FEHB Plans: Navigating the Federal Employees Health Benefits Program

fehb plans

## Introduction

What are FEHB Plans?

The Federal Employees Health Benefits (FEHB) Program is a comprehensive health insurance program available to federal employees, retirees, and their eligible dependents. As the largest employer-sponsored health insurance program in the world, FEHB offers a wide range of plans from various insurance providers, ensuring flexibility and choice for participants.

FEHB plans provide coverage for a variety of medical expenses, including doctor visits, hospitalizations, prescription drugs, and preventive care. The program is designed to meet the diverse needs of federal employees and their families, offering a range of options to suit different budgets, health needs, and lifestyle preferences.

To participate in the FEHB Program, eligible individuals must enroll during the annual Open Season period, which typically runs from November to December each year. During Open Season, employees can review plan options, compare benefits, and make changes to their coverage.

## Types of FEHB Plans

High-Option Plans

High-option FEHB plans typically offer more comprehensive coverage than other plan types, with lower deductibles, copayments, and coinsurance. These plans often provide a wider network of providers and may cover services such as dental and vision care.

Low-Option Plans

Low-option FEHB plans have lower monthly premiums and out-of-pocket costs compared to high-option plans. However, they may have higher deductibles, copayments, and coinsurance, and a more limited network of providers.

Consumer-Driven Health Plans (CDHPs)

CDHPs are a type of FEHB plan that combines a high-deductible health plan (HDHP) with a Health Savings Account (HSA). HDHPs have lower monthly premiums but higher deductibles. HSAs allow participants to save money on a tax-advantaged basis to cover eligible healthcare expenses.

Coverage Options

Medical Coverage

FEHB plans provide coverage for a wide range of medical services, including primary care, specialist visits, hospitalizations, surgeries, and emergency care. The level of coverage and out-of-pocket costs vary depending on the specific plan.

Prescription Drug Coverage

Most FEHB plans include prescription drug coverage. The coverage may vary depending on the plan, including the drugs covered, the formulary tier system, and the cost of copayments or coinsurance.

Dental and Vision Coverage

While not all FEHB plans offer dental and vision coverage, some plans do include these benefits. The level of coverage and out-of-pocket costs for dental and vision care vary depending on the plan.

Eligibility and Enrollment

Eligibility

To be eligible for FEHB coverage, individuals must be:
– Federal employees (active or retired)
– Uniformed service members
– Certain family members (spouses, children, and dependents)
– Former spouses in some cases

Enrollment

Eligible individuals can enroll in an FEHB plan during the annual Open Season period, which typically runs from November to December each year. Changes to coverage, such as adding or removing dependents, can be made during the Open Season or through qualifying life events.

Premium Contributions

Biweekly Contributions

FEHB premiums are typically deducted from an employee’s biweekly paycheck. The amount of the contribution is based on the plan selected and the level of coverage. The government contributes a portion of the premium cost for most employees.

Flexible Spending Accounts (FSAs)

FSAs can be used to set aside pre-tax dollars to pay for eligible healthcare expenses, including FEHB premiums. FSAs can help reduce the overall cost of health insurance and provide tax savings.

Additional Resources

### FEHB Program Website

The official FEHB Program website provides detailed information about the program, plan options, and enrollment procedures: https://www.opm.gov/healthcare-insurance/fehb/

### Office of Personnel Management (OPM)

The OPM is the agency responsible for administering the FEHB Program. Contact the OPM for assistance with enrollment, plan changes, and other FEHB-related inquiries: 1-877-888-3342 or https://www.opm.gov/healthcare-insurance/fehb/

### FEHB Representatives

FEHB representatives can assist individuals with plan selection, enrollment, and other FEHB-related matters. Contact a representative directly or through the OPM website.

Leave a Comment