about $1120 per month for family coverage This combines the employer and employee shares and does not include the administrative fees described in the attached letter How does this amount compare to the total monthly premiums for the insurance coverage currently received by your Tribal employees Our premiums are about the same Our premium is HIGHER than the FEHB average Our premium is LOWER than the FEHB average We donrsquot offer health insurance coverage for employees
2 We are trying to have a better understanding of health insurance across Indian country The contract year for FEHB and FEGLI coverage is based on the calendar year If you offer health insurance coverage for employees please share the contract year for insurance coverage currently received by your Tribal employees Calendar Year (eg starts January 1) Other (eg starts June 1 to May 31)
3 Does your Tribe or Tribal organization use an agent or broker to gain access to the health insurance coverage currently received by your Tribal employees No Yes
4 Does your Tribe or Tribal organization have an existing process used for employee payroll deductions and insurance premium collection Yes No
ELIGIBILITY 1 The scope of eligibility under this new provision extends coverage to employees of a
Tribe or Tribal organization carrying out a program under the ISDEAA or an urban Indian organization carrying out a program under Title V of the IHCIA Eligibility
for this program could be interpreted at least two ways 1) only employees of ISDEAA or Title V of the IHCIA programs are eligible or 2) all Tribal employees We would like your input on this issue
ENROLLMENT 1 To help us create a system to be used to enroll your Tribal employees we need to
determine the level of interest in accessing FEHB andor FEGLI coverage for eligible employees Do you believe your Tribe or Tribal organization would plan to take advantage of this program when it becomes available in 2011 Yes (please provide additional information regarding the estimated number of
enrollees from your tribe in both FEHB and FEGLI) Number of total anticipated FEHB enrollees ____________ Number of total anticipated FEHB enrollees if only 638 employees eligible _________ Number of total anticipated FEGLI enrollees ____________ Number of total anticipated FEGLI enrollees if only 638 employees eligible _________
No No not in 2011 but we would possibly enroll in a future year What is the
future target date for your participation _____________________________
2 If you do not want to participate at all please tell us why
Any other comments or input on implementation of this provision are welcome
Please submit your input within 30 days We are asking you to submit your input as soon as possible so we can keep the implementation process moving forward The questions can be returned to us by fax at (202) 606-0633 by email to ianhunteropmgov or by mail at the following address
Office of Personnel Management PO Box 791 Washington DC 20044
Please provide us with your own contact information
Name ________________________________________________________ Tribe or tribal organization ________________________________________ Phone number _________________________________________________
FAX _________________________________________________________ E-mail _______________________________________________________
We look forward to a successful partnership Thank you
The Federal Employees
Health Benefits Program
(FEHB)
Introduction
bull Federal Employees Health Benefits (FEHB) law enacted September 28 1959
bull FEHB Program administered by
the Office of Personnel Management (OPM)
Introduction (Cont)
bull 207 choices currently available in the FEHB Program
bull About 8 million covered lives
bull About $40 billion in annual premiums
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Form approved OMB No 3206-0251
Expires 4302011 Public Burden Statement
The public reporting burden for this information collection is estimated to be 20 minutes This burden estimate includes time for reviewing instructions researching existing data sources gathering and maintaining the needed data and completing and submitting the information Send comments regarding the accuracy of this burden estimate and any suggestions for reducing the burden to US Office of Personnel Management Planning and Policy Analysis Attn OMB Number (3206-0251) 1900 E Street NW Washington DC 20415-7900 You are not required to respond to this collection of information unless a valid OMB control number is displayed
FEHB FEGLI Implementation Questionnaire for Tribes and Tribal Organizations
CURRENT COVERAGE
1 The average FEHB premium for the 2010 plan year is about $498 per month for self only and about $1120 per month for family coverage This combines the employer and employee shares and does not include the administrative fees described in the attached letter How does this amount compare to the total monthly premiums for the insurance coverage currently received by your Tribal employees Our premiums are about the same Our premium is HIGHER than the FEHB average Our premium is LOWER than the FEHB average We donrsquot offer health insurance coverage for employees
