Health Insurance, Politics, and Your 2009 Health Benefits

Changes to the most popular health insurance plan for federal employees has raised concerns in Congress and led to an extension of the “open season” for enrolling in the FEHB for 2009. Changes have now been made to the 2009 plan that will benefit federal employees using this plan. Here is a summary of the changes.

For the past several weeks, there has been a controversy over changes to the Federal Employee Health Benefits Program. As federal employees became aware of the proposed changes, the concern or confusion appeared to be rippling through the federal workforce.

The controversy erupted over a change in coverage offered by the Blue Cross Blue Shield (BCBS) Standard Option plan. The BCBS standard option is the most popular federal employee plan. The change in question was over the "Standard Option planned surgical, out-of-network, non-participating provider benefit."

In other words, how much would you have to pay using this plan if you use medical services under some conditions from a doctor who is not part of the BCBS network.

The proposed change would have required those using this plan to pay a deductible of up to $7,500 for each procedure or surgery performed by a nonparticipating physician. Prior to this change, FEHB members  paid 25 percent of the plan allowance for an out-of-network procedure, plus any difference between the allowance and the billed amount.

Ripple Effects

The House Oversight and Government Reform Federal Workforce subcommittee got involved in a hearing in early December. The committee thought OPM should extend the open season as many people were not aware of the change and the impact it could have on them. The comittee also wanted OPM to negotiate a change to the new provision.

As a result of the proposed change, the open season for health benefits changes was modified to allow a "belated enrollment opportunity" through the end of January 2009 instead of ending in early December.

Plan Changes

Now, as a result of the controversy, there is another change that will benefit those using this service. In a press release, the Blue Cross Blue Shield organization writes: ""As a result of our collaborative efforts with OPM and in response to their request that all Federal Employees Health Benefits Program plans re-evaluate out-of-network surgical service payments, we have improved the process and FEP’s Standard Option members now will have a benefit consistent with other out-of-network services in 2009."

Under the new benefit which is part of the 2009 Standard Option program, the insurance will pay 70 percent of the amount specified by the plan allowance for planned surgeries performed by non-participating providers and members will be responsible for 30 percent of that allowance. The 30 percent share amounts to a five percent increase from the existing plan and is consistent with other out-of-network fees for the coming year.

This 30 percent of the allowable expense is financial responsibility of the federal employee, along with the BCBS Standard Option’s annual deductible. These costs are limited by the plan’s annual catastrophic maximum of $7,000.  This benefit does not apply to emergency surgery or surgery for accidental injuries within 72 hours of such an occurrence.

Special Telephone Service

To help you avoid  large bills from non-participating providers that you are not expecting, BCBS has addedl service for situations where the surgeon’s bill will be $5,000 or more. The company says you should use this service in advance of having your surgery. Beginning in 2009, you can call the number on the back of your FEHB ID card to obtain the information necessary to allow you to estimate your out-of-pocket costs for the surgery and make an choice about the provider you select for this surgery.

You can read this letter that is being sent by BCBS to members explaining the change.

About the Author

Ralph Smith has several decades of experience working with federal human resources issues. He has written extensively on a full range of human resources topics in books and newsletters and is a co-founder of two companies and several newsletters on federal human resources. Follow Ralph on Twitter: @RalphSmith47