As a result of changes in the Blue Cross/Blue Shield program this year, concerns were raised in Congress and the the media about the impact on federal employees who may not be aware of the changes that were being made to the program in 2009. After a hearing on the issue, the Office of Personnel Management took action to alleviate some of these concerns.
Several of our readers have been asking questions about this program and how this will impact their health insurance. To try and answer some of these questions, FedSmith is providing this information for our readers.
This information below is from the Office of Personnel Management on the subject of the belated enrollment for this year’s open season. The agency says that it is offering the chance for a belated enrollment past the normal deadline of December 8, 2008.
According to OPM: "We are taking this action in response to concerns over a change in coverage in the Blue Cross Blue Shield out-of-network reimbursement that would have established a $7,500 co-pay for out-of-network surgeries. We negotiated this change to address situations where enrollees could be billed tens of thousands of dollars for non-emergency surgeries performed by out-of-network providers, a practice known as balance billing."
Each year, OPM works with Federal Employees Health Benefits (FEHB) carriers to strike a balance of protection against catastrophic events without shifting a high-premium burden to enrollees. We are taking steps to provide additional protections for Federal employees participating in the FEHB Program who have non-emergency surgeries performed by out-of-network physicians. We have asked FEHB carriers to re-evaluate their benefits for non-emergency surgeries. We will communicate any benefit changes to you.
We are taking this action in response to concerns over a change in coverage in the Blue Cross Blue Shield out-of-network reimbursement that would have established a $7,500 co-pay for out-of-network surgeries. We negotiated this change to address situations where enrollees could be billed tens of thousands of dollars for non-emergency surgeries performed by out-of-network providers, a practice known as balance billing.
What This Means To You
You may make belated Open Season enrollment changes to your FEHB Program, Federal Employees Dental and Vision Insurance Program (FEDVIP) and the Federal Flexible Spending Account Program (FSAFEDS) if FEHB benefit changes affect your enrollment decisions in these programs. You will have an extended enrollment opportunity through January 2009 to make any enrollment changes in these programs.
Also, if you make a belated Open Season change to your enrollment in these programs, the effective dates of the belated change will vary among the programs. Depending on the timing of your change and your pay periods, it may take one or more pay periods for your Federal Benefits deductions/allotments to be adjusted to match your new election. You need to know if you make a belated Open Season change and you have claims for services incurred in 2009 under your former plan, you and/or your provider may be responsible for reimbursing the former plan for any benefits paid.
Belated FEHB changes will take effect the first day of the pay period that starts on or after January 1, 2009. Belated FEDVIP changes will take effect January 1, 2009. Belated FSAFEDS changes will take effect on January 1, 2009, or the day after the change is received, whichever is later.