2 We are trying to have a better understanding of health insurance across Indian country The contract year for FEHB and FEGLI coverage is based on the calendar year If you offer health insurance coverage for employees please share the contract year for insurance coverage currently received by your Tribal employees Calendar Year (eg starts January 1) Other (eg starts June 1 to May 31)
3 Does your Tribe or Tribal organization use an agent or broker to gain access to the health insurance coverage currently received by your Tribal employees No Yes
4 Does your Tribe or Tribal organization have an existing process used for employee payroll deductions and insurance premium collection Yes No
ELIGIBILITY 1 The scope of eligibility under this new provision extends coverage to employees of a
Tribe or Tribal organization carrying out a program under the ISDEAA or an urban Indian organization carrying out a program under Title V of the IHCIA Eligibility
for this program could be interpreted at least two ways 1) only employees of ISDEAA or Title V of the IHCIA programs are eligible or 2) all Tribal employees We would like your input on this issue
ENROLLMENT 1 To help us create a system to be used to enroll your Tribal employees we need to
determine the level of interest in accessing FEHB andor FEGLI coverage for eligible employees Do you believe your Tribe or Tribal organization would plan to take advantage of this program when it becomes available in 2011 Yes (please provide additional information regarding the estimated number of
enrollees from your tribe in both FEHB and FEGLI) Number of total anticipated FEHB enrollees ____________ Number of total anticipated FEHB enrollees if only 638 employees eligible _________ Number of total anticipated FEGLI enrollees ____________ Number of total anticipated FEGLI enrollees if only 638 employees eligible _________
No No not in 2011 but we would possibly enroll in a future year What is the
future target date for your participation _____________________________
2 If you do not want to participate at all please tell us why
Any other comments or input on implementation of this provision are welcome
Please submit your input within 30 days We are asking you to submit your input as soon as possible so we can keep the implementation process moving forward The questions can be returned to us by fax at (202) 606-0633 by email to ianhunteropmgov or by mail at the following address
Office of Personnel Management PO Box 791 Washington DC 20044
Please provide us with your own contact information
Name ________________________________________________________ Tribe or tribal organization ________________________________________ Phone number _________________________________________________
FAX _________________________________________________________ E-mail _______________________________________________________
We look forward to a successful partnership Thank you
The Federal Employees
Health Benefits Program
(FEHB)
Introduction
bull Federal Employees Health Benefits (FEHB) law enacted September 28 1959
bull FEHB Program administered by
the Office of Personnel Management (OPM)
Introduction (Cont)
bull 207 choices currently available in the FEHB Program
bull About 8 million covered lives
bull About $40 billion in annual premiums
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
for this program could be interpreted at least two ways 1) only employees of ISDEAA or Title V of the IHCIA programs are eligible or 2) all Tribal employees We would like your input on this issue
ENROLLMENT 1 To help us create a system to be used to enroll your Tribal employees we need to
determine the level of interest in accessing FEHB andor FEGLI coverage for eligible employees Do you believe your Tribe or Tribal organization would plan to take advantage of this program when it becomes available in 2011 Yes (please provide additional information regarding the estimated number of
enrollees from your tribe in both FEHB and FEGLI) Number of total anticipated FEHB enrollees ____________ Number of total anticipated FEHB enrollees if only 638 employees eligible _________ Number of total anticipated FEGLI enrollees ____________ Number of total anticipated FEGLI enrollees if only 638 employees eligible _________
No No not in 2011 but we would possibly enroll in a future year What is the
future target date for your participation _____________________________
2 If you do not want to participate at all please tell us why
Any other comments or input on implementation of this provision are welcome
Please submit your input within 30 days We are asking you to submit your input as soon as possible so we can keep the implementation process moving forward The questions can be returned to us by fax at (202) 606-0633 by email to ianhunteropmgov or by mail at the following address
Office of Personnel Management PO Box 791 Washington DC 20044
Please provide us with your own contact information
Name ________________________________________________________ Tribe or tribal organization ________________________________________ Phone number _________________________________________________
FAX _________________________________________________________ E-mail _______________________________________________________
We look forward to a successful partnership Thank you
The Federal Employees
Health Benefits Program
(FEHB)
Introduction
bull Federal Employees Health Benefits (FEHB) law enacted September 28 1959
bull FEHB Program administered by
the Office of Personnel Management (OPM)
