FAQs on New Self Plus One Insurance Option

May 21, 2015 12:25 PM
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The Office of Personnel Management has provided a list of frequently asked questions regarding the new self plus one insurance option under the Federal Employees Health Benefits Program.

Questions received on Self Plus One Teleconferences

1. When an enrollee switches a covered family member under a Self Plus One enrollment, will protection be extended to the first covered family member to prevent him/her from being dropped randomly?

a. Yes. Enrollees will only be allowed to switch a covered family member during the annual Open Season or upon experiencing one of a limited number of Qualifying Life Events (QLEs). Further, the general rule that the change must be consistent with the QLE experienced applies. For example, if an enrollee has a spouse and a child but only covers their child with a Self Plus One enrollment, when the child turns age 26 the enrollee may choose to stay in Self Plus One but switch their covered family member to remove their child once the child “ages out” and add their spouse. However, if an enrollee covers a spouse under a Self Plus One enrollment and then has a child, the addition of a family member is not a QLE that is consistent with switching a covered family member. In this circumstance, the enrollee would be allowed to increase to Self and Family to cover all of their eligible family members but not to switch from covering their spouse to covering their new child.

2. If the family member covered under a Self Plus One enrollment changes based on a QLE, will the employee also be able to change from his/her current plan to another?

a. In some instances, yes. If the enrollee experiences a QLE that allows both a change in plan or plan option and a switch in covered family member, then both changes will be allowed. Additional guidance on this topic is forthcoming.

3. If the family member covered under a Self Plus One enrollment changes based on a QLE, but the health plan does not change, will the employee just be required to contact the current health plan to identify the new covered family member?a. No. A new Health Benefits Election Form (SF 2809) will be needed to notify the carrier of the switch in covered family members. Carriers and online enrollment portals have been alerted to look out for enrollment actions that only switch a covered family member and do not change enrollment type or plan/option. If calls are received from individuals seeking to change their designated family member refer them to their employing office.

4. May an enrollee cover a child under a Self Plus One enrollment if their spouse, who is also a federal employee, carries a Self Only enrollment?

a. Yes, so long as no dual enrollments exist.

5. Does every existing QLE code allow an enrollee to switch their covered family member under a Self Plus One enrollment?

a. No. Additional guidance on this topic is forthcoming.

6. Will agencies automatically change enrollments for individuals enrolled in Self and Family with only one covered family member?

a. No. Enrollees must positively elect their enrollment type. OPM, agencies and carriers will not initiate enrollment changes on behalf of enrollees without an SF 2809 or through an agency self-service system.

7. Will an individual be allowed to enroll in Self Plus One if they have a court order requiring them to carry coverage for only one child?

a. Yes. An individual with a court order requiring coverage of only one child may enroll in Self Plus One. However, if the court order is for more than one child, a Self and Family enrollment will be required. Additional guidance on this topic is forthcoming.

8. May agencies comply with a court order to provide coverage for a child by switching a covered family member under an existing Self Plus One enrollment?

a. No. If an enrollee has Self Plus One coverage and the covered family member is not the child covered by the court order, agencies may only increase enrollment to Self and Family to comply with the court order.

9. What changes will be made to the SF 2809?

a. The actual form is not being updated. Changes are being made to the form instructions and the QLE chart.

10. Will the SF 2809 used to switch a covered family member become a part of the Electronic Official Personnel Folder (eOPF)?

a. OPM will look into this and provide guidance.

Systems Updates

11. Do online enrollment systems need to be updated with new Self Plus One information for the upcoming Open Season?

a. Yes. Enrollees will be able to select the new Self Plus One enrollment type during Open Season 2015. All online enrollment systems should be updated by September 1, 2015.

12. How can online enrollment systems conduct testing before the 2016 rates are available? a. Enrollment systems are encouraged to use mock rates for testing.

13. Should online enrollment systems include an indicator for individuals subject to a court order?

a. Yes. As is the case today, enrollees who are required by a court order to cover one or more children under their health insurance enrollment will include an indicator.

14. Will the Macon Data Hub provide flat files to agencies for system testing?

a. There is no distinctive file for testing. Agencies will update field 23 of the current file with the 3 and 6 in the third position of the enrollment code. That is the only update to the current agency flat file. Macon is ready to test now. Agencies may contact the Macon Data Hub to set up testing of the flat file. If contact information is needed email [email protected].

15. How will other systems, systems for payroll offices send FEHB premiums to OPM such as the Retirement Insurance Transfer System (RITS), be notified?

a. Communication will be sent to all impacted stakeholders.


16. When will OPM release rates for the new Self Plus One option?

a. As is standard operating procedure, OPM will release rates for all FEHB plans in late September or early October.

17. Will rates for Self Plus One be lower than rates for Self and Family? a. Additional information is forthcoming.

Additional guidance

18. Is there an expectation that OPM will issue a Benefits Administration Letter (BAL) to address the specifics of the new Self Plus One option?

a. Yes, several BALs are expected to be issued before Open Season 2015. Visit our website at www.opm.gov/selfplusone.

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Ian Smith is one of the co-founders of FedSmith.com. He enjoys writing about current topics that affect the federal workforce.