Introduction (Cont)
bull 207 choices currently available in the FEHB Program
bull About 8 million covered lives
bull About $40 billion in annual premiums
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
The Federal Employees
Health Benefits Program
(FEHB)
Introduction
bull Federal Employees Health Benefits (FEHB) law enacted September 28 1959
bull FEHB Program administered by
the Office of Personnel Management (OPM)
Introduction (Cont)
bull 207 choices currently available in the FEHB Program
bull About 8 million covered lives
bull About $40 billion in annual premiums
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Introduction
bull Federal Employees Health Benefits (FEHB) law enacted September 28 1959
bull FEHB Program administered by
the Office of Personnel Management (OPM)
Introduction (Cont)
bull 207 choices currently available in the FEHB Program
bull About 8 million covered lives
bull About $40 billion in annual premiums
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Introduction (Cont)
bull 207 choices currently available in the FEHB Program
bull About 8 million covered lives
bull About $40 billion in annual premiums
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
OPM Responsibilities
bull Administer contracts with carriers
bull Negotiate benefits and rates
bull Approve planrsquos FEHB brochures
bull Audit plans
bull Publish FEHB regulations and informational material
bull Prepare Open Season materials
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
OPM Responsibilities (Cont)
bull Maintain OPM and FEHB websites
bull Provide guidance to agencies and plans
bull Resolve disputed health benefits claims
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Carrier Responsibilities
bull Furnish a plan identification card to
each enrollee
bull Process claims andor provide services
to enrollee and covered family
members
bull Maintain provider networks
bull Reconsider disputed claims
bull Print and distribute plan brochures
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Picking a Health Plan
bull What types of plans are offered
bull Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
bull Health Maintenance Organization (HMO)
bull Which plan is best
bull Highly individual answer
bull Employees must make an informed choice
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
FFS Plans
bull Nationwide
bull Ten choices open to all employees
bull Others open only to specific groups
such as postal workers
bull Fewer costs are incurred if PPO providers are
used
bull Some paperwork if PPO provider is not used
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
HMOs
bull Enrollee must ldquoliverdquo or ldquoworkrdquo in HMOrsquos enrollment area to enroll (plan may be changed if enrollee or a family member moves)
bull Plans operate in a specific geographic area (service area)
bull Generally members must use the network and get referrals from primary care doctor
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
HMOs (Cont)
bull Out-of-pocket costs are generally limited to copays
bull Little if any paperwork
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
FEHB Program Features
bullNo waiting periods
bullNo pre-existing condition limitations
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Enrollment
bull Coverage is effective on first day
of pay period after enrollment
request is received
bull Two enrollment types bull Self Only
bull Self and Family
bull Do not need to reenroll each year
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Family Member Eligibility
bull Spouse (as defined in Defense of
Marriage Act)
bull Children under age 26
bull includes bull Married children
bull Adopted children
bull Stepchildren
bull Children who have or are eligible for
employer-provided health insurance
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Family Members not Eligible
bull Grandchildren unless foster child
requirements are met
bull Parents
bull Siblings
bull In-laws
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Open Season
bull Held annually from mid-November to mid-December
bull Enrollments and changes become effective on first day of first full pay period in January
bull During Open Season can bull Enroll bull Cancel enrollment bull Change type of enrollment bull Change from one plan or option to
another
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
Additional Opportunities to
Enroll or Change Enrollment
bull When experience a Qualifying Life
Event
bull Common QLEs include bull Change in Family Status
bull Enrollee or family member loses
coverage under other insurance
coverage
bull Enrollee enrolled in an HMO moves
from planrsquos service area
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
BCBS
Basic
Self Only $45348
Self and
Family
$106197
BCBS
Standard
Self Only $57861
Self and
Family
$130689
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
GEHA High Self Only $56762
Self and
Family
$129097
GEHA
Standard
Self Only $34662
Self and
Family
$78828
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
2011 Premiums (Nationwide FFS)
Plan Enrollment
Option
Total
Monthly
Premium
MailHandlers
Value
Self Only $28591
Self and
Family
$68163
MailHandlers
Standard
Self Only $61120
Self and
Family
$139876
More Information
Visit our website at
wwwopmgovinsurehealth
More Information
Visit our website at
wwwopmgovinsurehealth
